How to Appeal a Disability Ruling

January 19th, 2016 by Attorney John Colvin

Writing With Cast on Hand

Many people have experienced the disappointment of finding out their claim for Social Security Disability Insurance has been denied. In fact, only about 28 percent of SSDI claims are approved on the first try.

When you receive notice of denial, you have a 60-day window for appealing that decision. So if you intend to appeal a disability ruling, it’s important to start the process as soon as possible.

Starting your Appeal

SSDI claims reviewers may issue a denial based on medical or non-medical reasons. If a denial is based on medical reasons, a claimant may appeal online – a process that can take up to an hour, if you have all your paperwork ready.

As a general rule, if reviewers deemed your initial medical documentation to be insufficient in supporting your claim of disability, simply resubmitting your appeal without additional medical evidence is unlikely to produce a different outcome. You will probably need to provide additional evidence – statements from doctors, specifics about treatments and medications, and perhaps the results of medical tests.

The appeals process consists of four progressive stages: request for reconsideration, request for a hearing before an Administrative Law Judge, request for appeals council review, and a federal civil action. It’s at the reconsideration and hearing stages that claimants are most likely to prove their claim is warranted. With each subsequent stage in the process, claimants are statistically less likely to convince the Administration to approve their case.

If claims reviewers denied your SSDI filing for non-medical reasons, you normally cannot utilize the online appeal process. Instead, you must visit your local Social Security office or call the administration’s toll-free number in order to effectuate your appeal manually by submitting your appeal in writing.

Understanding “Gainful” Activity

The Social Security Administration defines disability as an impairment that is likely to result in death or prevents a person from substantial gainful activity for at least 12 months. Sometimes, medical denials occur because a claimant hasn’t proven that he or she is unable to work in some capacity.

For example, if you were a journeyman machinist and your left hand was severely injured at work, you would likely be able to prove you can’t work as a machinist. However, the Social Security Administration may decide that you retain transferrable skills from your previous occupation that allow you to perform less physically demanding work based on your physical limitations. For example: If your right hand is functioning normally, a vocational expert might argue that you could at least find another, lesser-demanding job that pays much less than a machinist job. These disputes about a person’s ability to work, and in what capacity, are often the basis for appealing the medical denial of a claim.

Involvement of Other Parties

If you ask for a reconsideration of your claim, a person not involved in the original denial will review your claim. But often, that person reaches the same conclusion as the previous reviewers.

After a formal reconsideration, you have the right to request a hearing before an administrative law judge. A judge has the power to summon witnesses, including doctors , along with vocational experts who can provide opinions about whether you can be reasonably expected to sustain gainful activity in a competitive work environment. If you are represented by an attorney, your attorney has the right to cross-examine witnesses during the administrative hearing.

If an administrative law judge upholds the original denial, you can ask the Social Security Appeals Council to review your case. If the Appeals Council declines your request, or affirms the administrative law judge’s denial, you may file a civil action in the United States Federal District Court.

Getting legal help early in the appeals process can increase the likelihood that a claim for disability benefits will be properly considered and increase the likelihood of an early resolution of the claim. Having a lawyer doesn’t guarantee success, but it does help claimants launch thorough, error-free appeals.

Licensed to Practice in Tennessee & Alabama