SSD Denial and Appeal FAQ
Applying for Social Security Disability isn’t an easy process. It can be tedious, time-consuming and endlessly frustrating. It’s even more disheartening when you find out that your application was denied.
You might be asking yourself what went wrong during the application process. Keep in mind that denials are common for SSDI applicants. Only about one-quarter to one-third of applicants are approved after an initial application. The appeals process offers you more chances for approval, but it is vital that any errors be fixed and a better case be made to the Social Security Administration.
John R. Colvin has assisted clients across Tennessee and Alabama to successfully make the case for SSDI benefits. If you’ve been denied by SSA and want help during the appeals process, contact John R. Colvin today to schedule an appointment.
Should You Appeal the Social Security Administration’s Decision?
While every case is different, the short answer to this question is yes. If your application was denied, you should definitely consider an appeal. Most claims are denied the first time around, and SSA allows applicants several opportunities for appeals. However, it is important to address the shortcomings of your initial application to have a chance at a successful appeal.
You don’t want to repeat the same mistakes that caused SSA to deny your initial application. As an applicant goes through the second, third and fourth possible stages of an appeal, the chances of an approval become more difficult, especially if you can’t provide additional evidence to those reviewing your case.
An attorney can help you review your initial claim to find out why it was denied and what should be done to maximize your chances of getting an approval during an appeal. As you’ll see below, the key to a successful appeal is identifying and fixing errors and offering SSA plenty of evidence to back up your claim.
Why Claims are Denied
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.
A claim can be denied for several reasons. SSA could determine that…
- Your condition does not meet the disability criteria set forth by SSA.
- The medical evidence for the existence of your condition is considered weak.
- You have not been disabled long enough.
- You haven’t cooperated fully with SSA.
- You earn too much income.
- Your forms are either incomplete or contain errors.
Many people are surprised at how many applications are denied because of errors. However, the amount of detailed information requested by SSA leaves a large margin of error for many applicants. It’s incredibly important to be as thorough as possible in your SSDI application, and the same is true during an appeal.
A lack of ample evidence supporting the existence of a disability is another common reason for denials. SSA is notoriously stringent about the evidence provided, which is why having an experienced attorney handle your claim is in the best interest of an applicant.
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.
Tips to Improve Your Chances for Ultimate Disability Approval
In Social Security disability cases, time is of the essence. You only have a limited amount of time to file the first appeal; this is called a ‘reconsideration.’ If you do not meet this deadline, you may not be able to file an appeal later. In the best case, missing the deadline leads to longer delays, as a new application may be required. In the worst case, you may never be able to receive SSD at all.
Continue Your Treatments
When you are in pain and frustrated, it is easy to stop going to your doctor’s appointments. Do not do this. Your best case for winning your disability case is with convincing medical evidence. The SSA always puts more weight on the opinion of your physician than it does on your personal testimony. Thus, it is critical that you continue to work with your doctor to treat your medical problems. Without current medical evidence of your health problems, your case has no chance for approval.
Seek Legal Help
If you have been denied disability, you understand how complex the SSD process can be. You must sign a lot of forms, make a lot of appointments, collect medical records, provide exhaustive information about your employment, and much more. With all the stress that you face from your health problems, it can be too much. If you hire a law firm to help you, much of the administrative stress is removed. Working with an experienced Social Security disability attorney will significantly increase your odds of getting approved.
Keep in mind that most SSD attorneys operate on a contingency basis. This means they are paid only if they win your case. Also, your attorney may charge only fees that have been approved by SSA. Current law states an attorney can charge you up to 25% of your back-pay benefits.
How John R. Colvin Can Help
First, we will review your application and feedback from SSA to determine the underlying cause of the denial. We will make sure that any oversights or errors are addressed and adjusted for the appeal.
Next, we will evaluate the evidence and records you have supplied SSA to ensure that your case is being made as strongly as possible. One of the benefits of working with an SSDI attorney like John R. Colvin is the years of experience he can draw on when making a case for a client. He knows what works and what doesn’t, which eliminates any potential guesswork on your part.
