Managing Claim Denials for Disability Benefits

Individuals can appeal a denial of Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).  The appeal process typically involves requesting a reconsideration of the claim, followed by a hearing before an administrative law judge, and a review by the Appeals Council. The individual can file a lawsuit in federal court If the claim is still denied. You should consult with an attorney specializing in Social Security disability claims before requesting reconsideration to ensure your details and paperwork are submitted correctly. Your attorney can help better navigate the appeal process and increase the chances of a successful outcome.

Appeals Process

Typically, the process to appeal a denied claim for SSDI and SSI involves the following steps:

1. Request for Reconsideration – This step involves submitting a written request on the program’s timeline and any new medical evidence that may support the claim.
2. Hearing with an Administrative Law Judge (ALJ) – If the reconsideration request is denied, an ALJ hearing allows you to present additional evidence and testimony supporting your claim.
3. Review by the Appeals Council – If the hearing before the ALJ is denied, you can request that the Appeals Council review the decision. The Appeals Council can either deny the request, remand the case to the ALJ for further consideration, or decide on the claim.
4. Federal Court Review – If you still disagree with the decision, you can file a lawsuit in federal court.

The appeals process can take several months or even years, and it makes sense to have a Social Security disability claims lawyer to counsel and represent your appeal. They can help you gather evidence and present your case in the most favorable light possible.

Common Reasons you may be Denied Benefits

According to the Social Security Administration (SSA), most first-time applicants receive a denial. Because of this high rejection rate, it’s important to know the common reasons for denial.

• You earn too much income – Regarding SSDI, you may earn too much money to be considered disabled. The SSA has an established threshold based on “substantial gainful activity” (SGA). As for SSI, a disability benefit for low-income people, you also must earn beneath the SGA when you apply, although, after approval, you may earn more until you reach a limit for all qualified earned and unearned income.
• Your disability isn’t severe enough or won’t last long enough – To qualify for either SSDI or SSI benefits, the SSA must believe your impairment to be severe enough to last a minimum of 12 months or result in your death. A single exception applies to SSI applicants who are blind.
• The SSA can’t locate you – The SSA and the agency that determines your medical eligibility, the Disability Determination Services (DDS), must routinely communicate with you to schedule meetings, examinations, or related critical matters. If you aren’t reachable, they may deny your benefits claim. A disability attorney provides a contact person for the SSA and DDS.
• Refusal to Cooperate – The SSA will need your medical records to grant disability benefits, but if you refuse to release the records, your claim will be denied. Similarly, the SSA may require additional data about your condition because a medical record may be incomplete or you don’t routinely see the same physician.
• Failure to follow a prescribed therapy – If you do not follow your doctor’s orders, the SSA can deny your disability benefits application. Still, the SSA will recognize certain legitimate excuses for failure to follow treatment protocols, such as mental illness, confirmed fear of surgery, or physical inability to follow therapy without assistance. Acceptable non-medical reasons may include no funds to pay for the treatment, religious beliefs, or a second opinion from a doctor who disagrees with the treatment.
• The disability is due to alcoholism or drug addiction – The SSA considers these conditions to be a contributing factor to your disability and will deny your benefits claim. The key factor for DDS determination is whether you would still be disabled if you stopped using.
• Crime conviction – Certain circumstances relating to criminal conviction or imprisonment will prevent you from receiving SS disability benefits.
• Committing fraud – If you receive disability benefits via dishonest means, the SSA can terminate your benefits and may prosecute you for fraud. Benefit terminations may also occur if someone working for the SSA helps you obtain benefits through fraud.

Appealing your Claim

When appealing a denied claim for SSDI or SSI, it’s important to:

1. Gather additional medical evidence to further support your claim. Evidence may include new medical tests, treatments, or evaluations since filing the original claim.
2. Consult an attorney specializing in SS disability claims. Your lawyer can help navigate the appeal process and increase your chance of a successful outcome.
3. Meet deadlines for filing an appeal and submitting additional evidence, or you may lose your appeal rights.
4. Be prepared for the hearing with an administrative law judge. Preparation may include submitting written statements from doctors and other treating professionals, providing testimony about your condition, and how it affects your ability to work.
5. Answer questions truthfully and provide accurate information during the appeals process.

The appeals process may take several months or even years. You will need to stay informed about your case and be patient.

What an attorney can do for you

While it’s not mandatory to have an attorney handle an appeal for SSDI or SSI, it is highly recommended. An attorney specializing in these claims can assist you with the following:

• Identifying the reasons for the denial of your claim
• Gathering and submitting additional medical evidence
• Preparing for and representing you at a hearing before an ALJ
• Submitting a request for review to the Appeals Council
• Filing a lawsuit in federal court if necessary
• Providing guidance on the appeal process and deadlines
• Advising you on the best strategy for your case

Additionally, working with an attorney may save you a lot of time and effort. An attorney specializing in SS disability claims typically charges a contingency fee, a percentage of the disability benefits awarded to you. In most cases, the benefits awarded are far more than the attorney’s fees. An experienced lawyer increases the chances of overcoming an initial denial of SS disability benefits. We invite you to contact our offices in Midway, Erie, and Franklin PA to learn more about your options.