Denied SSDI/SSI Claims

Denied SSDI/SSI Claims

Most first-time applicants for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits are denied. That’s true here in Ohio, and that is true throughout the country.

Sometimes the claims are rejected because the initial evaluator feels – rightly or wrongly – that the applicant fails to meet the qualifications for benefits. Other times, qualified applicants are denied because they fail to navigate the complex claims process.

The rejection needn’t be the final word, and many people do win the right to receive benefits after a successful appeal.

The timing of an appeal is crucial. The Social Security Administration, which oversees SSDI/SSI, must receive a written appeal within 60 days or (with rare exception) its decision becomes final. Unlike tax returns filed with the Internal Revenue Service, which must only be postmarked by the deadline, the request for SSDI/SSI reconsideration must actually be in the hands of the Social Security Administration within the 60-day window.

Every applicant for SSDI/SSI has the right to challenge an unfavorable decision, whether the government rejected the claim completely or only partially.  While the Social Security Administration offers free phone help for applicants who have questions, actual appeals must be made in writing. If a claim is denied for medical reasons, applicants can file their initial request for an appeal on the government’s website at www.socialsecurity.gov/disability/appeal.

Rather than handle an appeal on their own, many denied applicants immediately seek the advice of a lawyer, friend or another individual who has prior experience with the process. Doing so may improve the chances that an appeal will succeed while dramatically reducing the risk that the appeal will fail or be delayed because the applicant misunderstands the appellate process or overlooks crucial deadlines.

There are four levels of appeal, beginning with what is known as a “reconsideration.” As the first step in the process, the Social Security Administration will conduct a full review of the claim, using an evaluator who had nothing to do with the original decision.

During the reconsideration, the government revisits all of the original documentation as well as any fresh evidence that the applicant submits. Generally, the applicant isn’t required to appear in person. In some instances, however, it may work in the applicant’s favor to explain his or her disability face-to-face.

If after reconsideration, the applicant’s claim is again rejected, the next step in the appeals process is to request a hearing before an administrative law judge.  The hearing has the feel of a trial, where witnesses are called and additional evidence – both favorable and potentially unfavorable – may be submitted. Although the judge works for the Social Security Administration, the judge will be someone who played no previous role in the government’s denial.

The judge is likely to ask the applicant questions directly and may also question witnesses brought by the applicant in support of the claim. In some instances, rather than meet in person, the judge will opt to conduct the hearing using video conferencing.

The administrative judge alone will rule on the appeal. There is no jury. The applicant won’t learn the outcome immediately, but will receive the judge’s determination by letter.

The third step in the appeals process – and the last one that relies solely on the conclusions of the Social Security Administration – is to elevate the claim to the agency’s Appeals Council. This panel may or may not agree to conduct a review. If the reviewers believe it’s obvious that the administrative judge’s ruling was correct, it may not conduct a full review of the case. If the Appeals Council accepts the case, it may still affirm the judge’s original decision, reverse that decision in the applicant’s favor, or return the case to the administrative judge for additional consideration.

Finally, a denied claim applicant who remains dissatisfied after the first three review steps has the right to file a formal lawsuit in a federal district court. Such a lawsuit, which may take years to be fully adjudicated, does remove the ultimate decision from the purview of the Social Security Administration.

Experienced SSDI/SSI lawyers can handle many appeals-related activities, such as helping their clients obtain medical records to support their claims; preparing their clients and other witnesses for the hearing; filing the necessary paperwork for reconsideration, hearing and review; and being on hand for all face-to-face interactions with the Social Security Administration and, if need be, the federal district court.

As a protection for those filing claims, the Social Security Administration must preauthorize fees charged by SSDI/SSI lawyers. 

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