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SSI Denial Letter and Appeal

By December 18, 20195 min read

If you applied for Supplemental Security Income (SSI) disability benefits and were denied, now is not the time to give up. Only about thirty percent of applicants are approved initially with just their application, and approximately half of the people who appeal the denial decision are ultimately approved for benefits.

The two most important parts of the denial letter are the date of the notice and the instructions for how to appeal Social Security Administration’s (SSA) decision. You only have sixty days from the date of the notice to appeal your claim, not the date that you receive the decision in the mail.

The SSA denial letter provides an explanation for how SSA arrived at its decision not to award you disability benefits. It could be for medical or non-medical reasons. If you are denied SSI benefits for a medical reason, it’s because SSA does not believe that you meet the definition of disability. If you are denied SSI benefits for a non-medical reason, it’s probably because SSA has determined that you make too much money to qualify for benefits.

If your denial is the result of a medical disqualification, the letter will list all of the medical treatment sources that SSA used to make its decision. It will list all the conditions for which you were evaluated and provide a statement regarding your limitations and how they affect your ability to work. Lastly, the letter will state that “doctors and other trained staff” looked at the case and made a determination decision.

If your SSI denial letter said that you have a non-severe medical condition, it means that SSA agrees you suffer from a medical condition, but it does not believe it’s severe enough to be disabling. If SSA says that your condition does not meet an impairment listing, it means that it doesn’t meet the severity requirements outlined in SSA’s blue book of disabling conditions. Few people meet the listings, so this reason for denial is fairly common.

Some common reasons for why people are denied SSI benefits include: lack of sufficient medical evidence; too much income; missed paperwork deadlines; incomplete paperwork; medical records show conflicting information; alcohol or drug addiction; previous denial; failure to follow prescribed therapy; SSA unable to contact you; refusal to grant SSA access to medical records; prior felony conviction; or failure to comply with consultative examinations.

There are four levels of appeal with SSA. The first step after receiving your denial letter is to submit a Request for Reconsideration. In this phase, your claim will receive a complete review by someone who did not take part in the first disability determination. The assigned claims examiner will look at the evidence presented when you first applied as well as any additional information you submit. Look closely at your original application to see if you may have inadvertently left out important information. Only five-to-ten percent of people are awarded benefits at the Reconsideration stage.

If your Request for Reconsideration is similarly denied, you may appeal the decision and submit a Request for Hearing. At the hearing stage, an administrative law judge (ALJ) who took no part in either of the previous disability determinations will review your case. Waiting for your hearing to be scheduled will take the longest amount of time in the process. The hearing phase is where most claimants are approved for benefits—two-thirds of applicants are awarded benefits after a hearing. Hiring an attorney to represent you before your hearing can, therefore, significantly increase your chances of receiving a favorable decision.

Should the ALJ agree with the prior decisions, and your claim is again denied, the next two phases involve sending your claim to the Appeals Council and, later, to a Federal Court review. The Appeals Council looks at all requests but will deny your claim if they believe that the hearing decision was supported by and in accordance with Social Security regulations and law. Only two-to-three percent of people are approved for benefits at the Appeals Council level.

If you receive a denial letter for SSI benefits, do not take the denial personally and try not to get too upset about it. It might also be wise to hire an attorney to represent you, and he or she will have the experience needed to present the best case for your case going forward.