Disability Appeals for Denied Claims
Disability appeals can be tricky, but if you have already applied for benefits in the past and were denied, don’t give up! In fact, most people are initially denied when they apply on their own. You can still re-apply or appeal the denial with the help of a qualified social security disability advocate or attorney.
Many applicants accept the first denial without realizing that the majority of initial disability applications are rejected. In fact, sometimes the SSA rejects a claim solely on the basis of a technicality. It is important to understand that denial of your initial application is not the end of the disability appeals process!
Reasons for a Denial
Most often, the SSA determines that a claimant’s disability does not prevent him or her from performing all types of work. They will typically cite a claimant’s residual functional capacity as a reason for denial. The SSA might also determine that there is inadequate medical documentation for a claim of disability or that the consultative examination has produced evidence to refute the medical opinion of your primary physician. The Disability Determination Services (DDS) evaluation may find your disability won’t prevent you from working at least 12 months. If you receive a denial of your disability claim, you should appeal the decision. In fact, the law allows you four different steps in the disability appeals process to give you more chances for approval.
Disability Appeals: How the Process Works
There are four stages of the disability appeals process. They include:
- Reconsideration
- Administrative Hearing
- Appeals Council Review
- Federal Court
After denial of your initial claim by the DDS, you must file a “Request for Reconsideration” within 60 days. This disability appeals stage is conducted internally by the DDS. An examiner for the DDS that did not work on your claim specifically will evaluate the entry file and determine if your denial was made in error. However, statistics show that claims are rarely reversed at the reconsideration stage.
If the SSA denies your reconsideration, you have 60 days to request an Administrative Hearing. This is where you present your case to an Administrative Law Judge. The agency may schedule your hearing date any day from three months to one year from now. Your judge will review your claim before court proceedings begin. The focus of your hearing will be your residual functional capacity. This is a very typical court proceeding. You have the opportunity to make your case and the judge will ask you questions to further evaluate your claim. Witnesses may testify on your behalf. Occasionally, lawyers call experts to submit their opinion based upon an evaluation of your claim.
The judge will conclude the hearing once lawyers submit all supporting evidence. After your hearing ends, the judge makes a determination and notifies you of that decision in writing. The notification process typically takes two months.
Denial of an Appeal
Should your appeal be denied at the Administrative Hearing, the next stage in the process is to file an appeal with the Appeals Council. Once again, you have 60 days to file this appeal after receiving the judgment from the Administrative Hearing. The Appeals Council must review your claim before submitting your case to the United States District Court. The Appeals Council will review the decision made by the judge and the evidence presented at your Administrative Hearing. The possible outcomes of this review by the Appeals Council include: refusal, a request for additional information, a reevaluation by your Administrative Hearing Judge, or a reversal of the decision.
Legal Representation Makes Disability Appeals More Likely to Win Benefits
Clearly, once you must appeal a denial after reconsideration, you need a Social Security attorney to represent your case. Because the SSA is such an extensive bureaucracy, disability appeals are best left in the hands of experienced professionals. It is extremely difficult to establish evidence of a disability eligible for benefits without knowledge or experience comparable the SSA. Attorneys almost exclusively handle claims entering the third appeals stage (Administrative Hearing) for their claimants.
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