Social Security Disability Insurance (SSDI) is a federal program that provides income for individuals with medical conditions that prevent them from working. Unfortunately, the process of getting Social Security Disability benefits is not easy, even for individuals with qualifying disabilities. The Social Security Administration (SSA) routinely denies applications, and while there is an appeals process, it can be difficult to navigate.
That’s why injured and disabled New Yorkers need experienced legal counsel to help them with the Social Security Disability process. If your SSDI application has been denied, there are strict deadlines and legal requirements that apply. Protect your rights with an experienced Social Security Disability attorney on your side.
Reasons Social Security Disability claims are denied
The Social Security Administration is quite aggressive when it comes to denying initial applications to keep costs down. The main reasons a claim may be denied include:
- Lack of qualifying medical condition: To qualify for SSDI, you must have an injury or illness that prevents you from engaging in substantial gainful activity (SGA) and is expected to last at least one year or result in death. If your medical condition does not meet these criteria, your claim will be denied.
- Lack of medical documentation: You must have sufficient medical evidence to prove that your condition meets the criteria to qualify for SSDI.
- Not following treatment plans: A key part of qualifying for SSDI is demonstrating that you are under the care of a doctor and are still unable to work. If you cannot prove you are complying with your doctor’s orders, your claim may be denied.
- Inadequate work history: SSDI is for people who have paid into the system by working a sufficient number of years in jobs covered by Social Security. For most people, that is five of the last 10 years, although you can qualify with a shorter work history if you are age 30 or under.
- Earnings too high: If you earn enough money to exceed the SGA threshold, you are not eligible for Social Security Disability. Remember, this only includes your earnings from work, not passive income.
- Previous denials: Although it is perfectly legal to apply for Social Security Disability multiple times, if the SSA sees that your previous application was denied, they are likely to deny you again. That’s why it’s important to go through the appeal process instead of simply re-applying.
The appeal process for Social Security Disability applications
If your initial application is denied, you have recourse through the Social Security Administration, but you have to move quickly. There are strict deadlines and legal requirements at each stage in the process. If you miss a deadline, you must start over with a brand-new application.
- Request reconsideration. Reconsideration simply means that your application will be reviewed by a new medical consultant and examiner (that is, someone other than the person who denied your first application). You can also include any additional information you want the examiner to take into consideration. You have just 60 days from the day you received notice of denial to request reconsideration.
- Request a hearing. If your application is denied again on reconsideration, you can request a hearing with an administrative law judge (ALJ). If your application was denied for medical reasons, the ALJ will review any evidence you provide regarding your disability and ask questions about your medical condition. Likewise, if your application was denied for non-medical reasons (such as work history), the ALJ will ask about the dispute and review any evidence you provide. Again, you have just 60 days from the day you received a decision on reconsideration to request a hearing.
- Appeal to the Appeals Council: If the ALJ rules against you, the next stop is the SSA’s Appeals Council. Again, you have 60 days from receiving the ALJ’s decision to appeal to the Appeals Council. The Appeals Council may decide your claim itself or send it back to the ALJ for further review.
- Appeal to federal district court: The last step beyond the Appeals Council is to file a civil suit in a U.S. District Court asking for review of the Appeals Council’s decision. You can file in the federal district where you live or where you have your principal place of business. Once you file your civil suit and send copies to the SSA, the SSA will prepare a record of the claim and send it to the district court for the judge to review. Once again, you have 60 days to file a civil action.
Again, at each stage, there are not only strict deadlines but also complex legal standards to be met. The right attorney can make all the difference by shepherding your claim through the appeals process, filling out all forms meticulously, gathering evidence, and making winning arguments on your behalf
You need an experienced SSDI attorney to help you appeal
While you are not legally required to have an attorney at any stage in the process, it’s always in your interest to have legal representation, and the further along you go, the more important it becomes. An experienced attorney can manage the progress of your claim through the appeals process and keep you updated at each stage. An attorney knows the types of evidence and testimony that get favorable decisions in hearings and appeals, and they can put together a winning case while you focus on your health and your life.
Social Security Disability Attorneys offer free consultations and work on contingency: their fee is only a percentage of your past-due benefits, so you will never have to pay your lawyer out of pocket. If your SSDI claim has been denied and you need to file an appeal, don’t go it alone. Talk to an experienced SSD lawyer about your case today.
