What if My Application for Social Security Benefits Is Denied?
You’ve filed your application for Social Security disability benefits and are waiting anxiously for a decision. While you should keep a positive frame of mind, it’s a good idea to prepare yourself for the possibility that your social security benefits is denied. Why? Because most claims are denied, including the claims of many deserving applicants. If your claim is denied, as an experienced Poughkeepsie Social Security attorney, I can assure you it is not the end of the road. You have a right to appeal. A majority of applicants who appeal after an initial denial are ultimately awarded benefits.
How Your Application Is Processed
The road that leads to receiving Social Security disability benefits begins with the filing of form SSA-16-BK (the application), and form SSA-3368-BK, (the adult disability Report). These documents are initially filed and processed at a local Social Security Administration field office. The field office reviews the paperwork to determine whether or not you have worked and contributed to Social Security long enough to allow you to participate in the system. If the field office determines that you do qualify to participate, your paperwork will be forwarded to Disability Determination Services (DDS.)
The DDS is a State agency funded by the federal government. DDS looks at your information and decides whether or not the evidence establishes that you are disabled. Your file is then returned to a local field office for appropriate action and you are notified by mail of the decision. If DDS decides that you are disabled you are done! You will receive benefits as long as your disability continues.
Your Social Security Benefits is Denied — Should You Appeal?
What happens if the letter from the Social Security Administration informs you that DDS has determined that you are not disabled? What can you do if you disagree with the decision? The letter notifying you of the decision will tell you that you have a right to appeal the decision by requesting a reconsideration of your application. You must submit your request within 60 days of your receipt of the decision letter.
Now the big question. Should you request reconsideration of your claim? The experienced representatives of the Social Security Administration have determined that you do not meet the SSA’s definition of disability. How much chance is there the decision will be reversed?
The answer is that decisions made by the Disability Determination Services are frequently appealed and a significant number of those appeals are eventually successful. You should not give up on your claim until you have talked to an attorney who has experience in handling Social Security Disability claims. If you are already represented by an attorney who assisted you with the initial application process, call and make an appointment to go over the denial letter. If your attorney tells you that there is no reason to file an appeal, call a different attorney and get a second opinion. This is a very important decision. You need to act quickly and you need to know that you are taking the best steps to protect your rights.
Our office often gets calls from people who have filed an application for disability on their own. The person they met with at the field office helped them with the forms and assured them that they did not need to have an attorney represent them. Now they have received a letter from the SSA denying their claim. They still can’t work, and they do not know what to do. We advise most clients to appeal the decision. We prepare the paperwork and get it filed before the time for filing an appeal expires.
Levels of Social Security Appeal
There are actually 4 different levels of appeal. If your initial application is denied, your first appeal is a request for reconsideration. A request for reconsideration is a review of your claim by someone at the DDS who was not a part of the original decision. The evidence in your file will be reviewed along with any additional evidence that you have submitted to DDS. After the review, a decision is made to either grant your application for benefits or to confirm the original decision that you are not disabled.
If you are notified that, after reconsideration, you are still considered NOT disabled, you have a right to appeal that decision by requesting a hearing, (level 2.) The appeal hearing will be conducted by an administrative law judge. (Are you ready to hire an attorney now?)
An administrative law judge is not an elected official. The judge is an attorney, hired by the Social Security Administration, and given the responsibility of conducting hearings to review decisions made by the DDS. The judge will conduct a that you will attend if you are able. Additional evidence may be presented at the hearing, you will have the opportunity to testify and you may call witnesses to offer testimony on your behalf. After the hearing, the judge will make a decision and you will be notified by letter.
The decision letter finally arrives and you are still disabled! But it says that you are still NOT disabled! Now what!? Don’t give up yet! You are still unable to work. Your doctor says you are not going to get better, so…Press on! If you disagree with the decision of the administrative law judge, you can ask that your file be reviewed by the Social Security’s Appeals Council, (level 3)! The Appeals Council has the authority to deny a review if, after consideration, it believes that the decision of the administrative law judge was correct. If the Council decides that your case warrants review, the Council may hear your case itself or it may order your file returned to an administrative law judge for further action.
