When determining whether to approve or deny a first-time claim for disability benefits, the Social Security Administration is more likely to deny an initial claim than approve it. Unless the claimant is suffering from a terminal illness or a permanent disability with a negative prognosis, a denial should be expected within several months of filing for disability.
What Should You Do After Your Disability Claim is Denied?
Reasons for denials of first-time disability claims typically involve the following:
- SSA evaluators do not think you have proven your disability is severe enough to prevent you from working
- Missing medical documentation (lab reports, doctor reports, record of hospitalizations)
- Disability forms are incorrectly filled out
- Treatment recommendations are not being utilized
Fortunately, disability denials can be appealed and heard by an administrative law judge (ALJ) at an appeals hearing. The ALJ will examine your initial claim to determine whether your denial was warranted. Over half of all ALJ disability appeals are approved at the appeals stage. However, certain factors will contribute to increasing the likelihood that the judge will approve your claim. Being over 50 with no college degree and limited work experience are the primary reasons why your claim will probably be approved by an administrative law judge. Alternately, younger disability claimants often win their appeal as long as they have detailed medical records indicating the severity of their physical or psychological disability.
If you plan to represent yourself at an appeals hearing, be aware that some ALJs might see this as proof your disability is not bad enough to approve your claim. The best way to win an SSDI or SSI hearing is to hire an experienced disability lawyer to represent you at the hearing.
What Can a Disability Lawyer Do to Help Prove Your Case at an Appeals Hearing?
Although claimants are allowed to represent themselves at first and second appeals hearings, it is definitely not in your best interest to do so. Disability lawyers know what to expect at ALJ hearings and can present a fully prepared case to an administrative law judge. In addition, SSDI and SSI disability attorneys typically have had previous experience in front of many ALJs so they know how to approach these judges. Unless you know how an ALJ will approach a disability appeal, chances are you won’t meet the judge’s expectations.
Once you have hired a disability lawyer to represent you in front of an appeals judge, you don’t have to worry about collecting the massive amount of medical records essential for winning your case. Instead, your attorney will do all of the following for you:
- Collect documentation of every appointment you have had with your doctor, surgeon or other healthcare professional
- Collect receipts for medications and/or medical equipment you have obtained for the purpose of treating your condition
- Collect lists of all treatments and procedures you have completed that are associated with your disability
- Collect reports from physicians detailing the success or failure of treatments
- Provide an update (if applicable) of your symptoms to the ALJ. Since filing a first-time disability claim, your symptoms may have worsened. Symptoms can also include psychological problems, such as depression and anxiety
- Notarized letters from doctors, caregivers and other individuals who provide assistance to you on a daily or weekly basis
- A letter from your doctor explaining your condition and how it impacts your ability to work and perform activities of daily living.
A Social Security disability attorney has in-depth knowledge of disability law, knows how to build a compelling case and ensures all case documentation is submitted to an ALJ in a timely manner. If your initial disability claim was denied, be aware that you only have 60 days to file an appeal with an ALJ. Failing to meet this deadline means you must file a new disability claim that will likely be denied again by SSA evaluators.
What Happens After an Appeals Hearing?
Once your disability attorney has presented your case to an administrative law judge, it can take several months to receive your determination letter. A “fully favorable” decision means you have been approved for disability benefits and may be entitled to receive back (onset of disability) payments.
A “partially favorable” decision means the ALJ has approved your claim but that medical documentation indicates an onset date later than the one you initially established. In a partially favorable decision, you won’t receive back pay for your disability but will begin receiving normal monthly benefits.
An “unfavorable” decision means you have been denied SSDI or SSI disability benefits. Your denial letter will contain information regarding why the ALJ denied your claim.