Your claim is denied – now what?

If you have a physical or mental disorder, or both, that has prevented, or will prevent, you from sustaining fulltime work for a year or more, then you should be able to receive disability benefits under the Social Security Administration (SSA). Unfortunately, the SSA makes obtaining such benefits an uphill battle.

If you have been denied on your Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefit claim, then you should request an appeal as soon as possible — within the 60-day deadline. Amazingly, most disability claims that are denied are not appealed. Most claimants either give up or file their appeal too late. Still others start a brand new claim. This is a mistake. It is during the appeals process, as opposed to filing a new application, that you have the best chance of winning your claim and being awarded disability benefits.

There are four levels of appeal after your initial application has been denied:

  • Reconsideration
  • Hearing by Administrative Law Judge
  • Review by the Appeals Council and
  • Federal Court review

Statistically, initial claims have a denial rate of approximately 65%. Reconsideration appeals are denied at an even higher rate of 85%. Taking your case to a hearing in front of an administrative law judge (ALJ) is where you will have the best chance of success.

Denials based on medical evidence

When you apply for SSA disability benefits, you are claiming that there is no work in the national economy that you can do because of your impairment(s). Your medical records will comprise the majority of the evidence that will be used to prove this to the SSA. However, the SSA will attempt to show that, despite your impairment(s), there are still jobs that you are capable of performing. It does not matter to the SSA that the jobs it cites do not exist in your state or town.

A denial of disability benefits usually means that the SSA did not find your medical condition severe enough to preclude ALL work. However, you may have received a “technical denial.” This means that the denial was based on financial reasons rather than medical reasons.

Technical denials

If you are working currently and have earnings above the “substantial gainful activity” (SGA) limit, this will result in a technical denial being issued. The SGA limit in 2014 was $1,070 per month. This applies to both SSDI and SSI claims.

To be eligible for SSDI benefits, you need to have paid a certain amount into the Social Security system via payroll deduction. How many years you need to have worked depends on your age. For instance, if you are 50 years old, you need to have worked seven years at a job that pays into the Social Security system. SSI, on the other hand, is a needs-based disability benefit program. There are no past earnings requirements. However, to be eligible for SSI benefits, you cannot exceed current income and asset limits. Most technical denials in SSI cases are due to applicants exceeding the income and/or asset limits.

Technical denials, generally, cannot be appealed. If you don’t have the work credits to be eligible for SSDI, filing an appeal will not change this. In some cases, such as if the SSA made an error in evaluating income or assets, or if the denial was due to a paperwork error or a missing document, an appeal can be filed.

When you receive your letter informing you about the decision on your claim, it will include instructions on how to appeal the decision. But before you appeal, regardless of the level, it is important to figure out why your claim was denied. Was it a technical denial? Or, did you fail to prove that the severity of your medical condition prevents you from doing ANY work? Disability representatives are trained to assist you in sorting out the reasons for your denial. It may be in your best interest to retain the services of a lawyer or disability representative before you begin the appeals process.