Understand Why You Were Denied

The first step when you are denied disability benefits is to understand why your claim was rejected. The Social Security Administration (SSA) provides a detailed explanation of the reasons for denial in your decision letter.

Some common reasons for denial include:

• Failure to meet the SSA’s definition of disability: To qualify for disability benefits, your medical condition must be severe enough to prevent you from working for at least 12 months or be expected to result in death. The SSA may have determined that your condition did not meet this standard.
• Insufficient medical evidence: If the SSA believes your medical records do not sufficiently support your disability claim, they may deny your application.
• Earnings above substantial gainful activity (SGA): If you are working and earning more than a certain monthly threshold, the SSA may determine you are not disabled.
• Failure to follow treatment: The SSA may deny your claim if they find that you have not been following prescribed treatments or making reasonable efforts to improve your condition.

Review Your Denial Letter and Gather Additional Evidence

When you receive a denial letter, take time to review the reasons for the rejection carefully. Sometimes, the SSA denies claims simply because of missing documentation or lack of clarity in your medical records. Gathering additional evidence can strengthen your case and increase your chances of approval upon appeal.

Here are some actions to consider:

• Request medical records: If the SSA claims your medical evidence is insufficient, obtain updated or additional medical records from your doctors. Be sure to include any new tests, treatments, or diagnoses.
• Get a letter from your doctor: A letter from your treating physician that clearly outlines your disability and how it prevents you from working can be critical to your case. The more specific and detailed the letter, the better.
• Document your work history and income: If the SSA denies you for working too much or earning above the substantial gainful activity (SGA) threshold, you may need to provide documentation showing that your earnings were due to a temporary or part-time situation. Be prepared to provide detailed records of your income and job duties.

File an Appeal

If you are denied for disability, don’t be discouraged. The SSA allows you to appeal their decision. The appeal process has four stages:

Reconsideration

• What it is: The first stage of the appeal is a reconsideration, where your case is reviewed by someone who was not involved in the initial decision. This stage doesn’t require a hearing.
• How to do it: To request reconsideration, you must submit a formal request within 60 days of receiving your denial letter. You can file this request online or in person at your local SSA office.

Hearing Before an Administrative Law Judge (ALJ)

• What it is: If your reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ). The ALJ will listen to your case, review your medical records, and potentially hear testimony from experts.
• How to do it: The request for a hearing must be made within 60 days of receiving your reconsideration denial. You will be given a hearing date, and it is critical to be prepared with all relevant documents and evidence.

Appeals Council

• What it is: If you disagree with the ALJ’s decision, you can ask the Appeals Council to review your case. The Appeals Council can either approve your claim, deny it, or send it back to the ALJ for further review.
• How to do it: The request for an Appeals Council review must be made within 60 days of the ALJ’s decision.

Federal Court

• What it is: If the Appeals Council denies your claim or you disagree with their decision, you can take your case to federal court. This is typically the final step in the appeals process.
• How to do it: To appeal to federal court, you must file a lawsuit within 60 days of receiving the Appeals Council’s decision.

Seek Legal Help

While it is possible to navigate the appeals process on your own, the process can be complicated and time-consuming. Many applicants find it beneficial to consult with or hire a disability lawyer to guide them through the process.

A lawyer specializing in Social Security Disability can:

• Help you understand the reasons for your denial and how to address them.
• Gather and organize necessary evidence, including medical records and expert opinions.
• Represent you at the hearing before an Administrative Law Judge (ALJ).
• Provide advice on whether to appeal the decision and what steps to take next.

An attorney can significantly increase your chances of success, especially if you’re navigating the appeals process. Most disability lawyers work on a contingency fee basis, meaning they only get paid if you win your case.

Don’t Give Up

Many applicants are denied on their first attempt, but it’s important to keep trying. In fact, about 70-80% of initial disability claims are denied, but the majority of people who go through the appeals process ultimately win their cases. While the process can be lengthy, persistence and preparation are key.

Stay Organized and Meet Deadlines

Throughout the appeals process, staying organized and meeting all deadlines is crucial. Missing deadlines or failing to provide requested information can delay your case and hurt your chances of success. Keep a copy of all your documents and maintain a timeline of key dates, including:

• The date of your initial denial.
• The date you requested reconsideration, a hearing, or an appeal.
• Any important communications or hearings with the SSA.