Step 1: Receive Denial Notice
The first step in the appeals process begins when you receive an official denial notice from the Social Security Administration (SSA). This letter details why your claim—whether for disability (SSDI/SSI), Medicare, or non-medical issues like overpayments—was denied and informs you of your appeal rights.
What It Means
The denial notice is your starting point. It could relate to:
- Disability (SSDI/SSI): Your medical condition wasn’t deemed severe enough.
- Medicare: Denial of coverage for a service or enrollment issue.
- Non-Medical: Overpayment disputes or eligibility errors.
What to Do
- Read the notice carefully to identify the denial reason (e.g., insufficient medical evidence, income limits exceeded).
- Note the appeal deadline: 60 days from receipt (assumed 5 days after mailing).
- Gather supporting documents (e.g., medical records, bills, income statements).
Example Scenarios
Disability: Jane applies for SSDI but is denied due to "insufficient medical evidence." Her notice states she has 60 days to appeal.
Medicare: John’s claim for a wheelchair is denied as "not medically necessary." He needs to appeal with doctor’s documentation.
Non-Medical: Mike receives an overpayment notice claiming he owes $5,000. He disagrees and prepares to appeal.
Resources
Get started with these tools:
SSA Appeals OverviewFind an SSA Office Back to Home