Applying for Social Security Disability Insurance (SSDI) can be difficult as is, but appealing the Social Security Administration’s decision on your application can be even more difficult to do. So, how do you navigate the SSDI appeals process?
Thankfully, the process is pretty easy and starts with submitting an appeals application to the Social Security Administration (SSA) directly. The appeals process comprises four stages: request for reconsideration, an Administrative Law Judge hearing, an appeals council review, and a federal court review.
Read below to learn more about the SSDI appeals process and how to navigate it.
Common Reasons for SSDI Denial
Before you go ahead with the appeals process, it’s important to figure out the reason your SSDI application was denied in the first place so you can address the specific problem in your application during the appeals process.
Remember that if your appeals application is the same as the original application, the SSA won’t think too hard before rejecting your appeal as well.
Generally, SSDI denials can be categorized into two groups: (i) technical denials and (ii) medical denials.
The reasons behind a technical denial could be that:
- You are earning too much money
- You missed important deadlines
- You failed to add complete information to your application
The reasons behind a medical denial could be that:
- You do not have a qualifying disability
- Your disability did not meet the 12-month duration requirement
Many applicants are unable to gather the necessary medical evidence required for an SSDI application.
To be approved for SSDI, an applicant must demonstrate through medical records that their condition meets the criteria for the disability and that the disability prevents the applicant from working.
It is also important for an applicant to regularly get medical care for their condition. Many applicants get rejected simply because they failed to follow up on medical care or comply with the prescribed treatments.
In order to approve your SSDI application, the SSA must first assess your condition and determine whether it is treatable. But it has no way of doing so if there is no evidence that you tried to get treatment.
Another important factor during the application process is cooperation. You must cooperate with the SSA, meet deadlines, provide the requested information, and make sure to attend SSA-requested medical exams and appointments. If you fail to do all of these, then the chances that your application will be rejected may significantly increase.
There are also various other reasons that your application might get rejected; these include:
- Your condition does not meet the SSA’s criteria for disability.
- You are currently employed full time.
- Your medical information is outdated.
- You were convicted of a crime.
- You were out of reach for the SSA and failed to respond to them.
- Your disability is not severe enough to prevent you from working.
Most of the time, the SSA will send you a letter that will detail the reason why they rejected your SSDI application. You can use that information as you go forward with the appeals process.
Your Right to Appeal the SSA’s Decision
Luckily, regardless of the reason for getting a denial on your initial application, the SSA still provides you with the right to contest the decision and file an appeal either through their website or a neighborhood SSA office.
Applicants generally have a time limit of 60 days after they receive the rejection letter from SSA to file an appeal. The Social Security Administration will consider your receipt date to be five days later than the date mentioned in the letter.
If you received the letter later than that and thus couldn’t file an appeal on time for that reason, you will need to provide evidence of this to the SSA.
If the last date to file an appeal is a holiday or the weekend, then the last date to submit the application will move over to the next day.
Note that if you are unable to appeal an SSDI denial within the given time limit, the SSA might take away your right to file an appeal.
This means that the initial decision on your application will be finalized and cannot be contested. However, if you had a good reason for being unable to file an appeal, then it’s possible that the SSA will provide you with more time.
Appeal vs. Reapplying: Which Option is Better?
There are a couple of things to consider when deciding whether to appeal the SSA’s decision on your application or start a fresh application altogether.
Back Pay
If you appeal the SSA’s decision on your initial application and your application gets approved, the SSA will be required to pay your back pay.
SSDI back pay is the amount you should receive to cover payments between your application and approval date.
This will not include the 5-month waiting period from your established onset date. Payments are calculated based on the date when you filed your initial application. This means that the earlier you apply for benefits, the more back pay you will be entitled to receive.
However, if you do not file an appeal and start a fresh application altogether, you will lose your right to back pay.
Waiting Period
The SSDI application procedure is notoriously long. If you start a new application, then you will have to go through the tedious process of compiling documentation, filling out paperwork, and going through a lengthy waiting period.
Although the typical waiting period for SSDI applications is five months, hearing back from the SSA about your application may take as long as 10 months to a whole year.
Chances of Rejection
Your chances of getting rejected again increase if you submit a new application instead of appealing the SSA’s decision on your initial application. It may be likely that the SSA will reject your new application right away if they find that you’ve been rejected before.
So, while it can be quite difficult to navigate the process, once you know all the right things to do and your options, the process becomes smoother. Consulting a Social Security Disability lawyer can help you increase your chances of success.
