Social Security Denials and Appeals


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You applied for benefits from Social Security and were denied, what do you do now?  It is not unusual to be denied social security benefits especially if it is an initial application for disability benefits.  The reasons for denials are too numerous to mention.  Two important categories that denials fall into are not meeting threshold requirements and not providing enough information.

Social Security Threshold Requirements

These vary depending on what type of benefits you are seeking, for instance:

Retirement Benefits

You do not have enough work credits.  You must have 40 work credits to receive retirement benefits.  Forty work credits is equivalent to 10 years of work.  You earn four work credits per calendar year dividing the calendar year into quarters.  Work credits for retirement do not have to be consecutive.

Survivor’s Benefits

You cannot  prove the required relationship to the deceased to be eligible for benefits

Disability Benefits

You do not meet the two earnings requirements, the recent work requirement, and the duration of work requirement.

Supplemental Security Income

Your income and available resources are too high.

Failure to provide enough information, for instance:

Retirement benefits – you have work credits that are not being counted.  This can affect retirement benefits as well as social security benefits.  It is important to check the yearly statement you get from social security that shows income that is counted each year and make corrections if necessary.

Disability Benefits – a major problem in this area is medical records.  It is important to work with State Determination Services to make sure they have all of your medical information from all of your doctors, hospitals, or clinics.

Appeal a Social Security Denial

Every decision that Social Security makes on your claim can be appealed.  When Social Security reviews your case after an appeal is requested, they will review your entire case, not just the area you 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. 

Get Help Appealing a Social Security Denial

You do have the right to have representation concerning any aspect of social security.  Your representative can be an attorney or other qualified person.  Representation is advisable at any time after the initial denial, but is a necessity at the hearing level and beyond.  Social Security is a specialized area of the law, it is important to find a representative who is experienced at handling social security cases when looking for representation.  

Summary

The reasons for a denial of Social Security Benefits vary greatly.  They can be very technical or as simple as failure to provide medical records.  Any decision on your claim can be appealed.  There are four levels of appeals.  Representation is not required at the first level of appeal but is essential at the hearing, Appeal Council, and Federal Court Review stages.  The attorney who handled your personal injury case may not be appropriate for your Social Security case.  Question any potential advocate to make sure they are knowledgeable about Social Security and the appeals process. 

 

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