Understanding The Social Security Disability Insurance Appeals Process

When you need Social Security benefits, receiving a denial of your Social Security Disability Insurance (SSDI) claim can add a lot of stress onto your plate and uncertainty about the future. Understanding the SSDI claim appeals process can help you move forward and obtain the SSDI benefits you need. In this article, you can discover:

• How long you have to file an appeal, and what to do if you miss a deadline.
• The situations that could allow you to receive expedited processing for your reconsideration review.
• Strategies that give you a better chance of winning your appeal after an SSDI claim denial.

What Is The SSDI Appeals Process For Individuals Who Receive An Initial Denial Of Their Disability Claim?

When you receive a Social Security Disability Insurance (SSDI) claim denial, you have 60 days to file an appeal. This appeal is called a request for reconsideration. After you file the request for reconsideration, it usually takes 60 to 120 days for a response. If they deny you again, you can ask for a hearing, which is when you actually have a decent chance of winning.

What Steps Should I Take Immediately After Receiving An SSDI Denial Notice?

If you have received a Social Security Disability claim denial, you need to get a lawyer to file the request for reconsideration quickly. That gets the process started so that if the reconsideration is denied, the request for a hearing can be filed right away.

Are There Specific Medical Documentation Requirements That Applicants Should Be Aware Of To Avoid SSDI Denials?

One of the most common causes for an SSDI denial is not having proper documentation. What the documentation says is crucial.

Often, when we go to the doctor, we tend to be vague and the doctor may be in a hurry, so we tend to shorthand everything. However, it’s important to give the details when you see your doctor and to get those details into the medical records.

For example, imagine you go to the doctor and they ask how you are and how the medications are working. You might reply that they are working fine and you’re doing about the same. With this information, the medical records are likely to say that you are tolerating medications and that your condition is stable. If your claim has been denied, this will hurt you at the hearing.

If your medications are affecting you, such as making you fall asleep, even though the doctor probably already knows that you need the medications, you should make sure you state it every time you go to the doctor. This way, the medical records reflect your situation and don’t just say “Patient tolerating medications well.”

At your hearing, you can explain to the judge that you have trouble working because your medication makes you sleepy and it is difficult to function. If he looks at the medical records and they say “Patient tolerating medications well,” then the records do not match your story. If he sees “condition stable,” the judge tends to interpret this information as the condition being manageable.

In summary, it’s important that you go into detail with the doctor. For example: “There hasn’t been any change. I’m still suffering X, Y, and Z symptoms.” With more information about your condition in the medical records, especially specific information to back up your testimony, you have a higher chance of obtaining the desired outcome at your hearing.

Are There Time Limits For Filing An Appeal After An SSDI Denial, And What Happens If An Applicant Misses These Deadlines?

Generally, you have 60 days to file the appeal after an SSDI claim denial. If you miss the deadline, your options depend on why you have missed the deadline. The best thing to do is always file the appeal within 60 days. If you miss that, sometimes you can file a statement of good cause, which explains why you missed it — and hopefully has a legal excuse in there.

For example, you may have missed the deadline because the notice went to the wrong address, or an address where you no longer live. Or, maybe you were in the hospital when they sent out the notice, or you were on so much medication that you just couldn’t function. In these types of scenarios, we can file a statement of good cause, but the safest thing to do is always to file the appeal within 60 days.

What Is A Reconsideration Of An SSDI Appeal, And Is It Different From A Formal Hearing?

Reconsideration does not involve any hearings, it is merely another level of review. With a reconsideration, you’re asking them to review the records again, or maybe you have some new records.

In most cases, reconsideration has no effect. It’s just a mandatory step to get to the hearing. You cannot ask for a hearing before you go through the reconsideration process.

The Social Security system is set up based on what they call listings. If your condition exactly meets a listing, you can win on the initial application or on reconsideration. But if your condition doesn’t exactly meet all of the criteria in a listing (and the overwhelming majority of them do not), then you’re not going to win until you have a hearing.

How Can I Obtain Additional Medical Evidence And Expert Options To Strengthen My Disability Claim And Reduce The Risk Of Denial?

In years prior, it was much easier to get an SSDI claim approved. Your treating physician would write a letter for you explaining your medical condition(s) and the limitations this condition presented.

However, over the past 10 years, new policies have emerged, and many physicians are no longer willing to write these letters. It can be very difficult to get a claim approved, and if your physician is willing to write a letter for you, that can make a huge difference. In your case, it can be the difference between winning and losing.

In many instances, all you can do is ask your physician for a letter. Most Social Security applicants can’t afford to get an expert opinion outside of their physician, or hire someone to do a statement. Thus, 99% of the time, it comes down to asking your doctor to write a letter for you.

What Should Applicants Include In Their Appeal Letter To Effectively Communicate Their Situation And Address The Reasons For Denial?

The appeal process is based more on the medical records and documentation than what you say in your letter or paperwork. On the paperwork, you should point out the specific symptoms and conditions that prohibit you from working, and explain how they keep you from working. However, the medical records are the most important part of your appeal.

Can I Request An Expedited Review Or Reconsideration For My SSDI Claim In Cases Of Severe Financial Hardship Or Life-Threatening Conditions?

There are two main ways to obtain an expedited reconsideration:

1. Compassionate Allowance is a program through the Social Security Administration that allows you to expedite your case if you can establish that you have certain conditions. For example, if you have stage four or stage five cancers of certain types, they will expedite your case. Hopefully, you don’t fall into that category, but if you do, you may be able to speed up the review process.
2. Extreme financial hardship situations may also qualify for faster processing. If you are facing extreme financial difficulties, you can ask for an expedited hearing. Sometimes you’ll get one, and sometimes you won’t.

Most of the people who apply for Social Security Disability Insurance are in desperate circumstances, so the fact that you have desperate circumstances won’t necessarily lead to your case being expedited. However, it may also depend on your specific area.

In our district, the chief administrative law judge has set a standard that you have to be facing homelessness or unable to get medications that are severely and adversely affecting your health, or similar situations. It has to be very extreme for your case to be prioritized.

What Percentage Of SSDI Applicants Are Successful In Overturning Their Initial Denial Through An Appeal, And What Factors Contribute To Their Success?

Applicants who work with a qualified lawyer have a significantly higher chance of success compared to those who don’t seek professional legal counsel. Recent statistics indicate that fewer than 50% will win on the appeals. Previously, more than 70% of the claimants with lawyers would win their appeals, but they’ve become more stringent and the national figures have dropped to below 50%.

For more information on the SSDI Appeals Process In Arkansas, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (501) 984-7567 today.