Disability Denials and Appeals

Every decision that Social Security makes on your claim can be appealed.  Appeals must be made in writing within 60 days of the date you receive a letter from Social Security notifying you a decision.  Social Security assumes that you received their letter 5 days after it is mailed to you, unless you can prove otherwise. 

Levels of Appeals

There are four levels of appeals in Social Security Cases.  They are:

Reconsideration – this made by someone who did not review your claim the first time.  It is usually a paper review.  You can submit new information.

Hearing by an administrative law judge (ALJ) – the AL J is someone who did not review your case at any previous level.  You are entitled to present witnesses, give testimony, or question any witness that maybe asked to attend by the ALJ.  You may be asked to clarify any information that is in your file.  You also have the opportunity to review you file at this stage.

Review by the Appeals Council – the appeals council can deny a request for review if they feel the decision by the ALJ was correct.  If they deny your request for a review, you can appeal to the federal court.  If the Appeals Council decides to review your claim, they can decide your case themselves or return it to the ALJ for further action.  

Federal Court review – is a review by the federal court with all the requisite rules and procedures involved in any federal court case. 

Why was my claim denied?

There are many reasons why a claim for Social Security Benefits can be denied.  There are technical reasons and reasons that are more subjective for why a claim may be denied.

Technical Issues with a Claim

• Technical problems with a claim involve such issues as:
• Not having enough work quarters
• Not meeting the earnings tests
• Incomplete medical records
• Failure to respond to a request for information and
• Missing an appointment with a Social Security doctor for evaluation

Subjective Issues

Subjective Issues that cause a denial of benefits are more difficult to explain.  It is not always, what information you provide about your disability but how you provide it.  For instance, one of the issues in a disability claim may be pain.  Question: Does your condition cause you pain?

• Answer A: Yes, my condition causes me pain.
• Answer B: I am pain all the time.  If frequently wakes me up at night, so that I do not get a full night’s sleep.  When I take my pain medication, I am groggy and cannot concentrate or drive.  I have to take pain medication several times a day just to get through the day.  My family complains that I am short tempered and listless when I am taking medication.  I also sleep a lot because of the medication.

Answer B is the answer that is more likely to get your disability claim approved.

How Can a Social Security Lawyer help?

The complexities of Social Security Disability claims make legal representation essential once your claim for benefits is denied.  When looking for a lawyer to represent you, choose someone who has experience in handling these claims.  A good Social Security lawyer understands the subjective nature of much of the information needed when pursing a social security claim.  This person may bring out issues that you would overlook like, side effects from medication for your condition that make it impossible for you to return to work, testimony from family and friends that show the severity of your condition.  This kind of information is important if your condition does not meet one of the conditions in the Listing of impairments that would require a finding that you are disabled as a matter of law.

Summary

Any decision made on disability claim can be appealed.  Appeals must be in writing and made within 60 days of receiving the decision from Social Security.  There are levels of appeals, reconsideration, hearing before an administrative law judge, appeals council review, and federal court review.  Disability claims can be denied for technical reasons such as not having enough work credits or for subjective reasons relating to the information you provided on your claim.  An experienced Social Security lawyer can assist you with the technical issues related to your claim and is invaluable in handling the subjective problems.