Benefits Denied? How and When to Appeal

1Step 1: Find three things on the letter

Before anything else, find the reason for the decision, the date on the notice, and the deadline to appeal. The deadline is the one that cannot wait, and it differs by program:

Swipe sideways to see the whole table.

For Original Medicare claims the deadline is generally 120 days, and housing agencies, TANF, WIC, LIHEAP and school meal programs offer hearings under their own rules. The date on your own notice is the one that counts.

2Step 2: Decide whether to fix it or fight it

Many refusals are not judgments about whether you qualify. They are about a missing pay stub, an unanswered request or a missed interview. If that is your notice, the fastest route may be to send what was asked for, or to reapply, while you also file the appeal to protect your rights.

Read the reason twice and write it down in one sentence of your own. That sentence tells you what evidence the appeal needs, and it is the first thing a legal aid advocate will ask.

If you disagree with the decision itself, the appeal is the route. Agencies make mistakes, and many decisions are made on incomplete files: a large share of Social Security disability claims denied at first are approved later on appeal, and many SNAP and Medicaid terminations are reversed once the missing information arrives.

3Step 3: Ask in time, and in writing if you can

You do not need to prove everything at the start. Say that you disagree and why, and include your name, your case or claim number, and the date of the notice. Most programs also accept a request by phone; if you call, ask the worker to note the date and send confirmation. Keep a copy of everything and write down the name of anyone you speak to.

Social Security decisions, including retirement, disability and SSI, have four levels, and you move to the next only if you disagree with the one before:

1. Reconsideration, a fresh review by someone who did not make the first decision.
2. A hearing before an administrative law judge, where you can testify and bring witnesses and new evidence.
3. Review by the Appeals Council.
4. A lawsuit in federal district court.

You can file most Social Security appeals online, by phone at 1-800-772-1213 or on paper. If you missed a deadline for a good reason, such as serious illness, ask in writing for more time and explain why. For a disability denial, appeal rather than apply again, because a new application usually gives up your earlier filing date and back pay; our guide to how SSDI decides you are disabled explains the medical review.

4Step 4: Keep benefits going if you can

For benefits you already receive, speed can keep the money flowing. If Social Security says your disability has ended and you appeal within 10 days, you can ask for payments to continue. For SNAP and Medicaid, asking for a hearing before the change takes effect generally keeps your benefits or coverage at the old level until the decision.

There is a trade-off to understand: if you lose, you may have to repay what was paid during the appeal. For most people facing a cut they believe is wrong, keeping food and health coverage in place is worth that risk, but it is your decision to make.

5Step 5: Build your file

Evidence should answer the reason given. If income was the issue, send pay stubs or a letter from a former employer. If it was a disability, send recent medical records and a doctor's statement about what you cannot do. Ask to see your case file before a hearing so you know what the agency relied on, and put your documents in date order.

A SNAP household, for instance, whose benefit is cut because the agency used a pay stub from a job that has ended, can ask for a hearing right away and send the former employer's letter showing the last day worked. Often the agency corrects its records before the hearing date. Our SNAP guide explains how income is counted.

6Step 6: Get ready for the hearing

Most hearings are far less formal than a courtroom, and many are held by phone or video. SNAP decisions should be issued within 60 days of the request, and Medicaid decisions generally within 90 days, or faster when waiting could seriously harm your health.

• Write a few lines on what you think is wrong with the decision and what you want changed.
• Bring copies of your evidence for the hearing officer.
• For a disability hearing, make sure recent medical records are in the file.
• Ask in advance for a free interpreter or a disability accommodation if you need one, and ask to reschedule if you cannot attend.

You can bring a lawyer, a relative or a friend, and present documents and witnesses. If the decision goes against you, it will explain the next level of review and its deadline, so the process does not end at the first hearing.

7Three mistakes that cost appeals

• Letting a notice sit unopened until the deadline has passed.
• Asking for a hearing after the change took effect, when asking a few days earlier would have kept benefits going.
• Arguing the decision without fixing the missing document that caused it.

You do not have to do this alone. Legal aid offices help people with low incomes with benefit appeals free, and state notices usually say where to find them. You can name a representative to request the appeal, see your file and speak for you. For Social Security, any fee a paid representative charges must be approved by Social Security.

9Your notice controls

Deadlines run from different dates, and states apply their own procedures within federal limits, so the notice you received is the authority on your case. Federal court deadlines and the full rules for unemployment, Medicare, housing and other programs differ from those summarized here.