What to Do If Your Disability Claim Is Denied
Do you know what to do if your disability claim is denied?
It’s important to prepare for this possibility: every year, the Social Security Administration (SSA) denies many first-time claims. Knowing what to do can help you avoid a denial or appeal the decision as quickly as possible.
Keep reading to learn what to do if your claim is denied and how the appeals process works.
Why does the SSA deny claims?
In order to qualify for Social Security disability benefits, you need to prove to the SSA that you have a disability that prevents you from working. You also need to meet certain work requirements. (Read more about SSDI medical requirements and work requirements.)
The SSA might deny a claim for technical or medical reasons.
A technical denial might be due to missing paperwork or mistakes in your documents. The SSA also might deny your claim if they believe you haven’t worked long enough, or recently enough, to qualify for SSDI.
For example, if your disability began after your date last insured, the SSA would deny your claim. (The “date last insured” is the last date you’re eligible to qualify for SSDI and is based on when you last worked.)
The SSA might deny your claim for medical reasons, if they don’t believe your condition prevents you from working. For example, they might deny your claim if:
- Your condition is expected to improve in under 12 months
- You can still manage most or all daily activities
- You haven’t followed the recommended treatment prescribed by your doctor
- Your condition would be improved if you stopped drinking alcohol or using drugs
- You didn’t let the SSA know where you get treatment
- You didn’t show up to the SSA’s doctor’s appointment
- You didn’t include enough medical evidence of your condition in your claim
Note that the burden of proof is on you—the claimant—to prove to the SSA that you qualify for SSDI benefits. If you forget to include work or medical records, miss appointments, or otherwise make mistakes during your claim, this could lead to a denial.
For this reason, it’s often a good idea to have a Social Security disability attorney on your side. Working with an attorney can improve the odds that your claim is approved—the first time. What’s more, when you have an experienced attorney, you don’t have to handle everything yourself! You can rest and trust in your attorney.
What can you do if your claim is denied?
If the SSA denies your disability claim, they will send you a letter outlining their decision and their reasons for the denial.
If you get a letter of denial, don’t panic! You have the right to appeal the SSA’s decision.
When You Can Appeal
Don’t wait to start the appeal process after your disability benefits are denied.
The SSA allows 60 days from the date you receive the denial notice to submit your appeal. (The SSA also assume you receive their notice 5 days after the date on the letter, unless you can prove that you received the notice later than that.)
If you don’t appeal within 60 days, you may lose your right to an appeal! In that case, the SSA’s decision becomes final. Exceptions can be made in some circumstances, but you don’t want to count on the SSA making an exception for you. To ask for more time, you need to send the request in writing to the SSA.
How to Request an Appeal
If your claim is denied, you must request an appeal in writing and send it to the Social Security Administration. (This can be done online or by mail.)
When you appeal, you also have the right to representation. If your claim is denied, it’s a good idea to speak with a Social Security disability lawyer about your case. A lawyer can help you determine why your claim was denied and how best to prove your case to the SSA.
How does the appeals process work?
The Social Security Administration offers four levels of appeal:
- Hearing by an administrative law judge
- Review by the Appeals Council
- Federal Court review
If your first-time claim is denied, you can request a reconsideration. A reconsideration is a complete review of your claim, done by someone who wasn’t involved in the initial review. The SSA takes a second look at all of the documentation you provided in your initial claim, plus any new evidence you submit for review.
Depending on the reason for the denial, either the local SSA office or the Disability Determination Services (DDS) for Ohio will review your claim. If the denial was for a non-medical reason, the SSA office will do the review. If the denial was for medical reasons, the DDS handles it.
Hearing by an Administrative Law Judge
If, after the reconsideration, your claim is still denied, you can appeal at a hearing by an administrative law judge (ALJ).
You need to request a hearing within 60 days of receiving notice of denial.
After your request, the SSA will schedule the hearing and follow up with you with any questions. The office might ask you for more information and documents. During the hearing, an ALJ who didn’t take part in previous reviews will handle your case. You may need to answer questions. If you bring witnesses to help prove your case, they might need to answer questions as well.
After the hearing, the ALJ issues a written decision that you will receive in the mail.
Review by the Appeals Council
If you disagree with the ruling by the judge, you still have the option to appeal. You can request a review by the Appeals Council within 60 days of the previous decision.
The Appeals Council doesn’t have to review your case: they will take a look at your claim and either grant or dismiss your request for a review. If they believe the judge’s decision was correct, they dismiss the request and allow the previous decision to stand.
If the Council decides to review your case, one of two things may happen. The Council may decide your case itself, or send it back to the administrative judge for further review.
You’ll receive a copy of the Appeal Council’s decision.
Federal Court Review
If you disagree with the Appeal Court’s decision, you have the right to file a civil suit in a Federal district court. You have 60 days from notice of the Appeal Council decision to file a suit. This is the last level of the appeals process.
While it’s always a good idea to consider an attorney for your disability claim, it’s especially helpful at this stage of the appeals process.
Need Help Appealing a Disability Claim Denial?
We’re here for you.
The Social Security disability attorneys at Casper & Casper have extensive experience helping people whose claims have been denied. We’ll do everything in our power to get you the benefits you need.
Call us today to learn what we can do for you.