We know that a denied social security disability claim can be daunting. You may be relying on benefits to pay medical bills, living costs and other expenses. To suddenly face the possibility you might not get support for these needs can be distressing.
If you have applied for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, and you have been denied, do not panic. You have several avenues to appeal this denial all the way up to the Federal Circuit Court if need be. The most important thing you can do after your denial is to understand why you were denied and what you need to do to successfully appeal that decision.
When dealing with a denied social security disability claim, you have time limitations. You will want to:
- Act immediately. Never ignore letters or communications related to your social security disability claim. Open them as soon as you get them and take steps to address the issue at once. You have a 60-day window to appeal any denials, and waiting can hurt your claim. If you wait too long or try to file a new claim rather than appealing, you could lose your chance at benefits.
- Contact a disability benefits attorney as soon as possible. A denial is a serious concern, and it deserves prompt attention. A disability claim attorney focusing on SSI and disability benefits understands the common reasons for a denial — and how to appeal a denial successfully. It can be a significant advantage working with someone who has successfully appealed hundreds of denials, and in many cases, that means working with a disability attorney.
- Consider why your claim was denied. An attorney can help you determine what went wrong the last time and build a strong case for an appeal. If you understand what went wrong before, you may have a better chance of winning an appeal.
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The Social Security Appeals Process
To qualify for Social Security benefits you need to meet the Social Security Administration’s (SSA) definition of being disabled. You need to show that you have been disabled for at least a year, that you will be disabled for at least a year or that your disability is so serious that it will cause your death — for example, if you have ALS.
When you apply for SSDI or SSI benefits, a Social Security employee examines your claim to determine if you are making too much money to apply for Social Security benefits, which could result in what is known as a technical denial. Then your case is passed on to state employees at your state’ s Disability Determination Services (DDS) agencies.
These examiners will consider all the information that you have presented before making a decision. If they deny your claim, they will send you a letter explaining why they did. That letter will contain important information about how you can improve your application if you decide to go through the SSA appeals process.
If you are denied, do not feel indignant or angry. Examiners at the DDS offices deny most initial claims, roughly around 65 percent. Although the SSA says it uses the same methods across the country to determine whether claims will be approved or denied, the reality is that the rate of success for initial claims varies from state to state and even from office to office within a state.
The reason for this is simple — you are dealing with human judgment. Due to the overwhelming number of applications for Social Security benefits that a single SSA employee must consider, many claims do not receive the attention they deserve.
If you believe that your claim has been wrongly denied, the best thing to do is file an appeal. Some people, however, can be daunted by the length of the appeal process – which can last several months to two years – and decide not to appeal but submit a new application instead.
This is almost always a mistake. If you file a new appeal, and your examiner sees that you have already been denied once before, there is a very good chance they will deny your second application on the spot. You have a much better chance of obtaining Social Security benefits if you appeal your initial denial.
Time, however, is very important. If you decide to appeal your initial denial you must do so within 60 days of when you receive your denial letter from the SSA.
There are four steps to appealing a Social Security benefits denial:
When you ask for a reconsideration of your initial denial, someone not involved in the initial decision will review your claim. Your chances of successfully overturning your initial denial by asking for reconsideration, however, are not very good. The rate of successful reconsideration appeals is just under 15 percent.
2. A Hearing by an Administrative Law Judge (ALJ)
This is the stage of the appeals process where you have the best chance of success, particularly if you are working with an attorney experienced in dealing with Social Security benefits cases. A study by the Government Accountability Office (GAO) found that claimants who hire an attorney to work with them on their appeals process are three times more likely to be successful than claimants who go it alone.
Your attorney will help you prepare for the hearing. You can present more evidence about your medical condition at the hearing and even call witnesses if so desired. It is extremely important that your appeal be as well-developed as possible. Appeals that appear incomplete or lack documentation about your medical condition and the limitations it imposes on you and your ability to work will be denied.
You or your lawyer can work with your doctor to prepare a Residual Functional Capacity (RFC) form. Your doctor prepares this form to explain the seriousness of your medical condition, and the treatments that you have received so far. The ALJ uses this document to help determine whether you will receive SSDI benefits.
The ALJ will notify you and your attorney when and where the hearing will take place. In most cases, the hearing will be held within 75 miles of where you live. If necessary, it also possible to hold your hearing via video conference if traveling is difficult. The advantage of the video hearing is that it can be scheduled more quickly than an in-person hearing that can take several months to schedule.
The ALJ will listen to you and your representative explain why you think the initial decision was wrong and why you do deserve benefits. They will examine all the witnesses and medical documentation you present. In most cases, the ALJ will issue a decision about your appeal within 90 days of when a hearing was officially requested.
