Appealing A Denied Social Security Disability Claim
Disability Denial & Appeals

It is important for any disability applicant to keep in mind that most initial claims are denied. The SSA denies the majority of initial applications. The process of applying for disability can be very time consuming, frustrating, and tedious. Regardless of how thorough an initial claim may be, the most likely result is that it will initially be denied. (However, we beleive that if the social security administration knows that you have a qualified social security advocate or attorney on your side, your chances for initial approval are greatly increased)

Many applicants, after working so hard on their application, accept the first denial without realizing that the SSA typically rejects initial claims, sometimes solely on the basis of a technicality. It is important to understand that denial of your initial application is not the end of the application process!

Reasons for a Denial
Most often, the SSA determines that a claimant's disability does not prevent him or her from performing all types of work. The will typically cite a claimant's residual functional capacity as a reason for denial. The SSA might also claim there is inadequate medical documentation for a claim of disability or that the consultative examination has produced evidence to refute the medical opinion of your primary physician. The Disability Determination Services (DDS) evaluation may find that your disability is not categorized as long term and therefore a denial is issued. If you receive a denial for your disability claim you should appeal the decision.

Process of Appeal
There are four stages of appeal for a disability claim. They include:

  • Reconsideration
  • Administrative Hearing
  • Appeals Council Review
  • Federal Court
After denial of your initial claim by the DDS you must file a "Request for Reconsideration" within 60 days of your denial. This stage is conducted internally by the DDS. An examiner for the DDS that did not work on your claim specifically will evaluate the entry file and determine if your denial was made in error. However, because this part of the process is conducted within the department of DDS, rarely is a claim reversed at this stage.

If you receive a denial of your reconsideration, you again have 60 days to file for an Administrative Hearing. This hearing is where you present your disability claim to an Administrative Law Judge. The hearing will be scheduled as early as three months after you have filed to as long as a year. Once in court, the judge will have reviewed your claim before proceedings begin. The focus of the hearing will be upon your residual functional capacity. This is a very typical court proceeding. You are given the opportunity to make your case and the judge will ask you questions to further evaluate your claim. Witnesses may be called to testify on your behalf. Occasionally experts are called to submit their opinion based upon an evaluation of your claim. The judge will conclude the hearing once all supporting evidence has been submitted. After the closing of the hearing the judge will make a determination and notify you of the decision in writing. The notification process usually takes two months.

Denial of an Appeal
Should your appeal be denied at the Administrative Hearing, the next stage in the process is filing an appeal with the Appeals Council. Once again, you have 60 days to file this appeal after receiving the judgment from the Administrative Hearing. The Appeals Council must complete a review of your claim before your case is submitted to the United States District Court. The Appeals Council will review the decision made by the judge and the evidence presented at your Administrative Hearing. The possible outcomes of this review by the Appeals Council include: refusal, a request for additional information, a reevaluation by your Administrative Hearing Judge, or a reversal of the decision.

Legal Representation
Clearly, once a claim for disability has passed the process of Reconsideration, it is highly recommended a claimant secure legal representation. Because the SSA is such an extensive bureaucracy, those that represent this system are exceptionally familiar with the processes and practices involved in issuing denials of claims. It is extremely difficult to establish evidence of a disability eligible for benefits without knowledge or expertise that can match that of the SSA. Claims entering the third stage of consideration (the stage of appeal at the Administrative Hearing) are almost entirely handled by attorneys representing the interests of the claimant.

For a free evaluation of your denied claim, or for help with applying, click here.
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