Another benefit of working with us on your appeal is the amount of work we do on your behalf. Whenever possible, we gather the needed documents and organize them to present to SSA in a manner that is most effective. The amount of preparation required to launch a successful SSDI appeal is intensive, and having an attorney handle the process makes life much easier for clients.
The Stages of the Appeals Process
After a denial of the initial SSDI application, time becomes an even greater issue for the applicant. A request for an appeal must be made in writing and received within 60 days of the date on which you receive the letter containing SSA’s decision. There is a brief grace period to allow for mailing times, but it is in your best interest to act quickly.
There are four opportunities for appeal, each of which may result in either approval or another denial.
- Reconsideration – Your case, including your claim and any new evidence provided, will be reviewed by someone at SSA who was not involved in the initial denial. Your presence will not be required during reconsideration.
- Hearing by an administrative law judge – If a reconsideration doesn’t result in a favorable outcome, an applicant can request a hearing. Before the hearing, additional evidence can be submitted to strengthen your case. During a hearing, your case will be made before an administrative law judge, who might also ask several questions. Witnesses can also be questioned to aid your case. After the hearing, a judge will make a decision, which you will receive via letter.
- Review by the Appeals Council – If an applicant disagrees with the administrative law judge’s decision, a request can be made for a review by the Appeals Council. The Appeals Council can deny a request, though they will send you a letter explaining the reasoning behind their decision.
- Federal Court review – Whether the Appeals Council reviews and then denies your claim or simply denies reviewing your claim entirely, you can appeal to a federal district court as an opportunity for judicial review.
Why Hire an Attorney for an SSDI Appeal?
A skilled, experienced SSDI appeals attorney will be familiar with the process of appealing a claim. They’ll know what SSA is looking for and what is most effective when making a case. Your attorney will maximize your chances of approval by gathering evidence and presenting it to SSA or administrative law judges. If needed, an attorney will also be able to contact expert witnesses to help make your case.
Most applicants aren’t familiar with evidentiary procedures, which is an essential aspect of the appeals process. An attorney will review the initial application and denial to determine what was effective and what wasn’t, then determine the best course of action.
Attorney Fees in SSDI Appeal Cases
John R. Colvin works strictly on a contingency fee basis, which means that you owe him nothing unless your case is successful. If you receive SSDI benefits, we will deduct our fee from those benefits. We also offer you free consultations to help you determine whether you’d like us to handle your case.
Should I Appeal an SSD Denial?
Don’t give up if your disability claim has been denied. Even the SSA admits that the majority of SSD applications meet with a denial the first time around, so your next step should be to request reconsideration. You can do this by filling out and submitting a Request for Reconsideration within 60 days of the date on your notice of denial.
During reconsideration, a new disability determination specialist will review your information and decide if you do, in fact, qualify for benefits. Many denied claims are approved at the reconsideration stage because the claimant has corrected any deficiencies in their original paperwork submitted to SSA.
Should that not be the case with you, you can request a hearing before an administrative law judge (ALJ) and present information that supports your claim. The ALJ will make a determination based on that evidence. Approximately 50% of cases heard by an ALJ are approved, but if you are denied for some reason, you can ask the Appeals Council to reconsider the decision. If you are denied yet again, you have a final chance before a federal court.
As you can see, there are several stages of appeal, each one representing the hope that you’ll finally be approved for the benefits you need. Having a knowledgeable Social Security Disability attorney by your side can greatly improve your odds of success. Attorney John R. Colvin works with you to make sure that your claim is as compelling as possible.
Why Was My SSD Claim Denied?
Although each SSD claim is unique, there are a few reasons why some SSD benefits claims are rejected. Here are some common reasons why claims are often denied:
- Lack of Medical Evidence: You must provide strong medical documentation of your disability and how it prevents you from working. Many disability applications are denied due to insufficient medical documentation.
