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Social Security Disability Insurance: Steps You Can Take if Your Application Is Denied

Social Security Disability Insurance: Steps You Can Take if Your Application Is Denied

Over the past few months, we’ve discussed the benefits and potential pitfalls of the Social Security Disability Insurance (SSDI) program. In December 2022, we introduced the series in an article outlining this important social safety net that you’ve paid into for years. A month later, we described the complex behind-the-scenes vetting process that takes place once you’ve applied for SSDI payments. Then, most recently, we covered a variety of steps you can take to make your application more likely to be approved. This month, we’ll take on the issue of what happens in the likely event that your application is denied. Only a fraction of first-time claims are approved, so it’s important to be informed of details on the appeals process and ways to mount a successful effort to get your application approved.

The Social Security Administration can appear to be a sluggish, indifferent bureaucracy. However, that isn’t always the case. Appeals judges and other officials are merely doing their job – attempting to prevent fraudulent claims from sapping the funds we’ve all paid into. Many are quite sympathetic to disabled people whose genuine needs are not being met when their applications are wrongfully denied. So, appealing an initial denial isn’t a bad idea, though it can be a challenge to anyone unfamiliar with the process.

And it’s a fact – a large percentage of initial SSDI applications and requests for appeals are turned down. Over the past decade, an average of 67 percent of applications have been denied by the Social Security Administration. That means only one of every three claimants ever receives benefits. So, you’d be wise to take all possible steps you can to be sure your application (and appeal documentation if necessary) is accurate, complete, and submitted properly. Even officials at Social Security make it plain that having an advocate assisting you (think a specialized Social Security disability lawyer) is a smart move. In fact, they directly state that it’s your legal right to have professional representation. Once you’ve followed their advice and chosen an advocate to work on your behalf, you’ll need to let Social Security know you’ve done so by submitting the official six-page “Claimant’s Appointment of Representative” form — or you can also complete the required documentation online. We’ll be happy to help you with either one.

Why Are Social Security Disability Claims Denied?

As we mentioned, government officials are merely trying to be good stewards of public funds when they turn down many disability applications. Here’s some of what they have to say about their efforts to prevent fraudulent activity:

“Social Security, along with the Office of the Inspector General, identifies and aggressively prosecutes those who commit fraud. Our zero-tolerance approach has resulted in a fraud incidence rate that is a fraction of one percent. One of our most effective measures to guard against fraud is the Cooperative Disability Investigations program. Under the program, we investigate suspicious disability claims early, before making a decision to award benefits. In effect, we proactively stop fraud before it happens.”

That makes good sense from a financial perspective, although it’s a bit like arresting a suspect before a crime has even been committed. So, we enthusiastically work on behalf of clients at all phases of the SSDI application and appeals process to get their needs met and benefits paid.

Apart from genuine fraud, there are some other reasons SSDI claims tend to be rejected. Among them are the following:

  • Your work-related income level might be too high. SSDI benefits are need-based, so if you earn more than $1,470 a month from “gainful employment” this year, you will not be eligible for benefits from this program. Note that income here refers to funds you receive from actual work, not returns on investments. That’s because disability payments are intended for people who can no longer work due to injury or illness — other forms of non-employment income are not problematic.
  • Your disability is not sufficiently severe or long-lasting. SSDI benefits are paid only for disabilities that are strictly defined under the Social Security Act. Specifically, the law states that “A person is disabled under the Act if they can’t work due to a severe medical condition that has lasted, or is expected to last, at least one year or result in death. The person’s medical condition(s) must prevent them from doing work that they did in the past, and it must prevent them from adjusting to other work.” If you can return to work in less than a year, don’t expect to receive SSDI benefits.
  • You’ve failed to provide required information. If you don’t authorize the release of your medical records, or your medical providers won’t provide required details on your injuries or other health conditions, or you fail to report for what’s called a “Consultative Exam” (CE) given by an independent doctor appointed by Social Security, you are doomed to almost certain denial. Remember – you’re requesting money from a government program. You need to be an “open book” if you expect to receive benefits from this program, especially given the program’s ongoing need to prevent fraudulent claims.
  • You’re unreachable or don’t respond to communications. Common sense rules apply here. If officials attempt to reach you for clarification of your application, or to request that you undergo a Consultative Exam, and you don’t respond in a timely manner (or at all), their natural inclination will be to stamp “DENIED” on your claim and move on to the next one. It’s human nature, but it’s also logical since officials are dealing with thousands of disability claims, and they’re working hard to clear a buildup of applications. In fact, here’s an excerpt from the guidance provided to Social Security employees when they don’t hear back from applicants who’ve been asked to submit to a Comprehensive Examination: “When the claimant does not confirm the CE appointment within 10 calendar days, attempt one telephone contact to ask for confirmation.” Once that single call is made, and if you fail to answer it or don’t return a message left for you, it’s likely your claim will go into the proverbial “discard” pile.
  • You’re in prison or have been convicted of attempting to defraud the government. Claims made by incarcerated individuals are likely to be denied. While there may be legitimate reasons for you to become disabled in jail and entitled to benefits, you’ll have to meet very high standards of proof to receive them while you’re imprisoned and, presumably, being fed and clothed by the government already. Once you’re out of prison, however, you may be able to successfully apply and receive SSDI benefits. We invite you to contact us to discuss your specific circumstances if this applies to you.