If the Appeals Council denies your request for a review, or if after review the Council determines that you are not disabled, you still have the right to file a law suit in federal court (level 4), claiming that you are disabled and entitled to disability benefits.
Time to Get a Poughkeepsie Social Security Attorney Involved
If you decided to begin the process on your own and are now considering an appeal of a denial of your claim, it is time to think about retaining a Poughkeepsie Social Security attorney. If you are worried about being able to pay for an attorney, you will be interested to know that attorney fees for representation in Social Security disability cases are contingent on a determination that you are entitled to benefits. In addition, fees must be submitted to the Social Security Administration for approval.
The attorneys at the Herman Law Group have experience in handling Social Security disability claims throughout the New York metropolitan area. We know the appeals process and can make sure that your right to a fair and honest evaluation of your impairment is protected. Call us at 877-773-3030 to schedule your free case evaluation.
Appealing a Denied Claim
If 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:
- – Initial Determination
- – Reconsideration
- – Administrative Hearing
- – Appeals Council Review
- – 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.
Denied Disability Claim: What Are Your Options?
There are two ways to respond to a denied disability claim: you can appeal it, or ask the Social Security Administration to reopen it. Either way, you may end up with benefits AND backpay.
Appealing a Denied Disability Claim
Most states have a four-step appeals process:
- Request for Reconsideration. You must file this within 60 days of the denial. Be aware that some states have eliminated this step and that the SSA denies most requests.
- Request for a Hearing. You must make your request to be heard by an administration law judge (ALJ) within 60 days. Most cases that get approved for benefits are approved by an ALJ.
- The Appeals Council lets you fight an ALJ denial, as long as you appeal within 60 days. There are three possible outcomes. The AC can: (a) refuse to hear your claim; (b) disagree with the ALJ, awarding you benefits; or (c) bounce your claim back to the ALJ and tell them to review it, which may or may not result in benefits.
- The Federal Appeal. Your final option. First, you must submit a short, detailed document called a “brief,” explaining why all the earlier decisions in your case were wrong. You especially need legal help here, because federal briefs are hard to write and must follow complicated requirements most non-lawyers can’t meet.
Reopening Your Claim
This is your only option for fighting a denied disability claim if you choose not to appeal or miss the deadline. This actually involves opening a new claim related to the old one. Suppose you have severe hemophilia and can’t safely work in most environments. A related claim might result from a disabling injury sustained because you had no choice but to work anyway after your first claim was denied.
You can only reopen a denied claim while disabled, and there are limits you must follow. If the old claim is less than a year old, you can reopen it for any reason. If the claim is 1-4 years old, you can reopen it only if there’s new evidence or the old claim has an obvious “error on the face” on the part of the ALJ. You can open an older claim only if:
- someone committed fraud or left out important information;
- your benefits were miscalculated; or
- an error on the face needs correction.
Reasons to Reopen Your Claim
If you’re approved, you’ll get back-payments of benefits going back to your first application date, even if it was years ago. Social Security Disability (SSDI) may also add more “retroactive benefits” dating back to the day you first became disabled. Altogether, this can amount to many thousands of dollars.
Reasons NOT to Reopen Your Claim
It’s easier and better to appeal a denied disability claim instead of reopening it, because:
- You may have to wait more than two years for a final decision.
- The SSA can decide not to reopen your claim if (a) they think it doesn’t meet the deadline requirements; (b) they decide the new claim isn’t related to the old one; or (c) the old claim fails the evidential or error tests listed above. If they don’t reopen the claim, you won’t get backpay even if you get benefits for the new claim.
- An ALJ can deny your claim just because it was denied before. They’re supposed to review the case all the way back to the very beginning, but may assume it was denied for a good reason and deny it again without checking. Again, you get no backpay.
Social Security Disability Benefits: Denial and Appeal
Denial and Appeal in New York and New Jersey, approximately 55% of all initial applications are denied, although at Hermann Law Group, we are successful in over 60% of the initial applications we file. While the reasons for denial given by the Social Security Administration vary, we believe that the real reason the Social Security Administration denies such a large number of initial applications is to discourage claimants from pursuing appeals.
Many of our clients come to us at this stage, after their Initial Application has been denied. Even a poorly developed Initial Application can be turned into a winning claim in the hands of an experienced attorney. At Hermann Law Group, we can correct the mistakes and omissions of a denied Initial Application, and win a claim at this appeals level.
