Disability benefits can be a source of relief for many people who cannot stay employed because of their medical conditions. Unfortunately, approximately 65-70% of the initial applications are rejected. So, what do you do if you are denied disability and can’t work?
If your application for disability benefits was denied, you have the right to contest this decision. This usually involves going through a process of reconsideration and appeals. It’s recommended to consult a Social Security Disability attorney that can guide you through this process and save you from the common mistakes people make.
Keep reading below for more information.
What is Social Security Disability Insurance?
Social Security Disability Insurance (SSDI) is a program managed by the Social Security Administration (SSA). It is intended to help people with a medical condition limiting their ability to work or retain employment.
Individuals who feel they are entitled to Social Security benefits can apply by phone, online, or in person by visiting their local SSA office.
There is a waiting period of five months for SSDI. This means that, once approved, you will not start receiving benefits until the sixth full month of disability. A person disabled due to amyotrophic lateral sclerosis (ALS) is the one exception to this rule.
Eligibility for SSDI
The criteria for disability are the same for SSDI and SSI (Supplemental Security Income), both of which are SSA programs. According to the SSA, disabilities can be characterized by mental or physical conditions that either (1) have lasted or are expected to last at least 12 months or (2) are expected to cause death.
To qualify for SSDI, you need at least 40 working credits, or ten years of employment experience. In addition to that, you need to have earned a total of 20 credits within the last ten years prior to becoming disabled. There are several exemptions to these rules when you are younger than 31 years of age.
In order to be eligible for SSDI, you need to fulfill one of the following requirements:
- A person who is blind or has impaired vision.
- A person who is disabled and under the age of 65.
- Widows and widowers with disabilities who are at least 50 years old—In addition, the departed spouse must have accrued enough work credits.
- Adults who became disabled before age 22 may be eligible for benefits under specific conditions. Adults with disabilities may be qualified for financial assistance if a parent has passed away. They may also be eligible for benefits if the parent starts getting disability or retirement benefits.
How Many Disability Applications Are Denied?
As disability benefits are known for being difficult to get, you may wonder how many initial applications get rejected. If you’re currently working on your application, you won’t be happy to hear that over 70% of the initial disability applications get rejected.
This suggests that you need to make a very strong case for your application to be accepted. Otherwise, it’s likely that your claim will be denied by SSA. However, it also does not mean that all 70% of the claims that get rejected are invalid.
One common reason that applicants get denied disability is that the SSA thinks they did not provide enough information in their application to be awarded benefits.
This may be due to insufficient medical records that satisfy the requirements. In your application, the SSA will request that you provide information about your medical provider to obtain more data about your health status.
In the event that this information is not available, the SSA won’t be able to get detailed information on your medical condition and living needs.
The SSA also needs to see if you are complying with the treatment for your medical issues. If you do not take steps to treat your disability, the Social Security Administration (SSA) may conclude that your condition is not as severe as it actually is.
It is possible that they will reject your claim on the grounds that you do not visit the doctor on a regular basis.
Why Do I Keep Getting Denied for Disability?
The SSA may have rejected the application for any one of various reasons. But these reasons usually fall into two categories; (1) technical or (2) medical.
Technical Denials
There are some technical requirements for being approved for disability benefits as defined by the SSA. If your application fails to satisfy such benefits, then it will be rejected. This happens for approximately 30% of the applications.
Applicants for SSDI must have worked a minimum amount of time in the last 10 years before their application. The amount of employment time varies based on age. Applicants can also earn no more than $1,470 per month (in 2023) from their current employment.
The Disability Determination Services (DDS) determines whether or not your application should be approved. If your application gets rejected due to insufficient working credits, it means that you need to increase the amount of time you have worked.
On the flip side, if you make more than around $1,400 per month from work, it signals to the Social Security Administration (SSA) that you are not too disabled to work, and as a result, you are not eligible for benefits.
If an applicant does not pay all of their taxes as required, this might result in their application being denied on the grounds that they do not have a sufficient work history.
The Social Security Administration (SSA) keeps a record of a person’s employment history by assigning work credits determined by the amount of taxes the person pays.
Medical Denials
These denials account for the rest of the 70% of the rejected applications, so it’s safe to say that they are very common. This type of denial suggests that your condition is not considered a disability by the SSA.
The DDS considers your specific situation to determine whether or not you qualify, even if you have a condition from the Blue Book.
The strength of your medical evidence will be of the utmost importance, unless you have an illness that meets the criteria for a Blue Book listing (such as cancer in its fourth stage or ALS). However, the DDS and the SSA do not evaluate all of the evidence in the same way.