Another Potential Roadblock: SSDI is Using Obsolete Data to Deny Applications

Remember that SSDI benefits are intended to help support people whose medical condition(s) “prevent them from doing work that they did in the past… and prevent them from adjusting to other work.”

In other words, if you formerly worked as a bartender and suddenly go blind, it’s probably impossible for you to return to that specific job. But it doesn’t mean you can’t perform any gainful employment. Which is a problem, because sometimes officials deny a claim by saying a disabled person is capable of performing a job that might not even exist in today’s economy. As the Washington Post reported recently, job descriptions and employment statistics from 1977 are still being used by Social Security to deny claims based on outdated information. For example, one profoundly disabled former electrician from Tennessee was told he could find work as an egg processor, a dowel inspector, or a nut sorter – jobs which have become nearly obsolete in today’s society.

If you or someone you love find yourself facing a situation like this one, please call us immediately at 855-MIKE-WINS (855-645-3946). We would love to help you resolve it.

Navigating the Appeals Process if Your SSDI Claim Has Been Denied

Once again, it’s important to stress that research shows you’re more likely to succeed in making a claim if you are represented by a professional who’s intimately familiar with the SSDI process. Of course, you’re also free to attempt a “do-it-yourself” appeal of a medical denial using an online portal that requires you to provide the following documentation (among other information):

  • Name, address, and phone number of a friend or relative who knows about your medical condition.
  • Description of any change to your medical condition and any new medical conditions.
  • Name, address, phone number, and visit dates of all health care providers, type of treatments and tests since you last provided medical evidence.
  • Name of any medicine (prescription or over-the-counter) you are currently taking, why you are taking it, any side effects, and the name of the doctor who recommended or prescribed the medicine.
  • If you have documents that support your appeal, they will help Social Security make a decision on your claim for disability benefits. Supporting documents include any medical report, form, or written statement related to your disability.
  • You will be asked if you wish to upload any supporting documents in electronic format prior to submitting your online appeal.
  • After you submit your appeal, the Social Security Administration will provide a cover sheet you can use to submit any documents you want them to consider along with your request.

Appeals of benefit denials from non-medically-related causes are handled differently. In that situation, officials recommend contacting your local Social Security office to request a review. You may also wish to call their toll-free number – 1-800-772-1213.

But don’t expect either process to be quick. The Social Security Administration admits that in 2021 the average appeal took 147 days for reconsideration. This situation hasn’t likely improved much since then.

Here Are Your Final Chances to Win a SSDI Appeal

If your initial appeal seems to be taking too long, or you run into other roadblocks with either of these phases in the appeals process, you’d be wise to get in touch with us for assistance. Because the next step is a hearing before an administrative law judge – which is the first of three final opportunities you’ll have to reverse a denial. If you disagree with the judge’s decision, you’ll next have to seek reversal from an Appeals Council. If that fails, you must take up the matter in a Federal Court. Once again, we have a dedicated team of attorneys who specialize in SSDI matters, and we can take a look at your case at no up-front cost to help you decide how best to proceed under these circumstances. To get the ball rolling, call us at the usual number: 855-MIKE-WINS (855-645-3946) or contact us online. There’s never any up-front charge to you because we always work on a contingency basis. That means you only pay when we win together!