In New York, you may appeal an unfavorable Initial Determination directly to a hearing. In New Jersey and Connecticut (along with most other states) there is an intermediate step known as Reconsideration. Unfortunately, very little changes at the Reconsideration level unless there are new conditions that the State Agency did not know about or new treating sources they were unable to contact. If your claim is denied again at the Reconsideration, you have 60 days to appeal that determination and request a hearing.
We encourage anyone whose initial application has been denied to appeal the denial, and we urge them not to get discouraged. The rates of success dramatically increase at the appeals level, especially if you are represented by a good attorney. At Hermann Law Group, we win approximately 85% of the hearings we handle, compared to a 55% success rate for all claimants nationwide
You have 60 days from the date of your denial to file an appeal, both at the Initial Application level and the Reconsideration level. Again, at Hermann Law Group we will prepare and file all necessary forms on your behalf in order to appeal. In appropriate cases, we are able to request that an appeal be decided favorably without our clients actually having to attend a hearing, resulting in them getting their benefits months earlier than otherwise.
Losing Social Security Benefits
If you are concerned about the status of your Social Security benefits, you can contact our New Jersey disability lawyer for help. A common question is if you can later lose benefits after you begin receiving monthly payments. In general, yes, you can, but the professionals at our law firm can address your concerns.
Returning to Work
One of the main reasons that you can lose your benefits is if you regain your health and go back to work. Social Security encourages this practice and helps individuals continue receiving Medicare for a time while they are working.
If you are disabled and begin working part-time, you could lose your disability. The Social Security Administration considers earnings of $680 monthly high enough to disqualify a person. Once you have earned this amount for nine months, the SSA will likely sever benefits. However, the nine months are counted as cumulative and not consecutive for you to lose benefits. If you are working part-time, talk to our disability attorney in NJ about your benefits.
Complying with Medical Reviews
If you do not complete the reviews sent out by the SSA, you also run the risk of losing your benefits. The SSA will send out regular reviews, and you must turn in current medical documentation in order to keep your benefits. While you might be able to talk to your primary care physician about the evaluation, the SSA could direct you to see a different doctor of their choosing.
Updating Your Status
You need to keep the SSA apprised of your address, earned income and if you were in jail or in prison. Even if you lose your benefits, you can reapply. You might also decide to file an appeal, similar to the process you went through when you originally filed for SSD or SSI, and take your case to an administrative law judge.
Continuing Disability Reviews
Once you begin receiving benefits, Social Security has a right to review your case on a regular basis, usually no sooner than three years. Younger workers and psychiatric claims are more likely to get reviewed, and in a hearing decision the Judge can suggest a shorter review period if he or she expects you to have medical improvement in less time.
If you are still under active medical treatment these “Continuing Disability Reviews” (CDRs) are not usually a cause for concern unless your condition has improved dramatically. However, returning to work, even on a part time basis, may trigger a CDR
We always ask our clients to contact us if they receive notice that their entitlement to benefits is being reviewed. This way, we can make sure that Social Security receives all the information they need in order to maintain our clients’ benefits.
If Social Security decides that you are no longer disabled you may ultimately return for a hearing before an Administrative Law Judge. However, most CDR’s are resolved in favor of the claimant, and benefits are continued without a hearing becomes necessary.
Disability applicants can benefit from the expert guidance of an experienced Social Security disability attorney. Hermann Law Group will carefully analyze your case, and subsequently, provide straightforward and compassionate advice. Call today for a free consultation and case evaluation.
What Percentage of Claims Are denied?
Reasons Why Your Claim for Social Security Disability Benefits Could Be Denied in Error
If you are initially turned down when you file an application for Social Security benefits, don’t be discouraged because only about one-third of first-time applicants are approved. Claimants often successfully appeal their cases, especially with the representation of a New York Social Security Disability Law Firm.
How To Apply If Your Disability Claim Is Denied
As your disability lawyer will tell you, your Social Security disability claim does not end at the initial denial. Many claimants successfully appeal their denials and receive their benefits. There are three ways to initiate the appeal, and with timely actions and a resolve to see things through, you will also likely win your benefits.
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.