Social Security Disability Determination Process

Applying for Social Security Disability Insurance benefits isn’t a simple process. Aside from gathering a sometimes unfathomable amount of supporting documentation, a claimant may also be subject to denials – either initially or in future reviews – that necessitate the filing of additional paperwork.

In some cases, claimants must participate in a lengthy appeals process, if they hope to obtain SSDI benefits. But with the help of an experienced Tennessee Social Security Disability attorney, the entire process can be much less stressful.

If you need help with your SSDI claim, we’re prepared to offer you a no-obligation consultation, meaning you pay nothing up-front for legal services, and our fee comes from any future SSDI payments you may receive.

Application

Before you begin the application process, you might want to mentally prepare yourself for the fact that your claim is likely to be denied – at least initially. From 2001 to 2010, the Social Security Administration denied 72 percent of initial applications.

Gathering the appropriate forms before you begin your SSDI application may make an initial approval more likely. You may be asked to provide a number of documents, such as pay stubs, medical records, tax forms, military discharge papers, your birth certificate, a former spouse’s death certificate, and proof of other types of benefits (such as Workers’ Compensation or Federal Employees’ Retirement System funds).

Collecting the required documentation can be an overwhelming task, especially if you have moved frequently and can’t recall the details of your work history. But an attorney experienced with the SSDI application process knows how to access the records you’ll need for your claim.

Denial

Applications may be denied for technical or medical reasons. In 2013, the SSA issued nearly 906,000 technical denials for reasons such as failure to provide all the required paperwork, insufficient work history to qualify for benefits, or excessive income.

A technical denial may also occur if a gap exists between the SSA’s determination of Date Last Insured (DLI) and Established Onset Date (EOD). For example, a person who stopped working years before developing a disability may be considered no longer insured under SSDI, with a condition that developed after SSDI coverage lapsed.

A technical denial may be appealed, but only if it’s based on the SSA’s misinterpretation of information, or due to a mistake on the application. A person who lacks the work history to qualify for benefits, or who cannot qualify under a spouse’s work history, would have no grounds for appeal, because qualification for benefits is based on a formula that cannot be modified.

Medical denials commonly occur because the SSA determines a claimant hasn’t proven that his or her medical condition is a disability. To be considered a disability, the condition must prevent a person from substantial gainful activity for at least 12 months and be likely to result in permanent disability or death. The SSA may decide that while an injury or health condition prevents someone from doing his or her previous job, it does not interfere with that person’s ability to pursue other types of employment.

Even when a disability falls within the list of the SSA’s recognized disabilities, claimants must still be able to show that it severely limits their ability to work.

Appeal

The SSA allows an online method of appealing medical denials. Because of the importance of that first appeal, you may wish to consult an attorney to ensure you follow every step of the appeal process correctly.

In your first appeal, you may need to provide additional evidence, such as details about the severity of your disability or injury, along with possible testimony from occupational experts about your ability to work.

The initial appeal is called reconsideration. If the reconsideration also finds you are ineligible for benefits, the next step is a hearing before an administrative law judge. The judge may call witnesses, in order to gather more information about your health and your ability to work. If the results of the hearing confirm the previous two ineligibility rulings, the next step is a formal appeal, and the final recourse is federal action.

At each progressive stage of appeal, claimants are less likely to be approved for benefits. That’s why considerable effort should go into preparing for the reconsideration and – if necessary – the hearing.

An Advocate for You

The SSDI process may seem, at times, adversarial and claimants may feel that the odds are stacked against them. Having an attorney on your side may help you get through the process successfully, and help you get the benefits you’re entitled to receive.

Whether you’re applying for SSDI for the first time or need help with an appeal, contact us today – simply fill out our online form, or call us at (931) 962-1044 for your free consultation.