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Social Security Disability Claim Denied


Application Level

Social Security Disability claimants, who have a severe disabling health condition that is expected to last for at least 12 continuous months or result in death, can contact the Social Security Administration and apply for either Supplemental Security Income or Social Security Disability Insurance by phone, in person or online at www.ssa.gov.

Most claimants do not realize that it can take 90 to 120 days for the Social Security Administration to make their initial disability decision and up to 70% of the initial Social Security Disability applications are denied.

So if your Social Security Disability claim is denied what is the next step? Does this mean you will never receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits? If your Social Security Disability claim has been denied you have 60 days from the date of the Social Security Disability denial letter to file a Social Security Disability appeal.

Steps in the Social Security Administration Appeals Process

Reconsideration

Claimants who have applied for Social Security Disability benefits and have their disability claim denied may appeal their denial decision by filing a reconsideration. Some states, however, have eliminated this step in the SSA appeals process and claimants will instead immediately file for a Social Security Administrative Hearing.

What happens in the reconsideration? Unfortunately, this stage is useless for many disability claimants. The reconsiderations allow another disability examiner within disability determinations services office to review the same information and make a disability determination. The second examiner was not involved in the initial denial decision but they use the same criteria to evaluate either the SSI or SSDI claim and more medical information has generally not be added to the file so the denial rate for reconsiderations can be as high as 85%.

Some states have taken the proactive step to eliminate the reconsideration level, but many have not. If you have filed a reconsideration chances are you will eventually have to argue your Social Security Disability Insurance or Supplemental Security Income claim before an Administrative Las Judge at the Social Security Administration Hearing, which is the second step in the Social Security Administration appeals process.

Social Security Administrative Hearing

If a Social Security Disability claim has been denied at the reconsideration level the claimant has 60 days from the date of the Social Security Disability denial letter to appeal their denial and request a Social Security Administrative hearing.

An Administrative Hearing is conducted by the Office of Disability Adjudication and Review (ODAR) for the region that services the area where the claimant lives. Social Security Disability hearing locations are determined by zip code. Unfortunately, in many parts of the country the Social Security Disability hearing case loads (which are pending) can number in the hundreds and may be divided among only 5 to 10 Administrative Law Judges.

What does this mean for the disability claimant? It means the volume of Social Security Disability claims waiting to be heard and reviewed by the Social Security Administrative Judge is overwhelming, and it is not unusual for disability claimants to wait 12-14 months for a Social Security Disability Administrative Hearing to be held.

The wait can be very difficult for Social Security Disability claimants who may have been out of work for months and who are facing severe financial hardship. The good news for claimants is the Social Security Disability hearing is their first chance to share their story and present their disability claim in person to someone who has the authority to award them benefits. For this reason, it is recommended that if a claimant has not hired a Social Security Disability lawyer prior to the SSD hearing that they do so.

Social Security Disability Administrative hearings are held close to the claimant's home. They are fairly short, and although the Social Security Disability claimant is under oath, the hearings tend to be informal.

Do you need a Social Security Disability Lawyer for your Disability Hearing?

Many claimants do not think they need a Social Security Disability attorney, but before making that decision, claimants should ask themselves the following questions:

  • Do you understand how to read medical records?
  • Have you ever argued a Social Security Disability case in court?
  • Do you know all of the judicial processes, disability rules and regulations?
  • Are you ready to face an Administrative Law Judge (who you have waited months to see) and present your arguments for disability benefits?
  • If you are denied at the hearing level are you ready to start the process all over again?

Can a disability claimant present their case before the judge without a Social Security Disability attorney and win Social Security benefits? Maybe, but they could also spend months and maybe years fighting for Social Security Disability benefits when they are struggling to survive.

So what happens at the Social Security Disability hearing? The Social Security Disability hearing is not a contentious legal battle where prosecuting attorneys battle it out with a defense lawyer, but the Administrative Judge, a Social Security Disability lawyer (if the claimant chooses to hire one), a vocational expert and potentially a medical expert will all be present.

The Administrative Law Judge generally asks the Social Security Disability lawyer to answer a few questions, and the claimant also has a chance to answer questions. The vocational expert may also testify about a number of jobs they believe the claimant could perform, given their current mental or physical health condition, and the Social Security Disability lawyer has an opportunity to refute the job expert's testimony.

The Administrative Law Judge may make a ruling at the SSD hearing but the decision is not finalized until the disability claimant receives written notice, ideally within 6 weeks, but time estimates vary widely by court.

What should I do to improve my chances at my Social Security Disability Hearing?

The first thing to do is hire a Social Security Disability Law. Disability attorneys argue hundreds of SSI and SSDI cases each year. Disability lawyers understand Social Security Disability laws and how the laws will affect the claimant's Social Security Disability claim.

If the claimant has hired a Social Security Disability attorney, the attorney can review the claimant's SSA file, which includes the claimant's medical records, and make sure all of the appropriate medical documentation has been submitted to the court prior to the Social Security Disability hearing date.

Disability lawyers can also request additional supportive statements from the claimant's physicians. These are often referred to as Residual Functional Capacity forms (RFC forms).

RFC forms are beneficial for the claimant's case because they clearly identify what limitations the claimant may have to perform work. The RFC form is very helpful to dispute claims from the vocational expert that a claimant can perform certain job functions.

Residual functional capacity forms, combined with objective medical documentation can offer strong evidence that a claimant is disabled and unable to perform substantial gainful activity.

Although many Social Security Disability claimants are approved at the Administrative Hearing level, some are not. What do you do if your Social Security Disability claim is denied at the hearing? You can either begin the process again or you can request a review from the Social Security Appeals Council within 60 days from the date of the Social Security Disability denial letter.

Third Step in the Social Security Disability Appeals Process -- Appeals Council

The Appeals Council does not have the obligation to review all the appeal requests that are made to them. The Appeals Council can decide to review the disability case, remand it back to the judge for further review, or refuse to review the case. All issues which were considered by the Administrative Law Judge, including favorable decisions, can be review by the Appeals Council.

Claimants who disagree with the Appeals Council decision or who did not have their case reviewed by the Appeals Council will have to file a civil court in a federal district court. The Appeals Council is the last step of review within the Social Security Administration's appeal process.

Filing a Civil Suit in a Federal District Court

Claimants who are denied at the Appeals Council level have 60 days to file their civil action in the United States District Court. There is a fee for filing a civil action in Federal court, but the Social Security Administration does help prepare the record of the claim, including all of the evidence the Social Security Administration relied on to make their disability decision.

The claimant must file the civil action in the district court of the United States for the judicial district in which they live or have their principal place of business.

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