The Social Security Administration (SSA) offers disability benefits to individuals who are unable to work due to an illness or injury. Nonetheless, they do not make these benefits easily available. Navigating the application process — and the federal bureaucracy — is daunting. Moreover, the eligibility requirements are stringent, and nearly two-thirds of initial benefits claims are denied. While applicants have a right to appeal a denial, achieving a successful outcome depends on working with an experienced disability benefits attorney.
With offices in Tempe, Phoenix, and Tucson, the Disability Attorneys of Arizona provide comprehensive legal services to disabled individuals. Well-versed in the eligibility requirements for obtaining disability benefits, we guide clients through every phase of the disability benefits claims process. Our processes are designed to increase the likelihood of your claim being approved and guide you through the appeals process in the event of a denial. When you consult us, we will make sure you receive the medical care you need and the disability benefits you deserve. Contact our office today for a free evaluation of your case.
The Disability Benefits Application Process
There are two benefit programs available through the SSA, Social Security Disability Insurance (SSDI or SSD) and Supplemental Security Income (SSI). While there are specific eligibility requirements for SSD and SSI, for either you must be able to show that you are unable to perform any substantial gainful activity (SGA).
An application for disability benefits can be submitted by mail, online (the SSA recommends setting up a My Social Security account), or visiting the local SSA field office in your state. In completing the application, you must be able to answer a series of questions about your disability and work history. The application also includes a detailed questionnaire about your ability to perform daily activities. Specific personal information that must also be provided includes:
- Social Security Number
- Birth certificate
- Physician(s) contact information
- Names and dosages of prescription medications
- Complete medical records
- Detailed work history
- Copy of most recent W-2 or 1099
Your treating physician must also provide the Social Security examiner with medical records, such as an exam history, diagnosis, and prognosis of your illness or injury, results of any surgeries, list of prescribed medications, and records of any rehabilitation and/or therapy. While such records will support your claim, you may also be required to submit to a consultative exam with a physician selected by the SSA. Ultimately, you must be able to demonstrate that you have a medical impairment that has lasted, or is expected to last at least 12 months or is predicted to result in death.
Because the examiner’s final determination will be based on the information provided in the application, it must be error-free and include all the required information and medical evidence. If there are mistakes and/or omissions in any aspect of the application, the medical evidence does not support your claim, or your condition does not qualify as a medical impairment, your claim will be denied.
How Social Security Disability Benefits Claims are Evaluated
The examiner first looks to whether or not you have earned sufficient work credits, which are derived from your total annual wages or self-employment income. You can earn a maximum of 4 credits per year, and the total number of work credits you must have earned depends on your age at the time you became disabled.
Generally, to meet this test, it is necessary to acquire 40 credits. Half of these credits must be earned in the last 10 years, ending with the year you became disabled. Younger workers who have paid into the system for a shorter period of time, however, may qualify with fewer credits. If all of these conditions are met, the application is then sent to Disability Determination Services (DDS) for a comprehensive review.
THE DDS Process
DDS makes its decision regarding whether to approve or deny your claim by reviewing all the information and medical records included in the initial application. While the SSA maintains a listing of qualifying medical conditions, the DDS will approve or deny your claim regardless of whether your specific impairment is included in this listing. If it is not, you may still be eligible if your condition is medically equal to a listed impairment.
In addition to determining whether you have a qualifying medical condition, the DDS will also assess whether or not you (1) are able to perform the same type of work you did before the onset of the disability, or (2) can be trained for another type of work. If the medical information provided by your physician is found to be insufficient, you will be required to undergo go one or more consultative exams with an independent physician selected by the SSA.
The results of these examinations will weigh heavily in a final disability benefits determination. Once the DDS arrives at a decision, you will be informed of that decision in writing. If your disability benefits claim is approved, the letter will specify:
- The amount of your monthly benefit
- The date benefit payments will begin
- Whether the benefits are retroactive to the date you became disabled
If the claim is denied, the letter will provide a reason for the denial, inform you of your right to appeal the decision and how to initiate the process.
