A Primer on Disability Appeals

What can I do if my application for SSDI is denied?

Let’s face it: anyone can become disabled due to an accident or illness and be unable to continue working. While the Social Security Administration (SSA) has a program that provides benefits to disabled individuals, Social Security Disability Insurance (SSDI), obtaining these benefits can be difficult.

Eligibility for SSDI

To be eligible for disability benefits, you must have an injury or illness that prevents you from participating in substantial gainful activity. In particular, the medical condition must be expected to last for at least one year or result in death (the SSA has guidelines for medical conditions that qualify). There are however, a number of reasons that an application can be denied.

For example, your medical condition may not be on the list, or the SSA may determine that your condition is not a disability. In addition, in order to be approved for benefits, you must undergo an examination by an independent physician whose findings may not agree with those of doctor who treated you.

Added to this burden is the extensive paperwork that must be completed. If there are mistakes in the application or any required information is missing, the claim will be denied.  That’s the bad news.  The good news is that once you receive a notice of denial from  Disability Determination Services (DDS), the state agency in Arizona that determines whether your medical condition is a disability, you can file an appeal.

Appealing a Disability Denial in Arizona

If the DDS denies your disability application, the first thing to do is file a request for reconsideration within 60 days of receiving the notice of denial. Your application will be reevaluated by a different medical consultant and an examiner who were not involved in the initial determination. However, reconsideration claims are often denied; in fact only 5-10 percent are granted, particularly in cases in which there has been a new diagnosis or a condition has worsened.

If your reconsideration is denied, you have 60 days to request a hearing before an administrative law judge (ALJ). These judges are SSA attorneys who are tasked with upholding or overturning denials. Many disability applicants who are represented by an attorney with expertise in SSDI win these appeals. If you are denied by the ALJ, however, you can request the Appeals Council to review your claim.

The Council can either overturn the decision, send it back to the ALJ for reconsideration, or deny your claim in which case your last resort is to file a lawsuit with the U.S. district court. The judge will review the case for legal errors and determine if there are valid reasons to overturn the ALJ’s decision.

In the final analysis, whether you are submitting an initial application for disability benefits or considering pursing an appeal, your chances of having a claim approved are significantly greater when you have an experienced Social Security Disability attorney by your side.