Becoming disabled and unable to work is hard enough without having to go through the process of applying for Social Security Disability Insurance (SSDI) benefits. From application to approval, the ordeal to obtain disability benefits is complicated and lengthy. We cannot stress the importance of hiring an attorney to represent your interests enough. The process takes a long time to complete, and you can make it easier on yourself if you work with an experienced professional. A disability attorney can assist with communication and adherence to strict timelines as well as helping you present your best case.
The bad news is that most people are denied at the disability claim application stage; almost 65% of claims are denied initially. Once you submit your application for disability benefits, someone from Disability Determination Services (DDS) reviews your application and any evidence that you submitted to support your claim. Unfortunately, DDS denies many applications out of hand because the volume of applications is overwhelming, and they often do so because the applications are not filled out properly or are incomplete or because DDS does not believe the medical evidence you submitted fully supports your disability claim.
The good news is that receiving an initial denial from the Social Security Administration (SSA) does not mean that you will never receive disability benefits or that you are not qualified to receive them. It just means that you will need to enter the appeals phase of your claim. It is at this stage that must applicants are successful in obtaining benefits.
As soon as you receive your denial letter, review it with your attorney. The letter you receive from SSA will provide a description of your medical condition, the impairments that DDS considered, the medical and non-medical evidence that DDS considered, and an explanation for why you were denied. Then, contact SSA and request an appeal. You have 60 days to submit your request for appeal from the date on the denial letter. And the sooner you request your appeal, the sooner the next phase of your claim can begin.
Of course, just because you appeal SSA’s decision does not mean you are guaranteed benefits. But the best thing you can do is understand why you were denied initially and address those specific areas in your appeal.
There are a few common reasons most people are denied at the application stage. There might not be enough hard medical evidence to support the claim that you are so disabled you cannot work; if that is the case, work closely with medical professionals to make sure they understand how your disability affects your life so that the medical records they provide reflect your assertions. You will also likely be denied if you filed prior claims that were denied rather than appeal one and see it through to its conclusion.
Another common reason for disability claim denials at application is that you have demonstrated failure to follow a course of medical treatment or have failed to cooperate with SSA. If the DDS examiner cannot determine if you are unable to work because of your disability or because of your refusal to comply with treatment for it, you will be denied. Similarly, if you did not return important SSA phone calls or show up for scheduled medical examinations, you will be denied. In the event that you have a good reason for not following a course of treatment (i.e., treatment would require costly invasive surgery), your appeal is the appropriate place to explain your logic.
People are also frequently denied because they did not prove that their disability is severe enough to prevent them from working or that it would last for a continuous, 12-month period or result in death. Similarly, you will be denied if your disability is the result of drug addiction or alcoholism; DDS will question whether you would still be disabled without the drug use. Lastly, if SSA determines that you have obtained disability benefits fraudulently, SSA will terminate your benefits and prosecute you for fraud.
When you ask SSA to appeal your claim, there are actually four levels to the appeals process, some of which you will go through and some of which you will not. The first level is a request for reconsideration. Here, a different investigator from DDS will review your initial claim along with any new evidence submitted since your application, but the determination rarely changes. The next level is a hearing with an Administrative Law Judge (ALJ) who will look over everything provided up until a few days before the hearing and make an independent decision. Approximately two-thirds of applicants for benefits are approved at this stage.
If you are denied at the hearing stage, you may request that the Appeals Council review your claim, but they will not review any new evidence, and they usually uphold the ALJ’s decision if they believe the evidence supports it. Federal Court review is available in instances where you disagree with the Appeals Council’s decision, or the Appeals Council refused to hear your case, but your chance of success at this stage is extremely rare.
As you can see, there are many intricacies to the appeals process. Your greatest chance of winning your disability claim is to do your best at the appeals level, and your odds of success increase substantially with the help of an experienced Social Security Disability Insurance attorney. If you think an attorney will cost too much money, remember that disability attorneys work on contingency. That means that they only get paid if you win your claim, and their fee (limited by SSA) will come out of your back benefits, so you do not need to come up with any money up front to utilize their services.