Being denied disability benefits can be a frustrating and overwhelming experience. Whether you have applied for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), a denial can leave you feeling lost and unsure of how to move forward. Fortunately, it’s important to remember that denial is not the end of your journey, and there are ways to fight back and secure the benefits you deserve.
In this article, we’ll walk you through the steps to take if your disability benefits claim is denied. We’ll also discuss common reasons for denials, what you can do to strengthen your case, and how legal assistance can increase your chances of success. So, if you’re facing a disability benefits denial, don’t give up—read on to learn how to fight back and win your claim.
Understanding the Disability Benefits Process
Before delving into how to fight a denial, it’s important to understand the disability benefits process. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are federal programs designed to provide financial assistance to individuals who are unable to work due to a disability. SSDI is available to individuals who have worked and paid into the Social Security system, while SSI is available to low-income individuals with disabilities, regardless of their work history.
The process for applying for disability benefits can be lengthy and complex, involving several stages:
- Initial Application: The first step in the process is submitting an application for disability benefits. This includes providing detailed medical records, work history, and other relevant information.
- Reconsideration: If your initial application is denied, you can request a reconsideration. This is essentially a second review of your application by a different set of examiners.
- Hearing: If your reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ). This is an opportunity to present additional evidence and argue your case in person.
- Appeals Council and Federal Court: If you are still denied after the ALJ hearing, you can ask the Appeals Council to review your case. If that doesn’t work, you may file a lawsuit in federal court.
Each stage of the process can take months, and many claims are initially denied. Understanding these stages will help you prepare for what to expect and make informed decisions about the next steps in your case.
Common Reasons for Disability Benefits Denials
When your disability benefits claim is denied, it can be discouraging, but knowing the common reasons for denials can help you understand why it happened and how to remedy the situation. Some of the most common reasons for denial include:
1. Insufficient Medical Evidence
One of the primary reasons disability claims are denied is due to a lack of sufficient medical evidence to support the claim. Social Security requires clear documentation of your disability and how it affects your ability to work. This includes medical records from your doctors, hospital visits, lab results, and other relevant evidence that supports your claim.
If you have been denied because of insufficient medical evidence, it’s crucial to gather more detailed documentation and submit it with your appeal. This could include reports from specialists or additional diagnostic tests that were not previously included in your application.
2. Failure to Meet the Disability Criteria
To qualify for SSDI or SSI benefits, your disability must meet specific criteria set by the Social Security Administration (SSA). The SSA has a detailed list of impairments, and your condition must either be on this list or be medically equivalent to one of the listed conditions. If your condition does not meet these criteria, it could result in a denial.
If your disability isn’t listed, you still have options. You may be able to show that your condition is as severe as one on the list by providing medical evidence and expert testimony.
3. Earnings Above the Threshold
The SSA has strict guidelines about how much income you can earn while receiving disability benefits. If you are still earning a significant income, your claim could be denied. The SSA typically requires that you earn below a certain amount each month (known as Substantial Gainful Activity or SGA) to qualify for benefits.
If you are working part-time or earning above the limit, you may need to adjust your employment situation or provide evidence of your disability’s impact on your ability to perform work tasks.
4. Failure to Follow Treatment
Another common reason for denial is the failure to follow prescribed medical treatment. The SSA expects claimants to follow their doctor’s recommendations, including taking medications and attending regular medical appointments. If you fail to comply with treatment, it could undermine your claim for disability benefits.
If you’ve missed appointments or treatment, be sure to explain the reasons for this when you appeal. For example, if financial constraints or a lack of transportation prevented you from attending your appointments, make sure to address these issues during the reconsideration or hearing stage.
What You Can Do to Fight Back
A denial of disability benefits doesn’t mean the end of the road. There are several steps you can take to strengthen your case and improve your chances of winning your claim.
1. Request a Reconsideration
If your initial application is denied, you have the right to request reconsideration. This is essentially a second review of your case by a different set of examiners. During this stage, it’s critical to submit any additional documentation, medical records, or supporting evidence that was missing from your initial application.
Make sure to carefully review the reason for your denial and focus on providing the necessary evidence to address these issues.
2. Prepare for a Hearing
If your reconsideration is denied, the next step is to request a hearing before an Administrative Law Judge (ALJ). The hearing gives you an opportunity to present your case in person, and the ALJ will review all the evidence and make a determination. The hearing is your chance to explain the impact of your disability and provide testimony from doctors or other experts.
Be prepared for the hearing by reviewing your medical records, bringing any additional evidence, and consulting with a disability lawyer who can help you navigate the process.
3. Consider Legal Assistance
The disability claims process can be complicated, and having legal help can significantly increase your chances of success. A disability lawyer can assist with filing appeals, gathering evidence, and preparing for hearings. They can also provide valuable guidance on how to present your case in the strongest possible way.
If you need help with social security disability claims, it’s a good idea to work with an experienced attorney who understands the process and can advocate on your behalf. You can find skilled attorneys in your area, such as those at Berger and Green in Pittsburgh, who specialize in disability law and can help you navigate the complexities of your case.
4. Stay Organized and Persistent
Fighting a disability benefits denial requires patience and persistence. Make sure to stay organized by keeping track of all documents, letters, and communications with the SSA. You may have to follow up multiple times, but don’t be discouraged. Many claims are denied at first, but many people successfully win their cases on appeal.
5. Utilize Support Resources
Throughout the process, you may benefit from additional resources that can provide support. This includes local advocacy groups, online forums, and government agencies that specialize in helping individuals with disabilities. Additionally, you can stay up-to-date on disability-related news and legislation that may impact your claim. For example, Forbes recently published an article about long-standing laws designed to protect people with disabilities, which may offer useful information as you navigate your claim.
Conclusion
Being denied disability benefits can feel discouraging, but it’s important to remember that a denial is not the end. There are multiple ways to appeal the decision and strengthen your case, including gathering additional medical evidence, seeking legal assistance, and following the appeals process step-by-step.
If you’ve been denied disability benefits, don’t give up. With persistence, proper preparation, and support, you can fight back and increase your chances of winning your claim.
About the author: James K. Camper
Growing up in a family where asbestos-related cancer, lawsuits, and attorneys seemed to be the main conversation topic for a few years left a mark on me. One powerful enough to nurture an unrelenting seek of truth and justice. I spent my teenage years volunteering in hospice centers and nursing homes and I went to law school to learn how to defend the defenseless. I don’t want to become “just a lawyer” when I finish next year. I want to become a voice and an advocate for all those who need their rights protected. The articles I write for various legal magazines and online platforms are my way to inform, educate, and help people around me, just like others helped my family in their time of need.
