Step 3: Hearing with ALJ
If reconsideration fails, request a hearing with an Administrative Law Judge (ALJ). This step, taking 12-18 months, offers a chance to present your case in person, via video, or phone. It’s common for disability appeals but applies to others too.
Appeal Types Covered
- Disability: Most common—prove medical or vocational disability.
- Medicare: Argue coverage or enrollment disputes before an ALJ.
- Non-Medical: Rare, but possible for complex overpayment cases.
What to Expect
- The ALJ reviews your case anew, independent of prior decisions.
- Present evidence, witnesses, or testimony (e.g., doctors, family).
- Legal representation is recommended—success rates increase with advocates.
Example Scenarios
Disability: Jane attends a hearing, bringing her doctor to testify about her chronic pain.
Medicare: John argues via video that his denied surgery was essential, winning approval.
Non-Medical: Mike’s overpayment case escalates to an ALJ, who rules in his favor after reviewing payroll errors.
Resources
Form HA-501 (Request Hearing)File Online
SSA Office Locator Back to Home