When you experience a debilitating injury or receive a life-altering diagnosis, you may view your future differently. For many individuals in this position, Social Security Disability benefits, or SSDI, represent the hope of continuing medical care, staying afloat financially, and retaining their quality of life. Therefore, receiving an application denial from the Social Security Administration, or SSA, can be a devastating blow.
According to Nolo.com, the SSA only approves approximately 35% of initial applications for benefits. Because denial is so common, you can improve your chances of receiving the benefits you need by understanding why the SSA issues denials and how the appeals process works.
Why Social Security Disability Applications Are Denied
SSDI eligibility has strict parameters. Any applicant who doesn't meet these exact parameters may be denied, even if he or she really does need benefits for a debilitating injury or condition. Common reasons for denials include:
- Applicant failure to comply with prescribed treatments without accepted medical or nonmedical excuses
- Disability stemming from substance abuse
- Fraudulent or missing information
- Inability to communicate with applicant or complete necessary medical examinations
- Inadequate indicators that the disability will last more than one year
- Lack of medical evidence
- Monthly income of $1,180 or more (as of 2018)
If the SSA denies your application, you will receive a denial notice containing a summary of the information considered in the decision.
When to Appeal a Social Security Disability Benefits Denial
SSDI eligibility can only be based on the information you supply in your application. For example, many applications are denied based on a lack of medical evidence because the applicant was unaware that he or she should provide all medical records, including prescription history, summaries of doctor visits, and so on.
Similarly, any errors in your paperwork can result in denial, even though they technically have no bearing on whether or not your condition qualifies as a disability.
Additionally, some disqualifying characteristics have exceptions or potential alternatives. For example, while you cannot receive benefits for a disability stemming from alcohol or drug dependence, if you would still be considered disabled without the substance abuse issue, you could still be eligible.
The appeals process can allow you to clarify or correct the areas that led to a denial. In virtually every case, working with an attorney can expedite and improve your chances during preparation and the appeals process.
What to Expect From the Appeals Process
The SSDI appeals process has four potential stages, as follows.
Reconsideration consists of a review of your original application plus any additional information you include by SSA representatives who were not involved with the original decision. While reconsideration is a necessary appeals step, only 15% of reconsiderations receive approval.
If your approval is denied, your claim can be heard by an administrative law judge. At the hearing, you can present your case using witnesses and evidence as well as personal testimony.
The review stage involves an SSA appeals council reviewing all information presented up to that point. The council may refuse a review if they agree with the hearing decision.
4. Federal Review
In rare cases, applicants may decide to appeal at a Federal court level by filing a lawsuit.
If you decide to pursue an appeal, keep in mind that the appeals process takes time. Reconsideration takes a month, while hearing decisions may take as many as three. The third and fourth appeal stages can take considerably longer.
If your SSDI application was denied, consider which factors may have contributed to the decision. Discuss your situation with an attorney as you put together an appeal to increase your chance of receiving full benefits.
For expert help with Social Security claims, trust the legal team at Scholtens and Averitt, PLC.