- Failure to Follow Treatment Advice: If you don’t follow your doctor’s recommendations, your disability claim will almost certainly be denied. SSA examiners contend that it is not possible to determine your disability status if you aren’t undergoing recommended treatment or there are gaps in your care history.
- Failure to Cooperate: If you refuse to provide the SSA with additional information or otherwise refuse to cooperate during the application process, your claim will likely be denied.
An SSD denial and appeal attorney can help you prepare a thorough application package and advise you of any missteps that could potentially impact your claim.
How Long Does It Take to Appeal an SSD Denial?
How long it will take to appeal your SSD denial generally depends on where you are located, your local SSA office’s workload, and what stage you’re at in the process (for example, reconsideration vs. ALJ hearing).
With reconsideration, which is when you’re asking the SSA to review your initial denial, you can expect to wait anywhere from three to six months. If you’re denied and you request a hearing from an administrative law judge, the average wait time is 12 to 18 months. The next stage, which is an Appeals Council review, can take up to a year to happen. In the event that the Appeals Council decides against you, you may file a civil action in federal district court, which can take months.
As you can imagine, these delays can be stressful when you need your disability benefits now. Getting an SSD denial lawyer involved as early as possible increases your chances of getting the money you need sooner rather than later.
Do I Need an Attorney for a Social Security Disability Appeal?
Legally, no. However, those who work with an SSD appeal lawyer tend to meet with success more often than self-represented claimants.
It is best to hire an attorney before filing your SSD claim. Getting them to help you prepare your application can increase your chances of approval and reduce the amount of time it might take for the disability determination specialist to make a decision. At the appeals stage, a Social Security Disability appeal lawyer could help you by:
- Ensuring that you meet all appeal deadlines
- Preparing you for questions the administrative law judge (ALJ) may ask you
- Providing additional medical evidence to support key issues in your case
- Handling all paperwork and other communications with the SSA
Reconsiderations and appeals are often complicated and perplexing processes that require the completion of several forms and understanding the applicable rules and regulations. Your attorney can handle these critical areas for you, giving you peace of mind.
How Do I Pay for an SSD Appeal Attorney?
SSD lawyers work on a contingency fee basis, meaning their fee is a percentage of the final settlement. In other words, your attorney only gets paid if you do.
The legal fees for SSD claims are strictly regulated, unlike those associated with other forms of litigation, such as personal injury. The Social Security Administration (SSA) limits fees on cases awarded prior to going to federal court to 25% or no more than $6,000 of the applicant’s back pay once they are awarded benefits.
Once you have been approved for SSD benefits, you will not receive a bill for your legal fees. Instead, your lawyer will submit the fee agreement directly to the Social Security Administration. Once the attorney fee has been approved, the fee will be deducted from your back pay. Unless you receive past-due benefits, your lawyer won’t be compensated, which is why a lawyer will not take your case unless they are reasonably confident you are entitled to benefits.
Contact John R. Colvin for Help with Your SSDI Appeal
If you’ve been denied SSDI and are considering appealing the decision, it’s wise to talk to someone who knows the appeals process to maximize your chances of a successful claim. John R. Colvin helps clients in Tennessee and Alabama to make sure their case is made effectively and without error.
While the SSDI application and appeals process has a reputation for being difficult, enlisting the services of an experienced attorney can make that process less stressful and more likely to result in an approval. Time is of the essence when appealing an SSDI claim, so we encourage you to reach out to us as soon as possible.
When you need Social Security Disability (SSD) benefits to support yourself after suffering a life altering illness or a disabling injury, there’s nothing more disheartening than getting denied. If you are in this situation, you probably want to know how you can appeal the Social Security Administration’s (SSA’s) decision.
Attorney John R. Colvin receives a lot of questions from concerned SSD claimants who have seen their legitimate claims denied, so this resource page was created to give you some answers. If you don’t see your question here or you want to pursue an appeal, please call (877) 580-7968 or contact us online.
For more than 20 years, John R. Colvin has helped clients navigate the SSDI application process. Put your claim in the hands of an attorney who knows how to get results. Contact John R. Colvin today.