Disability Claim Denials and Appeals Process
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Disability Guide Topics
It is not unusual for a disability claim to be denied after the initial application. You will receive a letter from Social Security indicating that your claim has been denied, telling you why it was denied and explaining your appeal rights.
Reviewing Your Disability Claims File (Electronic Folder)
You have the right to review any of the information in your file from any source, no matter how it was filed.
Reasons Used to Deny a Disability Claim
Too Much Income or Assets
This is an issue in SSI cases only since eligibility is based on lack of income or assets. There are exceptions to the various rules regarding income and assets that may make a claimant eligible for benefits. For instance, your home is not a countable asset for SSI purposes. In some instances, assets that needed to maintain the home may make the asset excludable.
Your Disability Will not Last a Year
Social Security does not pay temporary or partial benefits. Your condition must be expected to last a year or result in death.
No Communication with Administrative Office
The claimant is the most important source of information in a disability case. You must notify immediately of changes in address or phone number.
Insufficient Medical Evidence
If you have not supplied sufficient medical evidence or have not submitted to a consultative examination, your claim may be denied. Your disability claim is based upon the medical evidence you or your health care provider submits. Social Security will pay the costs of medical records and an electronic filing process to help expedite the filing of medical record.
Consultative exams are requested by Social Security if the medical information they have is incomplete or inconclusive. These exams are at no cost to the claimant. You must have good cause for failure to submit to such an exam.
Your Impairments are Not Severe Enough
Having a diagnosis that is on the Listing of Impairments is not enough, your condition must also meet the severity test.
You Have not Followed Recommended Therapies
You must follow treatment prescribed by your treating source if this treatment can restore your ability to work. If you do not follow this prescribed treatment without a good reason, you will not be found to be disabled. You are not considered disabled if you refuse treatment without justification. If, despite treatment, your impairment(s) remain(s) sufficiently severe, you may be found disabled.
The Disability is a Result of Drug or Alcohol Addiction
Social Security stopped allowing benefits solely for drug and alcohol addiction in 1997. Drug and alcohol addiction could be a contributing factor to a mental impairment if it is evidence of self-medication to relieve the mental impairment.
Claimant is a Convicted Felon
You cannot receive benefits if you are a convicted felon. Additionally you cannot receive benefits under the following circumstances:
- You are under warrant for arrest for a felony
- You are in violation of parole
Appealing a Denied Disability Claim
1. Request for Reconsideration
This is made by someone who did not review your claim the first time. It is usually a paper review. You can submit new information.
2. Appealing to an Administrative Law Judge (ALJ)
The ALJ 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. The hearing is usually held within 75 miles of your home. In some cases, hearings can be held by video conference, which may make scheduling the hearing faster.
3. Appealing to the Appeals Council/Decision Review Board
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.
4. Appealing to a Federal District Court Judge
This is a review by the federal court with all the requisite rules and procedures involved in any federal court case. A petition will have to be filed and legal representation should be considered.
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