Strictly speaking, you do not need an attorney for a Social Security disability appeal – you can file and go through the process alone.
However, appeals have multiple stages and are even more complex than filing an initial claim. According to the National Council on Aging (NCOA), if you think the Social Security Administration (SSA) made a mistake with your denial, it can help to have an advocate familiar with Social Security disability policy and procedures on your side.
Why Would the SSA Deny Your Claim?
The SSA oversees two distinct disability programs:
- Social Security Disability Insurance (SSDI) beneficiaries qualify for benefits based on their earned work credits. You earn credits by contributing to the Social Security fund through taxes on your wages or self-employment income. To be eligible, you usually have to have a minimum of 20 work credits (five years of work).
- Supplemental Security Income (SSI) recipients qualify based on financial need. Beneficiaries must have minimal income or resources. Eligibility does not depend on work credits.
Both SSDI and SSI recipients must have a qualifying condition that is disabling – meaning it will prevent you from doing substantial gainful activity (SGA) for at least 12 months. According to the SSA, the 2022 SGA limit is $1,350, or $2,260 for blind recipients.
Given the program requirements, many application denials are due to insufficient medical evidence or issues with your income. However, technical errors can also cause a problem. Common reasons for denial include:
- You make too much money.
- You do not have enough earned work credits.
- You did not supply enough medical evidence.
- You made a technical or clerical error on your application.
- Your contact information is incorrect or out of date.
- You did not correctly complete an Adult Disability Report.
- Current drug or alcohol abuse materially contributes to your disability.
- You did not submit your most recent W-2 or tax return.
- You did not provide an original copy of your birth certificate or proof of citizenship.
An attorney with our firm can review your initial application and determine why the SSA denied your benefits. We can help you correct mistakes and fill in gaps in your medical records, work history, and financial documentation.
Qualifying Medical Conditions
To be eligible for disability benefits of any kind, you must have a qualifying medical condition. The SSA lists qualifying disabilities in the Blue Book, which include but are not limited to:
- Chronic heart disease
- Chronic kidney disease
- Skin disorders
- Endocrine disorders
- Neurological disorders
- Hearing, vision, and speech problems
- Mental health disorders
- Blood disorders
- Cancer
- Musculoskeletal disorders
- Digestive system issues
- Congenital disorders
- Immune system disorders
For a free legal consultation, call 412-661-1400
What Happens During an Appeal?
You can appeal the SSA’s decision for medical or non-medical reasons. The process starts with requesting a reconsideration of the initial determination. Your application will undergo a review by a party not involved with the original decision.
If reconsideration is not successful, you can ask for a hearing before an Administrative Law Judge (ALJ). The hearing can occur in person, online, or over the phone. During the hearing, the Judge will review the evidence and may question witnesses, such as medical and vocational experts.
If the ALJ does not decide in your favor, you can request a review by the Appeals Council. The Appeals Council may decide on your case or send it back to an ALJ. Finally, if the SSA still denies your benefits, you can file a civil action in United States District Court.
How Long Do You Have to Appeal?
You have 60 days from receiving notice of the SSA’s initial determination to file for reconsideration. You then have 60 days from notice of the reconsideration results to file for a hearing, 60 days from the hearing decision to ask for an Appeals Council review, and 60 days from that decision to file a court case.
Appeals can take a long time, and the waiting period between stages can be anywhere from six months up to a year and a half. In fact, according to the SSA, the national average for processing ALJ hearings was 307 days in 2022.
Why Can It Help to Have an Attorney?
Unfortunately, our attorneys cannot eliminate the wait times between the steps of your appeal. However, they can make sure that you are prepared for each step and will work to resolve your claim during the early stages. Our Social Security disability attorneys can:
- Help you file your disability claim
- Evaluate your initial application to determine the reasons for your denial
- Help you gather new or missing medical evidence, financial information, and work history
- Correct clerical or technical errors on your application
- File for every stage of your appeal
- Guide you through the appeals process and represent you during an ALJ hearing
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Berger and Green
For assistance with your Social Security disability appeal, call Berger and Green today for a free consultation.
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