Sample Disability Appeal Letter

Posted in Appeal Letters

Individuals who believe they are no longer physically or mentally able to work apply for disability benefits. They apply through the U.S. Social Security Administration (SSA). When the SSA denies a claim the applicant has the right file a disability appeal letter.

Format and Content
When appealing any claim to a government agency it is necessary to provide as much information as possible so that the SSA representative can identify the right claim. The disability appeal letter format should include your name, social security number, claim number, date you received your rejection letter and the reason given for the rejection. It is also necessary to obtain the proper address and the name of a representative to whom your appeal letter should be sent.

When individuals who apply for disability are denied benefits it is often a good idea to file an appeal. This disability appeal letter sample is from a person who had a brain tumor. She has undergone surgery to remove the tumor. The surgery was successful and the subsequent chemotherapy and radiation treatments were successful as well. The tumor and surgery, however, left her with diminished hand-eye coordination, difficulty concentrating and vision problems which have rendered her unable to maintain a job. She applied for disability, was denied and is now appealing.

Jennifer S. Long
654 George Lane
Topeka, KS 22222
SSN: 123-45-6789
Claim #: 951753
Mr. David D. Drake
Appeals Representative
Social Security Administration
P.O. Box 357159
Topeka, KS 22222
September 30, 2013
RE: Disability Appeal Letter for Denial dated September 20, 2013
Dear Mr. Drake,
My name is Jennifer Long and I am writing to appeal my denial for disability benefits dated September 20, 2013. I applied because I have been unable to maintain a job since my surgery to remove a brain tumor almost 2 years ago. I have tried extremely hard to work, but my vision is blurred and glasses do not help, my hand-eye coordination is very poor which prevents me from driving a vehicle and I have tremendous difficulty concentrating on tasks that are assigned to me.As a last resort I applied for disability because I have 2 children and my husband does not make enough money as a courier to support all of us.We have had to borrow money from family some months to pay our rent and utilities.
I have attached my medical records showing the damage done to my brain from the malignant tumor and the strong treatments. Also attached are results of tests showing my abnormal brain functions which have affected my hand-eye coordination, vision and ability to concentrate. There is also a letter from my physician explaining that in his opinion I am unable to work.I have included my husband’s W-2 form as well showing his income last year and the number of hours he worked.
Please reconsider my disability claim that you denied on September 20, 2013 using this additional information. I would like nothing better than to work, but my efforts for the last 2 years have been unsuccessful. Thank you for your time and consideration.
Jennifer Long
Jennifer S. Long
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