Reasons for Social Security Disability Denials

Before we dive into your options after a denial, it’s helpful to understand why Social Security Disability claims are commonly denied. Some of the most common reasons for denial include:

• Failure to Meet SSA's Disability Criteria: The Social Security Administration (SSA) may determine that your condition does not meet their strict definition of disability. This means your condition must be severe enough to prevent you from working for at least 12 months or result in death.
• Insufficient Medical Evidence: If you fail to provide enough medical documentation or evidence of how your condition affects your ability to work, your claim may be denied.
• Substantial Gainful Activity (SGA): If you are working and earning above a certain income threshold, the SSA may determine that you are not disabled because you are able to perform "substantial gainful activity."
• Failure to Follow Treatment Plans: If you don't follow prescribed treatment or miss medical appointments without a valid reason, it can affect your claim.
• Non-Compliance with SSA's Requests: If you don't respond to SSA requests for additional documentation, follow up on claims, or meet deadlines, your claim could be denied.

What Should You Do After a Denial?

If you are denied Social Security Disability benefits, all hope is not lost. You have the right to appeal the decision, and many individuals who are initially denied ultimately win their case through the appeals process. Here are the steps you can take after being denied:

Review Your Denial Notice

When you receive a denial letter from the SSA, it will include the reason for the denial. It’s important to carefully review the letter to understand why your claim was rejected. This will help you identify what aspects of your claim need additional support or documentation.

• Check for missing medical evidence: If the denial was based on insufficient medical records or evidence, you may need to provide more detailed information from your doctors or specialists.
• Look at SSA’s decision criteria: If the denial was based on SSA's disability criteria, see if there’s a specific issue that needs to be addressed (such as meeting the SSA’s definition of disability or proving your condition meets a specific impairment listing).

File for Reconsideration

The first step in the appeals process is to request a reconsideration. This involves asking the SSA to review your claim again, with a fresh set of eyes. During reconsideration, a different person will look at your case, including any additional medical evidence or information you provide.

• Timeframe: Reconsiderations typically take about 1 to 3 months to process, though it can vary depending on SSA’s workload and your location.
• Additional Evidence: This is your chance to submit new or additional medical records, doctor’s notes, or other evidence that may strengthen your case.

Request a Hearing Before an Administrative Law Judge (ALJ)

If your claim is denied after reconsideration, your next option is to request a hearing before an Administrative Law Judge (ALJ). This is one of the most critical stages in the appeals process. At the hearing, you will have the opportunity to present your case in person and provide testimony. The ALJ can ask questions about your medical condition, your ability to work, and the impact of your disability on your daily life.

• Timeframe: Hearing wait times can be lengthy, typically ranging from 12 to 18 months depending on the volume of cases in your area.
• Appeal Preparation: It’s highly recommended to have legal representation at this stage, as the process can be complex, and a lawyer can help you present the strongest case possible.

Appeal the ALJ's Decision

If the ALJ denies your claim, you still have options to further appeal the decision. The next step is to appeal to the Appeals Council, a group of senior SSA judges who will review your case.

• Timeframe: The Appeals Council may take several months to make a decision, and they can either uphold the ALJ’s decision, send the case back to the ALJ for further review, or overturn the ALJ’s decision and approve your claim.

File a Federal Court Lawsuit

If the Appeals Council denies your case or declines to review it, you have one final option: filing a lawsuit in federal court. This step involves asking a federal judge to review your case.

• Timeframe: This can take months or even years, depending on the court’s schedule. However, it is rare for most applicants to need to take this step.

What to Expect During the Appeals Process

Throughout the appeals process, it’s important to stay organized and maintain communication with the SSA. Here are a few things to keep in mind:

• Stay on Top of Deadlines: Make sure you meet all the deadlines for filing appeals and submitting additional information. Missing a deadline could delay the process or cause your appeal to be dismissed.
• Provide Additional Evidence: If you have new medical records, updated evaluations, or letters from doctors that support your case, be sure to submit them during each stage of the appeal.
• Work with a Disability Lawyer: While it’s possible to represent yourself during the appeals process, many people find it beneficial to work with a disability lawyer, especially if you’re at the hearing or Appeals Council stage. A lawyer can help you navigate the complex legal system and ensure that you have the best chance of success.