Denied Disability and Can't Work? Here's What to Do
If you have been denied disability and can't work, you should review the denial letter thoroughly, gather additional evidence and documentation, and appeal your claim. A disability lawyer can guide you through the appeals process and maximize your chances of approval.
Common Reasons Why Disability Claims are Denied
Five common reasons for denial of Social Security disability benefits claims are lack of medical evidence, income exceeding limits, failure to follow treatment, missing deadlines, and/or incomplete disability applications.
Lack of Medical Evidence
More often than not, claims require sufficient and comprehensive evidence of medical records. Insufficient evidence for a medical condition can lead to denial. Medical documentation such as physician reports, diagnostic test results, treatment plans, and progress notes may be required for submission in the application process.
Income Exceeds Limits
There are income limits to receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). If a household's monthly income exceeds the limit, applicants can be disqualified. SSDI and SSI have strict income requirements for disability programs.
For SSDI benefits, applicants must demonstrate they are unable to engage in Substantial Gainful Activity (SGA), which is defined by an income threshold updated annually.
For SSI benefits, both earned and unearned income are considered. Applicants from higher-income households may inadvertently disqualify themselves from monthly benefits if they have too much income or if resources exceed allowable limits.
Failure to Follow Treatment
If applicants fail to follow prescribed treatments for their disability without valid reasons, then it may appear that they are not trying to improve. Failure to follow medical treatments in healthcare can lead to disqualification.
Applicants who seem unwilling to remedy or manage their condition appear to have a less severe condition or health problems than on the original application. There are valid reasons, such as the inability to afford treatment, religious objections, or severe side effects associated with treatments, which would fall under the category of additional information or evidence needed in the application.
Missing Deadlines
Most SSI and SSDI applications have strict deadlines. Missing these timelines could lead to automatic Social Security Disability denial. Some deadlines that can be overlooked include requests for additional documentation. Typically, this documentation is needed within 30 days.
Another requirement with a specific deadline would be a medical appointment. If the Social Security Administration (SSA) schedules an exam for consultation or otherwise, then failure to show without sufficient evidence can lead to denial of disability benefits.
Incomplete Application
Missing information or insufficient medical evidence often prevents claims from being approved. Some of the most common pieces of missing information in a medical denial include:
Incomplete medical evidence
Lack of documentation from medical professionals
Missing medical records
Omission of past work history
Types of jobs or job duties
Lack of specific details about the disability
Missing personal information
What to Do If Your Disability Claim Is Denied
Review Your Denial Letter
Initial denial does not mean a final decision, so your first step after a disability denial should be to take the time to review your denial letter thoroughly. Once you receive the letter, the time to submit an appeal is 60 days.
If you are given the choice between reapplying or appealing after rejection, it's usually best to choose appeal. Appealing your case can get you further in the system, and SSA will also calculate back pay from the date of your initial application.
Gather Additional Medical Evidence
It is essential to ensure that your medical evidence includes correct personal information, correct dates and times, medical details, physician and provider details, and a complete list of healthcare providers and treatments. You may also be required to submit new evidence for your Social Security disability claim.
File an Appeal
The SSA has four levels of appeal: reconsideration, hearing by an Administrative Law Judge, Appeals Council Review, and Federal Court review. The deadline for submitting an appeal is 60 days. It is important to note that the 60-day requirement begins when you receive the notice in the mail, not the day it was mailed.
The Appeals Process Explained
Reconsideration
Reconsideration is the first step in the appeal process. During reconsideration, an examiner who wasn't involved in the initial decision will thoroughly review your claim.
Hearing by an Administrative Law Judge
If reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ). A hearing would require some preparation. You would need medical records, letters and testimonies from doctors, a possible vocational expert to testify, and any other supporting evidence. You may need an experienced attorney to represent you and give you legal advice.
Appeals Council Review
If the ALJ denies your claim, you can request a review from the Appeals Council. This stage of the appeal process is if you feel there was a mistake in failing to consider all medical or work history. The Appeals Council issues the final action on the administrative side for SSDI claims. If this is the case, the Appeals Council Review will decide your case for themselves, remand it to the ALJ, or deny your claim.
Federal Court Review
If the Appeals Council denies or declines to review your case, the next step would be to go before a federal court and file a lawsuit. At this point, a federal judge will review your case to ensure that no errors were made. This is a complex process, and you will need legal support from a lawyer to handle your disability case.
Consider Hiring a Disability Lawyer
A disability lawyer can advocate for you and make a difference in your case. Social Security disability lawyers know how the claims process works and can help you through a system that can seem overwhelming. They can help you by assessing your case, preparing you for a hearing, gathering evidence, representing you at a hearing, or handling appeals and litigations. The important thing is knowing an expert in disability law has your back in this process.