If you applied for Social Security disability benefits, were denied, and did not appeal before the deadline, you may be wondering whether the Social Security Administration (SSA) can reopen your prior application. In some cases, SSA may accept a late appeal if you had good cause for missing the deadline. If the prior denial has already become final, however, reopening is a different legal process. Oftentimes, you will first have to file a new application and then persuade SSA to reopen your prior application and consider it together with your new claim.
The legal rules for reopening sound relatively straightforward. The practical reality is not. SSA is badly understaffed, and many of its employees are overworked and underpaid. Reopening is also a technical issue that does not arise in every disability case. As a result, the person handling your new application may not recognize the issue, understand the applicable regulations, or know how to process the request correctly. Having a legal basis to request reopening does not guarantee that SSA will actually reopen your prior application.
Two Different Legal Standards Depending on Your Situation
Social Security disability benefits generally fall under two different federal programs. Social Security Disability Insurance (SSDI) is governed by Title II of the Social Security Act. Supplemental Security Income (SSI) is governed by Title XVI. The reopening rules are very similar for both programs, but the deadlines are not always the same.
For the issues discussed in this article, there are three important regulatory provisions for each program. The SSDI regulations are 20 C.F.R. §§ 404.988(a), 404.988(b), and 404.989(a). The corresponding SSI regulations are 20 C.F.R. §§ 416.1488(a), 416.1488(b), and 416.1489(a).
Reopening Within the First Twelve Months
The most favorable rule applies when fewer than twelve months have passed since the date of the notice denying your initial application.
During those first twelve months, SSA may reopen an SSDI or SSI determination “for any reason.” This rule appears in 20 C.F.R. § 404.988(a) for SSDI and 20 C.F.R. § 416.1488(a) for SSI.
This is a broad standard. You might have additional medical records, discover that important evidence was overlooked, or simply believe that SSA reached the wrong conclusion. You do not have to fit your request into one of the narrower good-cause categories that apply later.
However, the regulations say SSA may reopen the determination. They do not say that SSA must reopen it simply because you made the request within twelve months. You should still explain why the prior decision was incorrect, provide any supporting evidence, and make the request as clearly and promptly as possible.
Reopening After the First Twelve Months
The rules become more restrictive after twelve months.
For an SSDI application, SSA may reopen the prior determination within four years of the date of the notice of the initial determination if there is good cause. For an SSI application, the good-cause reopening period is only two years. These deadlines appear in 20 C.F.R. § 404.988(b) for SSDI and 20 C.F.R. § 416.1488(b) for SSI.
The regulations recognize three ways to establish good cause:
- New and material evidence is furnished.
- SSA made a clerical error.
- The evidence considered in the prior decision clearly shows on its face that an error was made.
These three good-cause grounds appear in 20 C.F.R. § 404.989(a) for SSDI and 20 C.F.R. § 416.1489(a) for SSI.
In most disability cases, new and material evidence is the most relevant of these three grounds. “New” generally means that SSA did not previously consider the evidence. “Material” means that the evidence could make a meaningful difference in deciding whether you were disabled during the period covered by the prior application.
For example, you might obtain medical records that existed during the prior application but were never added to your Social Security file. A treating doctor might provide a new opinion explaining limitations you already had during the earlier period. You might also discover that SSA failed to obtain important hospital, mental health, or specialist records before denying the claim.
Evidence showing that your health became worse only after the prior denial may support your new application, but it may not justify reopening the old one. The evidence usually needs to help prove that the earlier decision itself was wrong.
The other two good-cause grounds arise less frequently in disability cases. A clerical error may involve a mistake in entering information or calculating benefits. An error on the face of the evidence means that the materials SSA already considered clearly showed that something was wrong. It is not enough merely to disagree with how SSA weighed conflicting evidence. The mistake generally needs to be apparent from the prior record itself.
Once the four-year SSDI period or the two-year SSI period has expired, reopening becomes much more difficult. Certain narrow exceptions may still apply, but most people should not assume that an old application can be reopened indefinitely.
The Practical Reality of Reopening Your Application
A request to reopen a prior application can be made while SSA is considering a new application. However, simply filing the new application does not guarantee that anyone will identify the prior claim or consider whether reopening is appropriate.
At the initial application and reconsideration stages, your claim may pass between a local Social Security field office and a state disability determination agency. Reopening requests can be overlooked, misunderstood, or rejected without a meaningful explanation. The employee handling the claim may rarely encounter reopening issues and may not have the time or training necessary to fully investigate the prior application.
In practice, it is often easier to present a reopening argument to an administrative law judge at the hearing stage. Judges and hearing-office staff are more accustomed to legal arguments, and an attorney can submit a written request identifying the prior application, the applicable regulation, and the evidence supporting reopening.
But waiting for a judge creates its own problems. To reach the hearing stage, you will usually have to file a new application, receive an initial denial, receive another denial at reconsideration, and then request a hearing. That process can take two years or longer. Even after you reach a judge, reopening is never guaranteed.
An attorney can help determine whether you should request a late appeal, file a new application, request reopening, or pursue more than one option at the same time. An attorney can also obtain the prior claim file, calculate the applicable reopening deadline, identify new and material evidence, and clearly explain why SSA should reconsider the earlier period.
Reopening can make a major difference. If SSA considers only your new application, you may lose months or even years of potential benefits connected to the earlier filing date. But because the rules are technical and the result depends on the facts of each case, you should not assume that SSA will identify or correct the issue on its own.
If you were denied Social Security disability benefits and missed the deadline to appeal, please contact one of Hawks Quindel S.C.’s experienced disability attorneys for a free consultation. We help individuals throughout the Midwest.