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 Fort Smith 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.
The Most Common Reasons for Disability (SSDI) Denials in Arkansas
Insufficient Work Credits
It is important to understand that the SSD program is an insurance program for workers. As an insurance program, an individual must qualify for coverage to obtain benefits. A worker can determine if he or she qualifies by seeing how many work credits they would be required to have for the number of years they have worked. In 2015, workers can earn 1 work credit for each $1,220 they earn. Up to four work credits can be earned each year. For instance, a person who becomes disabled at age 44 would need to accumulate 22 work credits. If the disability onset date occurs at age 54, then 32 work credits would be required. You never lose work credits, but if you do not have sufficient credits, you will not qualify for SSD.
Earning too Much Money to Qualify
Before the Social Security Administration (SSA) ever considers or disability or impairment, you must also meet the income-based non-medical program requirement. Those who qualify for SSD must be, generally, unable to work and perform productive activities – what the SSA calls substantial gainful activity (SGA). SGA is adjusted on a yearly basis and is indexed against the national average wage index. Furthermore, a higher limit applies if the applicant is blind. In 2015, the limits on SGA for a blind individual is $1820 a month. For disabled but non-blind individuals, the SGA limit is $1090. If you exceed these limits you will not qualify for federal disability benefits.
Your Disability is Not Considered to be Severe or Will Not Last for the Required Time Period
One of the most frustrating denials a benefits applicant can receive is one that states that their condition was not considered to be severe by the SSA. The individual has undoubtedly been suffering from the effects of his or her disability or impairment, and now they receive a letter from the government that appears to say that there condition isn’t bad enough. What the government is really saying when you receive a denial of this type is:
- The impairment must be medically determinable.
- The impairment must be supported by objective medical records or testing results.
- The disability must cause severe limitations in your daily activities and prevent you from working.
- The disability must be expected to persist for at least 12 months or to result in death.
Understanding the exact nature of your medical denial can help you prepare for a SSDI appeal.
The SSA Cannot Find You or You Do Not Reply to the SSA’s Requests
The SSD benefits application process is an ongoing one that can last for several months or longer. During the process the SSA or its Disability Determination Service (DDS) may contact the applicant or his or her attorney. The SSA may request additional information regarding you condition, reports of daily activities or medical tests and results. You must respond to the SSA’s requests or risk denial. If you move often or otherwise do not have a permanent address, this can be a hardship. One way to work around this requirement is to appoint a Social Security representative. Your representative can receive and handle all correspondence regarding your SSA application.
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 Fayetteville AR disability lawyer 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 Bella Vista 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) 316-0438 or contact us online.