How to Appeal a Disability Denial
Get Help Appealing Your Disability Denial
Every year millions of Americans are diagnosed with conditions hindering them from working, attempting to collect disability. Unfortunately the Social Security Administration must deny the majority of initial applications for disability benefits to ensure only qualified claimants are awarded benefits, generally around 75% of initial applications.
Fortunately many disabled Americans choose to move forward, attempting to receive disability benefits by appealing the initial denial. In 2014 a total of 2.5 million Americans filed for disability and over 800,000 were awarded benefits; if a claimant has been initially denied, there is still hope.
Common Reasons For Denial
An applicant will be denied if he or she:
- did not have enough medical documentation to prove their disability.
- did not attend a consultative exam request by the SSA.
- did not complete the application properly.
- has an impairment that is treatable within a year.
- has not seen a physician in the past 6 months.
- is working to many hours.
- is earning more than the substantial gainful activity (SGA) limit.
- is receiving too much in unearned income.
Once an applicant receives a denial letter, he or she has 60 days to file an appeal with the corresponding organization (typically the SSA) to move on to the next stage in the appeals process. Under most circumstances, applicants have a higher chance for approval by appealing the SSA’s decision rather than starting over with a new application.
Initial denials to social security disability claims are common, with over 70% of Americans being denied in their initial application for disability benefits. A majority of these denials are not for lack of “disabilities” or medical proof but due to a technicality in their application. This technicality is known as a “technical denial” and is defined as when an applicant does not meet the general (non-medical) requirements for an approval of disability benefits.
The SSI benefit program has requirements that if not met would result in a technical denial. These requirements are income and assets based. Income can be earned such as wages hourly or salary. Income can also be unearned such as child support, alimony, SSDI or SSI from a spouse, trust funds or pension/private retirement etc.
If an applicant doesn’t meet the requirements below for at least one of the disability programs, the SSA would define the applicant as being able to engage in “substantial gainful activity” (SGA) resulting in a technical denial.
SSI claimant assets rules:
- An applicant who is single and over the age of 17 must have assets totaling less than $2,000.00.
- An applicant who is married and over the age of 18 must not have more than $3,000.00 in total assets.
SSI claimant income rules:
- An applicant who qualifies for SSI only and who’s married is allowed to have unearned income totaling $1102 or less each month.
- An applicant who qualifies for SSI only and who’s married is allowed to have earned income totaling $2249 or less each month.
- An applicant who qualifies for SSI only and is not married is allowed to have $741 in earned income and unearned income each month.
The SSDI program also has requirements an applicant must be fall under to avoid a technical denial. SSDI has no asset limits or unearned income limits.
SSDI claimant earned income rules:
- An applicant married or not married is not allow to earn more than $1090 in earned income each month.
Unfortunately if an applicant qualifies medically but doesn’t meet all technical requirements to be approved for disability benefits they will still be denied. Technical denials that are due to not meeting these requirements cannot be appealed; a new applicant must be submitted once the claimant meets all requirements. Other reasons for a technical denial may be due to lack of information or missing documents presented in the initial application. To learn more or understand how to best complete an applicant and ensure you are not technically denied please consult a disability advocate.
Four Stages to a Disability Appeal
The first step to appealing denied Social Security Disability benefits is to file a request for reconsideration. A claimant has 60 days to file this request including an additional 5 for mailing; if this request is not filed within the given timeline an initial application must be completed again. During this stage, the application will be sent back to the disability determination services (DDS) for review. To ensure a fair second evaluation is performed, a different medical examiner will review the claim checking to see if any errors were made in the initial denial. The request for reconsideration rarely reverses the denial with only a 14% approval rate.
A disability hearing is the second step in the appeal process; the claimant has the same length of time to request a hearing after the request for reconsideration is denied (60 days). This stage represents the claimant’s best chance to obtaining disability benefits. Once the request for a hearing is filed it can take up to one year to receive a hearing date. This is due to the backlog of applications and is why completing the initial application correctly is crucial.
A disability hearing is heard before an Administrative Law Judge (ALJ) who is responsible for overseeing the case and making the decision whether or not to award an applicant benefits. Before the hearing the judge assigned to the case will review and acquaint themselves with the claim. During the hearing process the claimant and potential representation will have the opportunity to explain how the claimant’s residual functional capacity inhibits them from working and engaging in substantial gainful activity. The judge determines this by reviewing any additional evidence that is brought before them and listening to a potential expert witness testify on the claimant’s behalf.
Once the disability hearing has concluded and the Judge has reviewed all evidence, a determination on the claim will be rendered but not stated during the proceedings. Statistically the claimant has a 52% chance of the decision being in their favor; this determination will be sent via mail to the claimant and can take up to three months to receive.
If denied by an Administrative Law Judge during the hearing proceedings, the subsequent step to appeal the denial would be to request to go before the appeals council. This also has the same time frame for submitting a request of 60 days plus 5 for mailing.
The disability application is then sent to the appeals council for review to ensure that the judge’s decision was made according to the laws set forth by the SSA. The appeal council may send the claimant before another judge to be reviewed once again, or can overturn the denial themselves. There is only a less than 5% chance that the decision by the first administrative law judge will be overturned. A Majority of the time a letter is sent to the claimant stating that the decision by the ALJ is going to be upheld by the appeals council.
The last possibility a claimant has to appeal a disability denial would be to request their application be reviewed in federal district court. The claimant must request the review within the same length of time as the appeal council review. During the federal court proceedings, the procedural steps taken in determining the cases decision is reviewed more than the application itself. The verdict possibilities can be to award the claimant disability benefits, agree with the procedures taken in denying the claim or to send it back to the Social Security Administration with directions on how to handle the claim. There is a 25% chance that at this stage the claimant will be awarded disability benefits.
Advantages of Having Representation
Once an initial application is denied, typically it is in the best interest of the applicant to seek some type of guidance or representation with their claim. The appeals process is quite complex and the appeals hearings involve legal aspects that the applicant may not be familiar with. A qualified disability advocate or attorney will prepare for the appeal by:
- Determining why you were denied and
- Gathering all additional, updated medical documentation required.
- Ensuring the right questions will be asked during the hearing.
- Helping prepare the applicant and their witnesses for the hearing.
- Acquiring personal knowledge about the ALJ who will be at the hearing.
Even though it is not required to have representation throughout the appeals process, having representation can significantly increase your chances for approval. For more information, check out our page the Advantages of Representation or contact us, the Disability Care Center at (888) 504-0035.