How to Appeal a Denied Disability Claim

So, you had your social security disability claim denied and are wondering what to do next. Luckily, there is a way for you to appeal for social security disability benefits.  The process requires many steps and can be quite complicated, however, it can be done, and you can be successful in winning your social security disability benefits.

This all may sound daunting, taking on the Social Security Administration (SSA) but here, we will review why your social security disability insurance (SSDI) was denied and go through the appeals process so you can understand why your benefits were denied and what to do next. Of course, you do not have to go this process alone, hiring a disability lawyer to guide you through the process and handle all of the legal aspects can greatly increase your chances of winning your benefits and make the process much less stressful for you.

Why Was Your Claim Denied? 

When a person is considering whether to appeal SSDI denials or not, they need to understand why their claim was denied. There are many reasons that a claim can be denied. A claim can be denied if it does not meet the eligibility criteria. To be eligible, you must have a disability that has lasted, or is expected to last, longer than a year or result in death and prevent you from working in Substantial Gainful Activity (SGA).

One of the main reasons a claim may be denied is lack of medical evidence. If you do not provide enough medical evidence to support your claim that your disability is preventing you from working in SGA or if your condition does not meet the SSA definition of a disability, your claim may be denied. Your claim may also be denied because you are currently working and earning above a certain threshold because the SSA may consider you not disabled enough to qualify for benefits.

A claim can also be denied because of an incomplete or inaccurate application that makes it hard for the SSA to determine the extent of your disability during the application process. The SSA may also deny a claim if you have an inadequate work history or if they believe that you can perform another type of work that you were not previously engaged in. 

Advice for Appealing a Denial of Disability Benefits

Social security disability appeals are a multitiered process that must be carefully navigated through. The first step to appealing a denied claim is filing a request for reconsideration. This must be done within 60 days of denial and results in about 10 to 15% of denials being overturned. If your claim is still denied, you will need to appeal through the judicial process. This process can be complicated, and you may want to enlist assistance from a qualified attorney.

The first appeal is heard by what is known as an administrative law judge. This judge will review your Social Security Disability Claim and listen to the arguments of the SSA and yourself to determine if your claim was properly denied. Having a disability lawyer can be a big help in this process because they know what information the judge needs to hear and all of the procedural and evidentiary requirements of the Court. Of course, if your claim is once again denied, there are other avenues of appeal and a disability attorney can help.

Review the Denial Letter

Before you appeal your denial, you will want to carefully review the denial letter from social security. This letter will offer an explanation as to why the SSA denied your claim and may cite factors such as lack of medical evidence, work history or income as the reason for your claim being denied.

If your claim was denied for lack of medical evidence, the denial letter may contain information on which tests, medical records, or examinations were reviewed and deemed insufficient to establish a claim. This will allow you to understand why your claim was denied and let you know what information you will need to appeal. 

The denial letter will also contain information on how to appeal and the deadlines you must meet to appeal. Be sure to pay close attention to these deadlines because if you miss them, you may lose your right to appeal. Be sure to take the letter to your attorney if you choose to retain one. 

Gathering Essential Documents

Now that you know the reasons you were denied for disability benefits, you will need to gather the essential documents needed for your appeal. What documents you need for your appeal will depend on the reasons for your denial. If you were denied for lack of medical evidence, you will need to gather medical records and information that more sufficiently explains your condition and meets the requirements of the SSA.

If you were denied for work related reasons, you may need to gather information such as pay stubs, W2s, and other financial information. If you were denied for any other reason, pay careful attention to the SSA’s reasoning so you know what documents will be needed for your appeal. Acquiring a disability lawyer in this process can be very helpful because they understand why claims are denied and will be able to tell you what documents you will need for your appeal.

Preparing for the Appeal

Now that you’ve carefully read your denial letter and gathered the essential documents needed, you will need to prepare for the appeal. Going before an administrative law judge can be a daunting process so you will want to make sure that you have all your documents in order and have all your arguments as to why your denial was improper in order. You will want to make compelling arguments to the judge to increase your chances of winning your social security disability benefits.

The social security administration office of hearings and appeals is the overarching body over all SSA appeals and a disability lawyer will understand the appellate process from start to finish including what to do if your appeal is denied at the administrative law judge level.  They will also know how to make a compelling case for you in front of the judge and reduce the stress of you preparing for your appeal.

Consult with Your Attorney

Before your appeal, you will certainly want to consult with a Hawaii disability attorney about your Social Security Disability Claim. Be sure to bring your denial letter and any essential documents you think may be important to you claim to your initial consultation. Your attorney will review your denial letter, discuss the reasons for denial, and help you gather the essential documents for your appeal.

They will also work with you to make a plan for the appeal, creating a carefully crafted strategy that gives you the best chance of prevailing. They will get your appeal filed and argue on your behalf in front of the administrative law judge. Having a skilled disability lawyer gives you the best chance of getting your social security disability benefits. And if your appeal is denied at the administrative law judge level, your attorney will know what to do and explain the other avenues of appeal. 

Frequently Asked Questions

Can I appeal a denied disability claim on my own?

Social security disability appeals can be done on your own, however, it will require diligent preparation and arguments to prevail on your claim. You will need to understand clearly why your claim was denied and have the information and documents to refute the denial. Having a disability lawyer who knows how to handle these appeals can greatly increase your chances of success. They know why claims are commonly denied and will help you gather the documents that will be used to prove your claim.

How long does the appeals process usually take?

Once you get a denial letter from social security, you typically have 60 days to file a request for reconsideration. Once filed, it can take a few months for the reconsideration decision to be made. After this, if you file an appeal from an administrative law judge, it can take a few months to a year to get a hearing but can vary significantly depending on the backlog and caseload in your region. And the process can take even longer if you are forced to appeal a decision from an administrative law judge.

What happens if I win my disability appeal?

If you win your disability appeal, you have proven that you meet the SSA eligibility requirements to be entitled to disability benefits. This is great, the SSA will calculate the amount you are entitled to based on your work history and other factors. You will also receive back pay for the time had your claim been initially approved.  You will also become eligible for Medicare to help cover your medical expenses after a waiting period. You will be notified of all of this by the SSA explaining all your benefits. 

Can I continue to receive disability benefits while my appeal is pending?

If you are appealing the cessation of your benefits, you can continue to receive your disability benefits while your appeal is pending. Typically, once you receive notice that the SSA has decided to cease your benefits, you will have ten days to request the continuation of your benefits. This must be done in writing and will allow you to continue receiving your benefits throughout the appeals process. Be sure to be cognizant of the deadlines and let your attorney know as soon as possible once you receive a cessation of benefits notice.