My loved one was denied disability. Should we appeal, and do we need a lawyer?

What is the key fact?

You have 60 days from the day you receive the notice to appeal. Social Security assumes you got it 5 days after the date printed on the letter, so mark that date on your calendar today.

Why claims for serious mental illness get denied

Many denials come down to the record, not the illness. Gaps in treatment can do that. So can a short hospital stay with no follow-up.

Notes that say stable can make it look like your loved one is doing better than they are. Social Security's own rules for mental disorders help here.

Schizophrenia is evaluated under listing 12.03, and bipolar disorder under 12.04. Social Security says it considers evidence from family members. That includes the support you give, like handing out medication or paying bills.

It also says it will not hold it against someone when an inconsistent treatment history is itself a feature of the illness. A period of improvement does not, by itself, mean a person can work.

Are adults judged by adult SSI rules?

Adults are judged by adult rules. For anyone 18 or older, Social Security asks whether the illness keeps them from working at a substantial level for at least 12 months. School records and child milestones are not the test.

What happens next?

1. File the reconsideration. Ask for reconsideration online, by phone at 1-800-772-1213, or with form SSA-561. A representative does not have to be a lawyer. Social Security lets a family member, a trusted friend, or a trained advocate act for your loved one, using form SSA-1696.
2. Fill the gaps in the record. List every provider, hospital stay, crisis visit, and medication tried, with dates. Look at which records the denial says were used, and point out what is missing.
3. A third-party function report lets you describe what you see at home. Tie every example to why work is hard, such as missed days, confusion, conflict, or unfinished tasks.
4. If denied again, ask for a hearing. You again have 60 days. Hearings are before an administrative law judge. You will get notice at least 75 days ahead.
5. Any new evidence is due at least 5 business days before the hearing. Many denials are reversed on appeal, so it is worth asking.
6. Decide on representation. If you use a representative, their fee is capped at 25% of your loved one's back pay or $9,200, whichever is less. Social Security has to approve it, and a fee is only paid if you win and back pay is owed.

What helped other families

From the community. Family members who've been through this shared what helped them. These are their experiences, not professional or legal advice.

• Families were split on lawyers. Some felt a lawyer adds nothing a family cannot send in, since decisions rest on the medical records. Others said an experienced representative knows how to fill gaps in a record and prepare your loved one for the hearing.
• Several said a representative matters more when your loved one has memory problems or trouble thinking clearly, and cannot speak up well at a hearing.
• Parents reminded each other that you do not pay a disability lawyer unless the claim is approved.
• A parent pointed out that years without seeing a doctor does not automatically block a claim, though records help.
• Watch out: some families said their representative did not upload evidence they had handed over. Ask what has been submitted, and keep your own copies.

Free legal resources

Free legal aid can help with disability appeals if your loved one qualifies. Illinois | Wisconsin | California for guides and free help where you live. If you live in DC, Maryland, or Virginia, start with that state's pages.

The programs themselves are on SSI, SSDI, and childhood disability benefits and disabled adult child benefits.