Social Security disability benefits were designed to assist disabled Americans and their families by providing such things as financial assistance, vocational rehabilitation, and more. However, many people find themselves being denied during the initial review process. If this happens to you, does it mean that you are unable to receive benefits? Not necessarily, and an experienced Social Security disability lawyer may be able to help.
What Are Social Security Benefits?
As noted by the Social Security Administration, Social Security pays disability benefits to people who can’t work because they have a medical condition that is expected to last at least a year or result in death. To obtain these benefits, known as Social Security Disability Insurance (SSDI) you must:
- Be at least 18 years old
- Not currently receiving benefits on your own Social Security record
- Have not been denied Social Security benefits in the last 60 days
In addition to disability benefits, individuals may also apply to receive Supplemental Security Income (SSI), which pays benefits to adults and children without sufficient income or resources. To qualify for SSI, you must:
- Be between 18 and 65 years old
- Have never been married
- Not be blind
- Be a U.S. citizen residing in the 50 states, the District of Columbia, or the Northern Mariana Islands
- Are applying for disability benefits at the same time you apply for SSI.
You should apply for your disability benefits as soon as you become disabled, bearing in mind that there is a three to five month time frame in which your application will be processed. Included in the review of your claim will be medical evidence regarding your disability as well as checking to ensure that you have worked enough years to qualify for benefits on your own Social Security record or can secure benefits on the Social Security record of someone else, such as a spouse or parent. Social Security applications are often made online, though benefits can also be applied for by mail or telephone. When the Social Security Administration receives your completed application, the process is as follows:
- You will receive either electronic or mailed confirmation that your application has been received.
- The application will be reviewed.
- You will be contacted if you need to provide additional information.
- You will be informed if other family members qualify for benefits or you are able to receive benefits on someone else’s social security record, such as a parent or a spouse.
- Your application will be processed.
- You will be informed by mail as to whether your benefits have been approved or denied.
Reasons for a Denial of Benefits
The rate of denial of benefits during the initial review process is quite high—some estimates put it at about 70 percent. Some of the reasons that applications for Social Security disability benefits and/or Supplemental Security Income are denied include:
- Improperly completed claim forms. Completely fill out every form you are asked to submit. Many people find that obtaining guidance from an experienced social security disability lawyer during the application phase increases their chance of filling all of the paperwork out properly.
- Lack of sufficient medical evidence to prove your disability claim. To avoid this type of denial, you should be sure to provide as much documented objective medical evidence about your condition as possible.
- Failure to attend a consultative medical exam. If the Social Security Administration asks you to participate in a consultative medical exam conducted by a third-party medical expert as part of the review process, be sure to comply.
- The SSA determines you can perform other types of work, in spite of your disability.
- For SSI benefits, if you are determined to be financially ineligible, you may not appeal the decision.
What Should Your Next Steps Be?
Once you have been notified that your application for benefits has been denied, you have 60 days to request an appeal. If you fail to do so during the time allotted, you may lose your right to appeal. The SSA has four ways for appealing a review denial, as follows:
- Reconsideration: A reconsideration is a complete review of your claim by someone from the SSA or your state’s Disability Determination Services office. The individual who will be reviewing your claim is someone who was not involved in the initial decision who looks at all of the evidence that was used in making the initial decision, as well as any new evidence that you have presented to them.
- Hearing: You may also request a hearing in which you can appeal the denial before an administrative law judge who had no part in the initial decision or the reconsideration of your case. This hearing is generally conducted within 75 miles of your home. Before the hearing, you may look at your file and add any information that may be useful to your claim. You may have an attorney present, and you may have medical experts testify.
- Appeals council review: If you are unsatisfied with the administrative law judge’s decision after the hearing, you may request a review by the Social Security Appeals Council. The Appeals Council may deny your request if, upon looking at all the evidence presented with your claim, they feel that the hearing decision was fair. If the council does take your case, they may render a decision or turn the case back to the administrative law judge for further consideration.
- Federal court: If the Appeals Council opts not to review your case or you disagree with their decision, you also have the option to file a lawsuit in federal district court, who will then decide, based on the documents presented, whether it will hear your case.
Your best chance of avoiding a denial of your claim or receiving a successful outcome from one of the SSA’s four appeals processes is to have the assistance of a qualified social security disability attorney. Your attorney can not only help you complete and file your initial application but can also provide representation and guidance through the appeals process.
