Appealing a Denied Claim

June 22,2017
imgpsh_fullsize (15)

denied claimIf you have a denied claim, you may feel hopeless. However, with the help of a representative, you can successfully navigate the appeals process. Most people who apply for Social Security disability are denied at first; however, many of them appeal those decisions further and finally are awarded benefits.

The 5 Levels of Review

Your Social Security disability application may go through five different levels of review:

  1. Initial Determination
  2. Reconsideration
  3. Administrative Hearing
  4. Appeals Council Review
  5. Federal Court Review

What Happens During the Initial Determination?

The initial application for Social Security disability can be complicated. You should gather personal information as well as descriptions of your education, training, and work activities. You may want to consult with a disability attorney before your begin your Social Security application in order to complete it fully and avoid a denied claim.

When you apply for Social Security disability benefits, your eligibility will be initially determined by a claims examiner. The examiner will evaluate all evidence that is submitted and may request additional information. He or she will specifically look at the following:

  • Your current work status.
  • Whether your impairment meets SSA criteria.
  • The severity of your condition.
  • Whether you can do work you’ve previously done.
  • Whether you can do any other kind of work.

More than 60 percent of applications for disability are denied at the initial level. Many of the common mistakes people make at this level can be prevented with the help of a Social Security disability attorney.

How Do You Request Reconsideration?

If your initial application is denied, you may request reconsideration of that decision within 60 days. Only 50 percent of the applicants who receive an initial denial will request reconsideration. At this step, your application will be assigned to a new disability examiner and medical team. They will consider all of the evidence you have already submitted as well as any additional evidence you submit. It is important that you continue medical treatment and obtain documentation of your disability to offer the reconsideration team additional information. Only 10 percent of the reconsidered applications will be approved.

What Is an Administrative Hearing?

If your application is denied at the reconsideration level, you may appeal to an administrative law judge (ALJ) within 60 days. Only18 percent of people who are denied at the reconsideration stage continue to the hearing level. An ALJ will review all evidence already considered as well as any new evidence on the record. You will appear before an ALJ, and you may bring witnesses with you to testify about your condition and abilities. It is important to present all information available to the ALJ in order to obtain a positive outcome.

At this level, it really helps to have a disability representative who can help you organize your evidence and present it effectively to the ALJ.  The representative will prepare you to tell your story and answer the ALJs questions.  The representative will also be able to cross-examine the vocational expert and medical expert. These are expert witnesses that the ALJ sometimes requests to attend the hearing to answer questions about jobs you can do and specifics of your medical condition.

How Does the Appeals Council Review Your Denied Claim?

If the ALJ denies your claim, you may appeal to the Social Security Appeals Council. However, your appeal may be refused. The only way to obtain a review by the Appeals Council is to show that the ALJ did not properly consider all information available. You may submit additional evidence, and the Council may consult with additional medical advisors. The Appeals Council may uphold, change, or reverse previous decisions. If the Council finds that the ALJ made a mistake, they will send your claim back to an ALJ for additional consideration.

What Are the Benefits of a Federal Court Review?

If the appeals council refuses to hear your claim or upholds the decision of the ALJ, you may appeal your disability claim to a federal court within 60 days. The court will consider all evidence already presented as well as additional evidence. The judge will review decisions made by lower level reviewers. You may also submit a brief discussing your claim and how the evidence you’ve submitted meets the requirements of a severe impairment. An experienced disability attorney will prepare a brief that addresses each of the requirements of the SSA.

How a Disability Representative Can Help You With Your Denied Claim

The process of applying for disability and defending a denied claim is complicated. A knowledgeable disability representative can help you understand the appeals process. If you want to apply for disability, or your application has been denied, contact us today for a free consultation.