According to the Social Security Administration (SSA), over 70% of applications for Social Security disability benefits are denied every year. What you might not realize, however, is that denial does not necessarily have to end your claim.
SSA provides options for reversing a denial. Through these procedures, you can present new medical evidence and argue against incorrect applications of the law.
Here is some information about your next steps after SSA has denied your claim for Social Security disability benefits.
Grounds for Denial of Disability Benefits
SSA divides denials into two categories. Technical denials happen when SSA has found a problem in your claim. Medical denials happen when SSA does not believe your disability qualifies for benefits.
If you received a technical denial, it means that SSA never reviewed your medical records. Instead, it denied your claim based on a problem with your claim or work history.
If you received a medical denial, SSA reviewed your medical records but found:
- Insufficient documentation of your disability
- Your illness or condition did not fit into one of SSA’s listings
- Your disability does not prevent you from working or training
SSA could issue a medical denial if your doctor failed to conduct one of the tests SSA expects for your condition. Similarly, SSA could issue a medical denial if you worked or earned more than SSA allows. This would show that your condition or illness did not interfere with your ability to work.
Technical denials make up over 37% of denials. This means that you can substantially improve your chances of having your claim accepted if you can avoid technical problems with your claim.
If you can get past the technical review, SSA approves 51% of disability claims. In 2019 — the most recent year reported — SSA approved 529,599 claims for disability benefits.
Next Steps After a Denial
If SSA denies your claim, you have several ways to have your claim reviewed.
Request for Reconsideration
First, you can request reconsideration of your claim. You must request reconsideration within 60 days of the decision to deny your claim.
Reconsideration takes place at the same level as the initial decision. A different disability examiner will review your application and accept or deny the claim. You can submit new medical evidence or correct problems in your claim when you request reconsideration.
In 2019, SSA permitted 12.8% of the claims for which applicants requested reconsideration. But bear in mind that because of the massive number of claims received every year, SSA only allowed 39,612 claims to move forward with reconsideration.
Appeal and Hearing
If you do not receive an allowance for reconsideration, you can file an appeal. An appeal moves one level up from the disability examiners to an administrative law judge (ALJ).
ALJs are usually lawyers trained in Social Security and disability law. Before your hearing, you can submit new medical evidence or make legal arguments against the grounds for denial.
In 2019, ALJs allowed 54.5% of claims that were previously denied. This extraordinarily high rate means that you have a fair chance of getting disability benefits, even if you’ve had two prior denials.
If an ALJ denies your claim, you can seek a higher-level review. You can request a review by the Appeals Council. However, you cannot submit new evidence to the Appeals Council. Instead, your request must usually cite a legal error by the disability examiner and ALJ.
The Appeals Council does not accept every case for review. If the Appeals Council accepts a case for review, it can uphold, modify, or reverse the ALJ’s decision. The Appeals Council can also vacate the ALJ’s decision and send it back to the ALJ for a new hearing and decision.
If the Appeals Council denies review or upholds the rejection of your claim, your last option is to file a lawsuit in federal court. Federal court judges must defer to the denial if it is supported by substantial evidence.
As a result, judges can reverse denials if the ALJ committed a legal error or the record lacked substantial evidence to support the ALJ’s decision.
The Role of the Disability Lawyer
A disability lawyer can prepare your claim so you reduce the risk of a technical denial. This can substantially improve your chances of acceptance. A disability lawyer can also prepare the evidence needed to fight a medical denial during reconsideration or appeal.