Applications from patients who seek treatment on a regular basis, particularly from specialists, are given higher priority.
What Should I Do if I am Denied Disability and Can’t Work?
If your application for Social Security Disability benefits is rejected, you can contest the decision by filing an appeal. Generally, you have the option to file an appeal within 60 days of receiving the denial. It’s also important that you act quickly.
If you delay the appeal for your benefits, then the SSA might ask you the reason for this delay, which it may or may not find justified.
In the appeals claim, it’s important that you add any new medical records or information that may have changed since your initial application. The officer reconsidering your case will consider new and old evidence (including the one on which your denial was based). A final decision will be reached after doing this.
The Appeals Process
Claims submitted to the Social Security Administration for disability benefits are subject to a total of four stages of appeal. Generally speaking, claims advance from one level to the next in the following order:
Stage 1: Reconsideration
If a claim for Social Security Disability has been denied, the typical first step in the appeals process is to submit a Request for Reconsideration. Under the context of this appeal, your claim file will be examined by medical professionals and many other disability specialists working for the agency that handles disability determination in your state.
It will be a new group of medical professionals who are in charge of reviewing and deciding whether or not to approve your claim at this stage. Nonetheless, even if a new team of reviewers is involved, it is likely that the application will still be denied.
Again, this might be due to the stringent standards that the SSA has in place about the requirements for receiving disability benefits, or it could be a mistake.
Stage 2: Hearing Before Administrative Law Judge (ALJ)
In the event that your Request for Reconsideration is turned down, the next step is to have a hearing in front of an Administrative Law Judge, often known as an ALJ.
The hearing before the ALJ is significant because, at this stage, in addition to your testimony and the testimony of any witnesses, your medical evidence and any other witnesses’ testimony are also taken into consideration when determining your impairment.
At the hearing stage, you will have the opportunity to present both fresh evidence and evidence of any developments in your condition that have occurred since you initially filed your application. After the hearing is finished, the Administrative Law Judge will issue you a written decision informing you as to whether or not you have been granted disability benefits.
Stage 3: Appeals Council Review
The Social Security Administration’s Appeals Committee is composed of a separate group of judges who are not familiar with your case. These judges are considered to be impartial. The Appeals Council is responsible for making the decision regarding whether or not it will review the decision made by the Administrative Law Judge.
In the event that the Appeals Council agrees to look into your claim, any fresh evidence will not be taken into consideration. The sole purpose of the Appeals Council’s review of the Administrative Law Judge’s decision is to ensure that all applicable laws and procedures have been carried out in an appropriate manner.
After considering a claim, the Appeals Council has the ability to either uphold the decision made by the hearing judge, revise the decision, overturn the decision, or return the decision to the ALJ for a second hearing.
In the event that the Appeals Council chooses not to reconsider your case, the decision made by the ALJ will be considered the final decision in your matter.
Stage 4: Federal Court Review
In the event that your appeal to the Appeals Council is denied, you have the right to file a further appeal with the United States District Court that has jurisdiction over your case. You will initiate legal action against the Commissioner of the Social Security Administration in the capacity of the defendant in the case.
If you end up losing your case in the United States District Court, you have the option to appeal it to the United States Court of Appeals and eventually to the Supreme Court of the United States. However, the United States Supreme Court reviews requests for Social Security Disability benefits very infrequently.
Increasing Your Odds of Being Accepted for Disability Benefits
There are a few things you may do to increase the likelihood of being approved for disability compensation.
Check the Requirements
Check your job history to ensure that you have sufficient work credits to qualify for Social Security Disability Insurance (SSDI) benefits. According to the law, in order to qualify for SSDI benefits, you need to have worked for a certain amount of time within the most recent ten years.
Get Treatment for Health Conditions
It is essential that you maintain regular contact with a qualified medical expert. The Social Security Administration has to have access to the latest medical records in order to fully evaluate your claim.
Open Communication With the SSA
It’s possible that Social Security will want you to visit one of their doctors. This type of examination is known as a consultative exam. It is essential that you show up for this consultation exam and comply with any other requests made by the SSA.
Your Social Security payments could be terminated if you refuse to comply with the Social Security Administration.
Consult an Attorney
You may want to seek the assistance of a lawyer when applying for disability compensation. An accomplished attorney who focuses on Social Security Disability claims can help you obtain your medical records and the views of your treating physicians on your disability.
During the course of the appeals procedure, they can also file the necessary documents on your behalf.
Conclusion
If you have been denied disability and can’t work, it’s important that you do not lose hope. The appeals process is in place for a reason. However, it’s essential to act quickly to increase the chances of success for your appeal claim.
