What Happens If My Social Security Disability Application is denied?Updated May 24, 2018 Social Security Disability
Although many people apply for Social Security Disability Insurance, unfortunately about 70% of all initial applications for disability benefits are denied by Social Security Administration (SSA). There are many reasons why an initial claim might be denied. Some of the more common reasons include:
- Incomplete forms
- Lack of establishing medical records
- Lack of sufficient work history
- Your medical condition or impairments do not qualify as a disability
- You are still able to work at some kind of job
- You exceed substantial gainful activity limits
If you are denied disability benefits for these reasons or for most others, you do have the right to appeal your disability claim decision. Some people choose to hire an attorney or a disability lawyer to assist them with the appeals process. Hiring a Social Security disability lawyer will likely increase your chances for approval.
The first level in the appeal process seeking benefits is what is known as a Reconsideration Appeal. Claimants have 65 days to file an appeal to Social Security Administration which they can do so through the SSA website or at a local SSA office. After the forms have been filed, the case is forwarded to a state Disability Determination Services (DDS) office for review. DDS offices sometimes go by different names depending on the state you live in.
Your benefits appeal will be reviewed the same way your original claim was reviewed, except by different claims representatives and medical examiners. It generally takes less time at a Reconsideration level to reach a decision that with an initial benefits application. This is because SSA already has most, if not all, of your medical records in hand. As part of your benefits appeal process to SSA, you may have included additional medical records for your case. As part of your benefits claim, you may have also attempted to correct any errors that led to being denied initially. The bottom line is that you were rejected for a reason the first time around, and you need to correct the reason a decision was made for your denial.
A small percentage of disability benefits claims are approved at the Reconsideration level, but the vast majority are still denied. If you are denied, then your next step is to request a hearing in from of an Administrative Law Judge (ALJ). At this level, many people choose to retain the services of a seasoned disability lawyer to assist them with their case. A disability lawyer can be a valuable asset in gathering additional medical evidence, formulating a compelling case for approval of benefits, and keeping a claimant focused on facts.
The big drawback with seeking a hearing with an administrative law judge is that there is such a backlog of cases waiting to be heard, and a limited number of judges available, that it is not uncommon for a benefits hearing to take as long as 12 months or more before it can take place.
When it is time for your case to be heard, you can expect that the judge has taken the time to review your files, and he/she will be prepared to ask you several questions about your medical condition and why you should qualify for SSDI benefits.
Judges have heard hundreds of disability benefits claims cases, and that’s why it is imperative that you are truthful and accurate when you answer any questions. They will know if you are not being forthright, and that could lead to a quick denial on your claim.
If you are denied benefits in an appeals hearing, then you can file an appeal with the’s Appeals Council. This is the last and final level of appeal. You have 60 days from when you receive your ALJ denial letter to file a request to be hear by an Appeals Council. The primary function of the Appeals Council is to ensure that judges’ decisions are accurate and that they did not make any legal mistakes while evaluating your claim.
The majority of the time, the Appeals Council will uphold the ALJ’s decision, and your claim will be denied. If this happens, you can file one last appeal within 60 days with a federal district court that is not a part of SSA. An Appeals Council may also choose to remand a case back to the same administrative law judge that originally heard your case. This will happen when the Appeals Council believes that the ALJ made a technical error in a case, or did not taken all medical record evidence properly into consideration. In a few rare cases, the Appeals Council may render a completely new decision in a claimant’s favor based on an error that the judge made, but this only happens in about 2% to 3% of cases. The other thing to note is that what ever is decided, it is going to be slow because it takes anywhere from three months to up to two years for an Appeals Council to reach a decision.