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If You Are Denied Disability Benefits

The unfortunate reality is that applying for disability is a challenging process which often initially leads to a rejection notice from the Social Security Administration.  Statistics vary by source, but most estimates place the average approval rate for Arkansas claimants no higher than approximately 30%, and others report numbers closer to 25%.  In either case, the result is that well over half of all Arkansas disability benefits applications are denied after the initial submission and review.

However, a denial isn’t necessarily the end of the story: there are additional steps you can take toward an approval.  If you are initially denied by the SSA, you have another chance in the form of Reconsideration.  Then, even if Reconsideration fails, you can still request a hearing before an ALJ (Administrative Law Judge).

So how do you initiate Reconsideration, and what can you expect as the process unfolds?

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Basic Tips for the Appeals Process

Before we discuss the timeline following a denial, an important point to always remember as you go through the appeals process is that time is of the essence.  If you miss a deadline, instead of appealing your original claim, you will have to create a new application and begin again from scratch.  Consistently sticking to deadlines will help to keep the process as smooth, rapid, and cost-efficient as possible.

When the SSA sends you a rejection notice, you should also receive a detailed explanation of the rationale behind the decision.  This can help you address any flaws, weaknesses, or errors which may have undermined your application the first time, so that your future efforts are stronger.

Requesting Reconsideration After an Initial Denial

If you disagree with the SSA’s conclusion, you can request Reconsideration.

You can make this request by submitting an electronic or paper version of Form SSA-561 (Request for Reconsideration) to the SSA, along with these two additional forms:

  1. Form SSA-3441 (Disability Report – Appeal)
  2. Form SSA-827 (Authorization to Disclose Information to the SSA)

The Request form (561) is about four pages long, and asks for basic information such as your address, SSN, and reasoning for disagreeing with the rejection.  Form 3441 is actually far more involved, and asks the claimant detailed medical questions, all of which must be answered.  If you don’t know how to answer a question, state as much: do not leave a field empty.

Here are a few examples of what you can expect to see on the form:

  • “Has there been any change (for better or worse) in your illnesses, injuries, or conditions
    since you last completed a disability report?”
  • “Are you currently taking any medications for your illnesses, injuries or conditions?”
  • “How do your illnesses, injuries, or conditions affect your ability to care for your personal
    needs?”

It is extremely important that you file your Request and associated documents within 60 days of the date of the denial. While the SSA adds a five-day grace period as a cushion for mailing time, it is simply safer to either submit the form electronically, or, if submitting via post, to send the form well before the deadline nears.

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The Reconsideration Appeal

After you submit your Request, you will be granted Reconsideration appeal.  This appeal is a fairly rapid and straightforward process.  An examiner with a local DDS (Disability Determination Services) bureau will review your claim.  After this review is completed, you will be sent written notification informing you of the outcome and the reasoning behind the decision, usually within about five months.

The bad news is that the Reconsideration stage traditionally has a terrible prognosis: the average success rate for Arkansas claimants is only about 8.7%, meaning over 90% of all appealed rejections are rejected yet again.  (On a national level, the average approval at Reconsideration is not much better: just 13.8%.)

The good news, however, is that the next stage (the ALJ hearing) actually has an excellent prognosis: 49.6%.  That’s a robust fifty-fifty chance.  Some sources even report numbers as high as approximately 62%.

Interestingly, the hearing office (ODAR, or Office of Disability Adjudication and Review) which arranges your ALJ hearing may have a slight impact on your chances.  Of the two hearing offices which currently exist in Arkansas, the ODAR located in Fort Smith has a 47.1% award rate, while the ODAR in Little Rock has a slightly higher average rate of 50.6%.

Nonetheless, you cannot simply skip ahead to the ALJ hearing.  Even though the likelihood of approval is low, you must complete Reconsideration before advancing through the tiers of the appeals process.

The ALJ Hearing

There is a high chance your Reconsideration will not yield an award, meaning you will probably advance to the ALJ hearing stage.  Fortunately, many applicants fare much better at this stage.

As the term implies, this hearing takes place before an ALJ, or Administrative Law Judge.  (Your attorney will request this hearing for you by filing a formal request.)  The medical details and documents supporting your application will be reexamined by the judge, who will then make a determination.  For this reason, it is of the utmost importance that you are supported by a skilled and experienced attorney who can advocate on your behalf.

To schedule your private legal consultation with an Arkansas disability lawyer, call Ken Kieklak, Attorney at Law at (479) 439-1843, or contact us online today.