If My Initial Disability Application Is Denied, What Are My Options?Updated May 29, 2018 Social Security Disability
If you file an application for disability and you are denied benefits, fear not. You are in good company. That’s because about 70% of all initial applications are rejected by Social Security for a number of reasons. These can include not fully completing all required forms, not submitting enough medical evidence to support your claim, submitting when you do not have a qualifying disability, or being turned down for technical, non-medical reasons, such as exceeding the substantial gainful activity limit.
If you are turned down, you do have several options as your next steps. Let’s take a closer look at each of them.
File a new application. Many people believe that starting over is the best way to go. That way you can have a clean slate and attempt to correct any shortcomings that may have been identified on your first pass through the system. While this may make sense to you, the fact of the matter is, it is the wrong way to go in most all cases. There are a couple of reasons for this.
First, if you were denied benefits initially, without the assistance of someone familiar with the filing process, such as an attorney, there’s a good chance you will make the same mistakes again, despite your best efforts. The other solid reason is because Social Security will take a look at your file and will see that you already filed once and were turned down for benefits. Like it or not, this does raise a red flag and is likely to invite questions on why you chose to start the entire process over again.
File an appeal. Far and away, this gives you the best chance at having a denial overturned. Social Security actually gives you several levels of appeal that you can go through. The only downside is that the appeals process can take months, if not a couple of years, before your case is decided.
The first level of appeal is known as a Reconsideration. With a Reconsideration, a second claims examiner and medical consultant will look at your files and pertinent records to see if you do qualify for benefits. You have 65 days from the date of your initial denial notice date to file an a request for Reconsideration. During that time, you can gather additional medical records and other supporting documentation to strengthen your claim, which you can then submit as part of the overall review process. While an initial review of an application can take up to five months or more, Reconsiderations are generally decided more quickly because most, if not all of the needed records are already in hand by Social Security.
If you claim is denied in a Reconsideration, the next level of appeal is to request a hearing in front of an Administrative Law Judge (ALJ). Due to a long backlog throughout the nation, it can take quite a while to get a date for a hearing, so be prepared to wait as long as a year or more for your chance to plead your case. When that chance comes, you or your legal representative will be able to present your case face-to-face in front of the ALJ. In preparation for your hearing, the judge will have already reviewed your files and will be familiar with your case. He may ask you pointed and direct questions designed to determine if you meet all the criteria for approval. Your best strategy is to be honest, forthcoming and complete in explaining your situation, also presenting any additional evidence to support your claim. If you use your time wisely leading up to the ALJ hearing, you can get substantial medical expert evidence to back your claim in an effort to put your best case forward. It is at this level that the highest percentage of denials are overturned and benefits are granted, so it is imperative that you do everything in your power to create a compelling argument in your favor.
If you are denied benefits by an ALJ, your next step is to seek approval of benefits by requesting a review by an Appeals Council. Appeals Councils will review the processes and methodology used by the ALJ to reach their decision, making sure that all medical evidence was considered appropriately and that the judge’s efforts were thorough and in line with accepted hearing practices. The Appeals Council will then affirm the judge’s decision by denying benefits, overrule the judge and grant benefits, or remand the case back to the original ALJ for further review.
If you are denied benefits at this level, you can go outside of the Social Security system and file a suit in Federal Court to have your case heard. This is a last ditch effort that sometimes works, but in the vast majority of cases, it does not.
It is important to note that at all levels, there are strict deadlines for filing an appeal. It is highly in your best interests to not miss these filing deadlines, or your request may be denied before it is even considered. If this happens, you have the choice of either filing a new disability application and starting the process over, or you may request that your appeal move forward because you had good cause why you missed your deadline and filed late.
Explore expedited claims processes. For those people who have severe or terminal impairments, they may be eligible to be processed in an expedited manner. Social Security speeds approval under the Compassionate Allowance program, if a person has a condition on the Compassionate Allowances list, allowing for approval in a matter of days instead of several months. There are about 220 qualifying conditions and the current list of those Compassionate Allowances can be found on SSA’s website.
For those who can prove they have a terminal condition, and not expected to live more than 6 months, a quick decision may be made through the Terminal Illness Program (TERI). For Supplemental Security Income applicants, if they have an obvious disability or condition, immediate benefits may be payable through the Presumptive Disability Program. Benefits for this are not available for SSDI applicants.