Why are disability benefits claims denied?
Nearly two-thirds of benefits applications are denied. SSDI is typically denied because the applicant did not have sufficient work credits, there were errors or omissions in the application, or the submitted medical information did not support the claim. As for SSI, these benefits are reserved for those with limited financial resources and the method of determining income and assets is complicated. The best way to avoid mistakes during the application phase is to work with an experienced disability benefits attorney.
Why Would SSI Be Denied?
One of the primary reasons for an SSI application denial is because the applicant earns too much income. SSI is a benefit program designed specifically for low-income individuals. Even more specifically, SSI is for low-income individuals who are unable to make more than the substantial gainful activity level.
One of the other central qualifications for SSI benefits is that your impairment which prevents you from substantial gainful activity last for a minimum of one month or will result in your death. Blindness is the only exception for this requirement. If your impairment will not last at least a month, then SSI will be denied. This, of course, is out of your control. However, if your impairment will last at least a month, but there is a failure in the medical evidence to support this assertion, then your SSI will be denied. The medical evidence, your medical records, must support the fact that your impairment will last at least a month in duration or eventually prove fatal. Your doctor needs to put in the records that your impairment prevents you from working and meets the durational requirements for SSI.
In some cases, an individual is denied SSI simply because the Social Security Administration (SSA) and Disability Determination Services (DDS), the agency tasked with determining medical eligibility for SSI benefits, cannot find you. You need to be sure to provide them with up to date contact information and respond to requests for scheduling examinations as well as complying with other requests. In addition to communication failures resulting in SSI denials, uncooperative applicants are also at risk of being denied benefits. You must comply with records requests and other SSI application requirements. Refusal to comply with SSA requests may very well lead to a denial of SSI benefits.
You may also be denied SSI benefits if you fail to comply with follow up with therapy prescribed by your doctor. While there may be legitimate excuses for failing to go to prescribed therapy, it can also be a valid basis for denying SSI benefits. Your SSI benefits may also be denied if your disability is due to drug addiction or alcoholism. While you may struggle with alcoholism or drug addiction and still qualify for SSI, a DDS medical consultant must decide whether or not the SSA would find you disabled even in the event you stopped use of drugs or alcohol
How to Appeal a Disability Benefits Claim Denial
Although you have the right to file an appeal if your claim is denied, you must act quickly because the SSA imposes strict deadlines at each stage of the appeals process. After you receive notice of denial, you must file a request for reconsideration within 60 days of receiving the denial notice.
An SSA medical consultant and an examiner who did not participate in the initial decision will reevaluate your application. Generally, a reconsideration claim will only be approved if there has been a new diagnosis or the condition has become more severe. If the reconsideration claim is denied, the next step is to request a disability hearing within 60 days of the denial. The hearing will be presided by an Administrative Law Judge (ALJ).
Unlike a court judge who is appointed or elected, an ALJ is usually an SSA staff attorney who is authorized to uphold or reverse the ruling. The ALJ will ask you a series of questions, under oath, about your disability, your work history, and how the disability affects your daily living activities. It is crucial to be represented by an experienced disability benefits attorney who can arrange for a medical expert to provide testimony in support of your claim.
If the ALJ denies the claim, you have a right to request the Appeals Council to conduct a review. The Council can either overturn the decision, send it back to the ALJ for reconsideration, or deny the claim. If the Appeals Council denies the claim, it may be possible to file a lawsuit in federal court to have the decision overturned.
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.
Higher-Level Appeals
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.
Contact Our SSDI/SSI Appeals Lawyer
If your application for SSDI or SSI has been denied, you may have concerns about finding the medical care you need, as well as supporting yourself and your family. We can help to address those concerns by explaining all of your rights, guiding you through the appeals process, and fighting for the disability benefits you deserve. When your physical, emotional, and financial welfare is on the line, the Disability Attorneys of Arizona will provide you with the aggressive legal representation you need and the caring, personal service you deserve. Please contact us today by calling (800) 975-1866. You will not pay any attorneys’ fees unless we win your case.