It is a sad truth that your long wait for a Social Security Disability benefits decision will likely end in a denial. Many people will give up after that initial decision or make the mistake of filing a new claim.
Neither course of action is a good decision. There is still life after the initial denial as the Social Security Administration offers an extensive appeals process. While it may take even more time and place you in a position of uncertainty, the important part is that there is still hope of securing benefits. Here are the steps you can take after a denial as well as actions to avoid.
Social Security Disability Claim Denial: Your Most Likely Scenario
Being denied is an expectation with every Social Security Disability application. The average success rate for initial applications between 2001 and 2010 was 28 percent. Denied disability claims averaged 53 percent during that same time frame.
The most common reason for denial is a lack of medical evidence. This frequently arises because applications are submitted by laypeople and may not contain all the needed information. It is also not uncommon for doctors to fail to submit needed reports or provide records. Also, since the rate of denial on the initial application is so high, most will not bother with hiring an attorney until the appeals process, which also leads to incomplete information. If you fail to allow authorization to access your medical records, that will also mean a denial since the agency cannot get the information it requires.
Other reasons for denial include excessive income or failure to consistently receive medical care. People with criminal histories or drug or alcohol addiction can also expect a denial on the first application. Denials can also arise from a criminal history or a pattern of drug addiction.
The “Worn Out Worker”
If you have been denied for Social Security Disability benefits and meet the three criteria listed below, you may be successful when your case is heard before a Law Judge.
- To be considered a “worn out worker” one must have 35 years experience in an unskilled job;
- It must be demonstrated that that person is physically unable to perform the unskilled labor he or she has done for so long;
- The worker must have no more than a 6th grade education
If these criteria can be met and the medical evidence supports an inability to work in the unskilled position, you may have a decent chance of approval at the hearing level.
Time For The Appeals Process
When you receive your denial notice, time is of the essence. Immediately download the Request for Reconsideration and fill it out to preserve your appeal rights. Deadlines and links will be contained in this notice so read it carefully.
Like your initial application, the Social Security Administration can deny your Request for Reconsideration as well. Decisions normally arise three to four month after you file that form. Once you receive the denial, you can file a request for a hearing. In New York, it can take an average of 14 months until your case is heard in front of the administrative law judge. As that is an average, prepare to wait for almost two years.
Even the administrative hearing is not the end of the line if that too ends in a denial. You then have the options of the Appeals Council. The council chooses which cases to review so your possibilities are a rejection, a denial or an approval. It will take another year to reach a decision at this level.
Your final stop in the Social Security Disability escapade is the federal court system. Taking this step involves filing a lawsuit in the appropriate district court in your area. The denial from the Appeals Council will include information about taking that step.
What To Do, What To Avoid
First and foremost, never expect an immediate decision. You may be one of the lucky few who receive an early decision but never count on that outcome. Expect this process to take a long time and make plans. Minimize your expenses as much as possible and apply for other benefits. You may also want to weigh carefully whether disability is the right decision for you or if there is some type of minimally demanding work you can perform.
Second, use the time to build your case. Follow your attorney’s instructions carefully and sign authorizations needed to collection medical records and reports. While waiting for decisions, filling in paperwork, and receiving more denials may appear burdensome, it will work to your advantage in one way—more time to prepare your case. Collecting information and attending appointments develops better evidence for your case. Since most claims are denied due to a lack of evidence, time can build a stronger case that may prevail on appeal.
Finally, resist the temptation to let your claim expire so you can file a new one. There are claimants who let their appeal rights go thinking it will be easier to start at the beginning. There is no bigger disruption to your case. That course of action only starts your claim over so you have to jump through the same hoops again. You are much better off sticking with the multiple appeals processes.
Hire An Attorney
As you experience the Social Security Disability gauntlet, you will require legal assistance. There are many forms to complete, medical records to collect, and administrative processes that will likely overwhelm you. Focus on managing your medical condition rather than the multiple demands of the Social Security Administration.
Paul Giannetti, Attorney At Law, offers free consultations for those seeking disability benefits. Call (866) 868-2960 to make an appointment and start this process effectively.