Pursuing an Appeal When Public Benefits are Denied

The staff at Hickman & Lowder receive almost daily requests for assistance when public benefits have been denied or reduced. The following guidelines may be helpful in deciding whether and how to pursue an appeal:

Understand the Steps in the Process

Each agency has its own procedure to hear appeals.  You need to understand all steps in the process and follow them exactly.

Understand the Issue

Each reviewing agency will decide the appeal based on a clearly defined test.  The definition of “disabled,” for example, is different for Social Security or SSI coverage, DD services, ADA coverage, or educational services under IDEA.

Follow the Timelines

Failure to meet the timelines can cause the appeal to be dismissed.  Timelines are set in the rules for the agency conducting the appeal and will vary among the agencies.

Gather all Facts and Reports

Having complete and accurate facts to present to the reviewing body is essential. 

Agencies often refuse to approve benefits or services because the information they need has not been supplied.  At times a medical provider did not send the proper record or report.  At times the family did not supply the needed information. 

If you are seeking reports from health care professionals, they need to understand exactly what kind of report the Agency wants, the issue to be addressed and the supporting information needed. 

Organize and Simplify

When you present evidence to the reviewing body, the evidence should be clear, relevant and succinct.  The evidence should address the issue under review.  Exhibits should be clearly labeled and numbered. 

If you bring witnesses, they should understand what the issue is and what role they have in the hearing.

Focus on Fact

Facts and law, not emotion, will be considered by the reviewing agency. 

Should you have a lawyer?

Most administrative appeal procedures are designed to allow persons to appeal without the need for a lawyer.  When you have a hearing in front of an administrative law judge or hearing officer, however, you will be better off with a lawyer.  A lawyer who is familiar with the process will help to gather the necessary information, put the information in order and present the case in a way which clearly addresses the issues.  The agency will frequently have a lawyer presenting the agency’s position and parents without lawyers will be at a significant disadvantage.

Posted in Blog, Disabilities.