Navigating Social Security Disability Appeals: What to Do If Your Claim Is Denied
Navigating the complexities of Social Security Disability (SSD) claims can be daunting, especially when faced with a denial. If you've recently received a denial for your initial SSD claim, it's crucial to understand the next steps rather than starting from scratch with a new application. This blog guides you through the appeals process, detailing how to effectively file for reconsideration or a hearing, and what to expect at each stage. With the right approach and understanding, you can enhance your chances of overturning the denial and securing the benefits you need.
A large proportion of initial Social Security Disability claims are denied. If you find yourself in this situation, it's crucial to respond promptly by filing an appeal rather than a new application, unless your denial was based on technical reasons like surpassing income limits.
The notice of denial you receive will outline the specific steps required to appeal the decision. In most states, the initial step after denial is to file a “Request for Reconsideration” within 60 days. This involves a second review of your case, though it's important to note that a significant number of these reconsideration requests are also denied. If your request is not successful, the next stage involves filing a “Request for a Hearing before an Administrative Law Judge (ALJ)”.
In certain states, such as New York, there is no reconsideration step, and you directly file for an ALJ hearing following your initial denial. Remember, the national average processing time for an ALJ hearing was about 595 days as of 2017, which underscores the need for patience and persistence through this lengthy process.
Should your claim be denied at the ALJ hearing, you have the option to appeal to the Social Security Appeals Council, which reviews decisions and can remand cases back to judges for reconsideration. Although the Appeals Council overturns only a small percentage of cases, it's a critical step for those seeking further review. It typically takes about a year to receive a decision from the Council.
If your claim is ultimately denied by the Appeals Council, you still have the option to escalate your appeal to the Federal Court in the district where you reside.
The strength of your medical evidence cannot be overstated. Comprehensive medical records — such as physician’s examination notes, mental health records, blood work panels, and imaging study reports — are essential. These records should provide detailed information about the nature and severity of your condition to support your claim effectively.
Include all relevant health conditions in your claim. For example, if you are dealing with both physical impairments and a mental health condition, ensure that both are documented and included in your claim.
Moreover, some individuals may have severe medical conditions that meet the SSA's standards for a Compassionate Allowance or fall under one of the fourteen “listed impairments” categories, which can expedite the disability determination process. However, even if your condition does not meet these listed impairments, you might still qualify for disability benefits if your condition is deemed medically equivalent to the criteria in a related listing, or if it severely limits your ability to work and perform daily activities.
It is also beneficial to have representation throughout this process. While you can represent yourself, statistics show that claimants represented by experienced Social Security Disability attorneys tend to have more favorable outcomes, especially in complex cases. These professionals can help strategize your claim, gather necessary evidence, and present your case effectively. Most attorneys work on a contingency basis, meaning they only charge fees if you win your Social Security claim.
Kimberly A. Slimbaugh, Esq.
Meggesto, Crossett & Valerino, LLP
313 E. Willow Street, Suite 201
Syracuse, New York 13202
(315)471-1664
kslimbaugh@mcvlaw.com
www.mcvlaw.com