If your disability benefits claim is denied, you can appeal the Social Security Administration’s (SSA) decision. However, appeals can be complex. The National Council on Aging (NCOA) suggests that if you believe your denial is in error, you should find a lawyer familiar with Social Security to assist you.
What Do You Need to Qualify for Disability Benefits?
There are two different Social Security disability programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both programs require that you have a condition that is disabling.
However, to be eligible for SSDI, you must have earned enough work credits by paying into the Social Security system through taxes on your wages. To qualify for SSI, you do not need work credits. This needs-based program provides benefits to individuals with very low income and limited resources.
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Why Was Your Claim Denied?
According to the Social Security Office of Retirement and Disability Policy, the SSA denies more than 60% of disability claims, and denials have increased by nearly 10% since 2010. There are many reasons you may receive an initial denial, including:
- Lack of medical evidence
- The SSA does not believe your disability will last at least 12 months
- You make too much money from working
- You do not have enough earned work credits
- You made a technical error on your application
- You did not provide correct or up-to-date contact information
- You did not provide proof of citizenship or lawful alien status
- You did not correctly complete or submit an Adult Disability Report
Qualifying Conditions
To receive disability benefits, you must have a qualifying medical condition. Eligible conditions include:
- Respiratory disorders
- Skin disorders
- Mental disorders
- Cancer
- Chronic heart problems
- Immune disorders
- Musculoskeletal disorders
- Hearing, vision, or speech impairments
- Congenital conditions affecting multiple body systems
- Blood disorders
- Chronic kidney disease
- Neurological disorders
- Digestive system disorders
You can find a complete list of eligible injuries and illnesses in the SAA Blue Book. However, just because your specific condition is not listed does not mean you do not qualify. The SAA adds new conditions to the Blue Book every year, and if you can prove your disability prevents you from earning a substantial income for at least one year, you may still receive benefits.
Income Requirements
While work credits only affect SSDI claims, SSDI and SSI both require that your disability prevent you from performing substantial gainful activity (SGA). According to the SSA, the SGA limit for 2022 is $1,350 per month ($2,260 for blind individuals). Therefore, if you earn more than this amount, you may not qualify for benefits.
How Do You Appeal If Your Disability Benefits Claim Is Denied?
If the SSA denies your benefits application, you can file an appeal. There are four stages to the appeals process, and you can potentially resolve your claim at any stage:
Reconsideration
The first step of an appeal is to request reconsideration for either medical or non-medical reasons. A person not involved with your initial decision will review your application and make a determination. You must file for reconsideration within 60 days of receiving an application denial.
Administrative Law Judge (ALJ) Hearing
If you are not satisfied with reconsideration, you can ask for an ALJ hearing. A hearing can occur in person, over the phone, or by video conference. During the proceedings, the Judge will review the evidence and may question witnesses, such as medical professionals or vocational experts. You have 60 days from receiving the reconsideration decision to file for a hearing.
Appeals Council Review
You can request that the Appeals Council review the ALJ’s decision. However, the council will only permit the review if they find a Social Security law or regulation issue. The Appeals Council will either make a decision or refer your case back to the ALJ. Again, you have 60 days from receiving notice of the ALJ hearing decision to file for review.
Federal Court
If all other attempts have been unsuccessful, you can file a civil action in the United States District Court. You must file your case within 60 days of notice of the Appeals Council’s decision.
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What Can a Disability Attorney Do?
A Social Security disability attorney with our firm can represent you through every step of your case, starting with evaluating your initial application. We will correct any application errors and gather additional evidence to support your medical claims and illustrate your work history. Finally, we will file your reconsideration paperwork or hearing requests and represent you during your ALJ hearing or in court if necessary.
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Contact Berger and Green
Berger and Green has helped thousands of clients across Pennsylvania and Ohio successfully seek Social Security benefits. We can assist with your appeal for no upfront fees. We only get paid if we win your case. To learn more, contact us for a free consultation.
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