Receiving a favorable decision on your Social Security Disability Insurance (SSDI) claim can be a huge relief. However, many beneficiaries worry about the possibility of this decision being reversed. This article explores what a favorable SSDI decision is, what might trigger a reversal, the appeals process, the role of the Appeals Council, and what actions to take if notified of a review. Understanding these aspects can help ensure you are prepared to handle any challenges that may arise.

Answering the Question: Can A Favorable SSDI Decision Be Reversed? 

What is a Favorable Decision?

A favorable SSDI decision means that the Social Security Administration (SSA) has determined you meet the medical and non-medical criteria to receive disability benefits. This decision can be made at various stages of the application process, including the initial application, reconsideration, or after a hearing before an administrative law judge (ALJ). Once you receive a favorable decision, you become eligible for monthly disability benefits and possibly back pay for the period you were disabled but not yet approved.

What Triggers a Reversal?

A favorable SSDI decision can be reversed under certain circumstances. Common triggers include:

  1. Continuing Disability Reviews (CDR): The SSA periodically reviews cases to determine if beneficiaries are still eligible for disability benefits. If your condition has improved and you no longer meet the criteria, your benefits may be discontinued.
  2. Errors in the Initial Decision: If the SSA discovers that the initial favorable decision was based on incorrect or fraudulent information, they may reverse the decision.
  3. Failure to Cooperate: Not complying with SSA requests for information or failing to attend required medical examinations can lead to a reversal.
  4. Returning to Work: If you return to work and earn above the substantial gainful activity (SGA) level, the SSA may determine that you are no longer disabled.

The Appeals Process

If your SSDI benefits are at risk of being reversed, you have the right to appeal. The appeals process includes several steps:

  1. Reconsideration: If your benefits are terminated, you can request a reconsideration, where a new examiner reviews your case.
  2. Hearing by an Administrative Law Judge: If reconsideration is denied, you can request a hearing before an ALJ. This is a more formal process where you can present new evidence and have witnesses testify on your behalf.
  3. Appeals Council: If the ALJ denies your claim, you can request a review by the Appeals Council. The Council can either make a decision itself or return your case to the ALJ for further review.
  4. Federal Court: If all previous appeals are denied, you can file a lawsuit in federal court.

The Role of the Appeals Council

The Appeals Council reviews cases where claimants believe the ALJ made an error. The Council can deny the request, review and decide the case, or send it back to the ALJ for further action. It is crucial to provide a thorough explanation of why you believe the ALJ’s decision was incorrect and include any additional supporting evidence.

Actions to Take if Notified of a Review

If you are notified that your SSDI case is under review, take the following steps:

  1. Respond Promptly: Ensure you respond to all SSA requests for information and attend any required medical exams.
  2. Gather Evidence: Collect all relevant medical records, physician statements, and other documentation that supports your continued disability.
  3. Consult a Lawyer: Consider seeking legal advice to navigate the review process and ensure your rights are protected.
  4. Stay Informed: Keep track of deadlines and the status of your case. Missing a deadline can jeopardize your benefits.

Do you Need Help Applying for Social Security Disability Benefits?

If you need help navigating the Social Security Disability process, including handling reviews or appeals, reach out to Disability Associates, a Social Security disability law firm in Towson, MD. Our experienced team in Towson, MD, is dedicated to providing the support and guidance you need to secure and maintain your SSDI benefits. Contact us today for a consultation.