Understanding the Social Security Disability Benefits Appeal Process

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While local award rates vary somewhat, the nation-wide award rate for workers’ initial Social Security Disability (SSD) claims is only approximately 35%. 65% of applicants must then appeal the initial determination or accept the Social Security Administration’s initial denial. Unfortunately, the approval rate does not increase for appeals. However, working with an experienced Social Security disability attorney can help you understand the determination process, the appeals process and more. Further, an experienced advocate can analyze and present your medical, occupational, and education evidence in a clear and strategic manner.

This post is intended to help those researching SSD understand why claims are denied. Additionally it will briefly explain the benefits appeals process.

Why are Disability Claim Denied by Social Security?

There are two main categories for the reasons why SSD claims are denied: medical denials and technical denials.

Technical denials are more common in the initial determination and first level of appeal. Technical denials are not based on your medical condition or impairments. Rather technical denials are issued because the Social Security claims examiner or administrative law judge has determined that you do not satisfy a non-medical program requirement. Examples of reasons for technical denials include:

  • You do not have sufficient work credits to qualify for SSD.
  • You are currently working.
  • Your substantial gainful activity (SGA) exceeds program limits.
  • Your last work is too recent.

However an attorney or representative who understands with the process may be able to help you appeal a technical denial. For example, because certain sources of income are not counted by the Social Security Administration, your SGA may have been incorrectly computed. An experienced attorney can identify errors like these and file an appeal, if appropriate.

The other main type of denial are medical denials. Medical denials are issued because the claim examiner has determined that you condition does not qualify for medical reasons.  However in some cases the examiner may misinterpret the circumstances and evidence. For example, it is possible for an individual to not follow prescribed therapy, medication or other treatment for reasons other than refusing to do so. For instance, the individual may not be able to afford the medication that was prescribed or they may be unable to care for themselves. In other instances the longitudinal medical record may need to be developed further prior to the granting of a disability award.

How can I Appeal my Social Security Disability Denial?

Regardless of whether your denial was due to technical or medical reasons, you are entitled to appeal the decision. However, do not sit on rights.  Your appeal to the initial determination must be filed within 65 days of the date on your denial letter. If your claim is late and you cannot show good cause you will have to restart your application process.

Your first appeal, Reconsideration, can be requested by completing the Request for Reconsideration form. Along with the reconsideration request, the Disability Report – Appeal form should also be completed. This form is mainly interested in the changes in your condition that may have occurred. If there have been significant changes, the assistance for an experienced advocate can help you present an accurate and clear picture of the limitations your experience due to your severe impairment.  Furthermore working with an attorney and legal team can help you marshal evidence of your condition from doctors, hospitals, former employers, educational records, and many other sources.

The approval rate for Reconsideration requests is extremely low. Therefore you should not be shocked or discouraged if you receive a Reconsideration denial. However the good news is that you chances improve somewhat at the next level because your situation will be reviewed by an administrative law judge. Like in the previous appeal, you will be required to submit an updated report on your condition, limitations and medical treatment. Those who appeal should request a disability hearing before the judge. In some instances a medical or vocational expert may testify about your condition or the type of work you should be able to perform, respectively.

If your claim is denied by the ALJ, you will receive an explanation for your denial. You may then appeal to the Appeals Council where, if accepted, your case is reviewed by a panel. The Appeals Council will not only analyze your condition but also it will look for legal or procedural errors that may have been made.

If your claim is still denied, there is one more level of appeal. However in many, if not most, instances appeal to this level is unlikely to produce a different result. However in stances of a novel issue, a lawsuit in the federal court system is the final level of appeal. The federal court can dismiss your claim, remand it back to the SSA for further proceedings, or grant your claim if is it disagrees with the SSA’s determination.

Put our Social Security Appeal Experience to work for you

Applying for disability benefits and filing an appeal can be a daunting process.  However the experienced social security disability lawyers of the Law Practice of Ken Kieklak can handle each step of the process. To schedule your free and confidential Social Security Disability consultation, call (479) 251-7767 or contact us online.

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