You do not have to attend the hearing and can have your attorney represent you. It is always in your best interest, however, to go to the hearing. The ALJ may have questions about your case that only you can answer. In some cases, the ALJ will delay the hearing because they feel they need to speak to you in person, so it is usually best to plan on attending.
If you have taken the time to prepare your documentation and present a solid case that explains why you should be given Social Security benefits, your chances of success at this level are much greater. Almost two-thirds of appeals to an ALJ are approved.
3. An Appeals Council Review
If the ALJ denies or dismisses your appeal, you can ask for the Social Security’s Appeals Council to review your case. At this point, it is wise to review your options with your attorney. You need to carefully consider your chances of success if you decide to ask for an Appeals Council review.
The success rate for an Appeals Council review is about two percent, although you have a one in five chance that the appeals court will remand the case back to the ALJ for further review. The Appeals Council denies or dismisses over 75 percent of all appeals it hears.
It can also be quite time-consuming. Although you need to file an appeal to the Appeals Council within 60 days of your case being denied by an ALJ, it can take several months for a hearing to be scheduled and then several more months for a decision to be rendered. In some cases, it can be a year or more.
4. Federal Court
If your appeal is denied or dismissed by the Appeals Council, or if they decide not to take your case, you can file a lawsuit in federal court. The Appeals Council will send you a letter explaining their decision and also inform you about how you can ask a court to examine your case.
When you filed your initial application, you probably did not see yourself filing a lawsuit in a federal district court to fight for your benefits, but this can happen.
If you have not yet hired an attorney to help you with your case, it is vital that you do so now. Only a licensed lawyer can represent you in court.
You may not have paid anything to this point, but a federal appeal will cost you money. The first few stages of the SSA process are free, and if you have been working with a lawyer, they are working on a contingency basis. You will need to pay a fee, however, to file your case with the federal court.
Most people think of this stage of the appeals process like a “trial.” Your lawyer and a Social Security lawyer will present written briefs to the court arguing for and against your case. Depending upon the nature of your case, you may not have to appear in court at any time, as most of the arguments will take place in writing.
Once all the briefs have been presented, the judge assigned to your case will decide whether or not to award you Social Security benefits. The judge may take a year or more to make a final ruling.
If the judge decides against you, you have one last step. You can appeal to the federal circuit court. If you have reached this stage, however, you and your attorney need to discuss your realistic chances of success at this level.
If My Initial Social Security Benefits Application Is Denied, What Are the Best Ways to Ensure My Chances of Success During the Appeals Process?
If your initial claim is denied, you can help improve your chances of a successful appeal by taking the following steps:
1. Make Sure Your Documentation and Information Is Complete and Well Organized
As we noted above, many initial claims are denied by the SSA because the information presented in by claimants does not provide enough evidence that they have a true disability. If your initial claim has been denied, and one of the reasons for that denial was inadequate information, particularly medical information, you should talk to your doctor immediately about doing an RFC and gather all the documentation you can about doctors, treatments and any specialists you may have seen. Make sure you talk to the specialist about also providing medical information about your disability.
2. Hire an Attorney
Hiring an attorney to help you present a successful Social Security benefits claim has many positives to it:
- If you are injured and not well because of your disability, it may be hard for you to collect all the documentation you need and prepare it on time to make an appeal. Once you hire an attorney, they will step in to help make sure that all this information is gathered and all your paperwork is filed on time.
- Hiring an attorney is a proven successful strategy. The GAO study mentioned above has already shown that working with an attorney on a Social Security benefits claim means that you are three times more likely to be successful.
- Social Security benefits attorneys work on a contingency basis. They don’t make money unless you make money. And their fees are set by the Social Security Administration. Attorneys will either earn a 25 percent share of your awarded benefits or $6,000, whichever is lower.
- If your impairment is a disability that might be harder to prove, such as carpal tunnel syndrome or loss of hearing caused by loud noises in the workplace, you have a much better chance of proving your case with an attorney helping you to present your evidence.
Let KBG Injury Law Help You With Your Social Security Benefits Appeal
Appealing a denial in a Social Security disability claim case is time-sensitive. The attorneys at KBG Injury Law offer quick consultations and respond to your inquiries fast — so you can get your legal issues addressed quickly. If you are interested in a free consultation, you can call us at 1-800-509-1011 or leave your contact information and some details about your case on our contact us page, and a member of our team will get back to you as soon as possible. Contact KBG Injury Law today if your disability benefits claim has been denied.