Understanding the Appeals Process for Denied Social Security Claims

When you're unable to work due to a disability, Social Security benefits can be a vital source of financial support. But getting approved isn't always easy. Many applicants receive a denial after their initial application, leaving them frustrated and uncertain about what to do next.

Fortunately, the Social Security Administration (SSA) has an appeals process that allows applicants to challenge denied Social Security claims and continue pursuing the benefits they need.

Understanding the appeals process is key to successfully overturning denied Social Security claims. Each stage of the process has different requirements, deadlines, and steps that must be followed carefully. Armstrong Law Offices, P.S. in Kent, Washington, can break down the appeals process from the first reconsideration request to a potential federal court review.

The Four Levels of Appeal

The SSA provides four levels of appeal for denied Social Security claims. Each stage gives applicants another opportunity to present their case and provide additional evidence.

1. Reconsideration

This is the first step in the appeals process. According to the SSA, you have 60 days from the denial date to request reconsideration. A different claims examiner will review your case and any new evidence you submit.

Most reconsideration requests are also denied, but this step is necessary to proceed to a hearing.

2. Hearing Before an Administrative Law Judge (ALJ)

If reconsideration is denied, you can request a hearing before an ALJ. The hearing allows you to present your case in person, submit new medical records, and bring witnesses such as doctors or vocational experts. The ALJ will review all evidence and issue a decision.

Many applicants are approved at this stage, making it one of the most critical parts of the appeals process.

3. Appeals Council Review

If the ALJ denies your claim, you can request a review by the SSA’s Appeals Council. The council will examine the ALJ’s decision to determine if any errors were made. They can either uphold the decision, send it back for another hearing, or overturn the denial.

Only a small percentage of cases are reversed at this level.

4. Federal Court Review

If the Appeals Council denies your request or upholds the ALJ’s decision, the last option is to file a lawsuit in federal court. A federal judge will review your case and determine if the SSA made any legal errors. This process can be lengthy and requires legal representation.

Each level of appeal builds on the previous one, meaning strong preparation from the beginning can increase your chances of success at later stages.

Reasons Why Social Security Claims Are Denied

Understanding why Social Security claims are denied can help you strengthen your appeal. Common reasons for denials include:

• Lack of medical evidence: The SSA requires medical documentation proving your disability prevents you from working. If your medical records don’t demonstrate the severity of your condition, your claim may be denied. This includes insufficient test results, lack of ongoing treatment, or failure to submit records from physicians.

• Earnings above the substantial gainful activity (SGA) limit: If you earn more than the SSA’s monthly limit, you won’t qualify for benefits. The SSA sets an income threshold each year, and if your earnings exceed this amount, your claim will likely be denied regardless of your medical condition.

• Failure to follow prescribed treatment: If you don’t follow your doctor’s treatment plan, the SSA may assume your condition isn’t as severe as claimed. For example, if your doctor prescribes medication, physical therapy, or other treatments, and you don’t comply, the SSA may argue that your condition could improve with proper care.

• Short work history: For Social Security Disability Insurance (SSDI), you need enough work credits to qualify. If you haven’t worked long enough or recently enough to earn sufficient credits, you won’t be eligible for SSDI. However, you may still qualify for Supplemental Security Income (SSI).

• Previous denials: Some applicants reapply instead of appealing, which often results in another denial. The SSA keeps a record of previous applications, and submitting a new one without addressing the issues that led to the original denial will likely lead to the same outcome. It's usually better to appeal rather than start over.

• Failure to cooperate with the SSA: If you don’t respond to requests for additional information, attend scheduled medical exams, or provide necessary documentation, your claim may be denied due to lack of cooperation.

• Drug or alcohol abuse affecting your condition: If the SSA determines that drug or alcohol use is a significant factor contributing to your disability, your claim may be denied. However, if you can prove that your condition would persist regardless of substance use, you may still qualify for benefits.

Knowing these common pitfalls can help you address any issues in your appeal and build a stronger case.

Gathering Strong Evidence for Your Appeal

To improve your chances of approval, you should gather additional evidence that supports your claim. This may include:

• Updated medical records: Request recent records from your doctors, hospitals, and specialists. Outdated or incomplete records can weaken your case, so it’s crucial to submit the most up-to-date medical evidence.

• Detailed physician statements: Ask your doctor to provide a written statement explaining how your condition limits your ability to work. The SSA gives great weight to medical opinions, especially when they come from specialists who have treated you regularly.

• Functional capacity evaluations: These assessments measure your ability to perform daily activities and work-related tasks. A physical or occupational therapist can conduct these tests and provide documentation supporting your Social Security claims.

• Work history records: Provide details about your past jobs and how your condition prevents you from performing them. This includes job descriptions, employer statements, and any accommodations you required before you stopped working.

• Daily activity logs: Keeping a journal of how your condition affects your everyday life can provide a valuable look into your limitations. Describe how pain, fatigue, or other symptoms impact your ability to perform basic tasks such as cooking, cleaning, or driving.

• Witness testimony: Statements from family members, caregivers, or former employers can help demonstrate the impact of your disability. These individuals can provide firsthand accounts of how your condition affects your ability to function on a daily basis.

• Psychological evaluations: If you have a mental health condition, an evaluation from a psychiatrist or psychologist can provide additional evidence to support your claim. Mental impairments can be just as disabling as physical conditions, and proper documentation is essential.

• Medication side effects documentation: If the medications you take for your condition cause side effects that limit your ability to work, having a record of those effects can strengthen your case. Ask your doctor to document these side effects in your medical records.

The more evidence you can provide, the stronger your case will be. Submitting thorough documentation that clearly illustrates your limitations can significantly improve your chances of getting approved.

Smart Ways to Prepare for Your Hearing

The hearing before an ALJ is often the best chance to get a denial overturned. Preparation is key, and taking the following steps can help you present a strong case:

• Review your file: Understand why your claim was denied and be prepared to address those reasons.

• Work with an attorney: A legal representative can help you organize your evidence and present your case effectively.

• Practice your testimony: Be ready to explain how your condition affects your daily life and ability to work.

• Bring supporting documents: Have all relevant medical records and supporting statements ready for submission.

A well-prepared hearing can significantly increase your chances of getting a favorable decision.

What Happens After the Hearing?

Once the ALJ makes a decision, you'll receive a written notice outlining the outcome. There are three possible results:

• Approval: If the judge rules in your favor, you’ll start receiving benefits, including potential back pay.

• Denial: If your claim is denied, you can request an Appeals Council review.

• Partial approval: In some cases, the judge may approve benefits for a limited period or under specific conditions.

If your claim is denied again, you still have the option to continue appealing. The appeals process can be made easier with the help of a skilled attorney.

Contact Us Today

Appealing a denied Social Security claim can be frustrating, but it’s not the end of the road. Legal representation from Armstrong Law Offices, P.S. in Kent, Washington, can make a big difference, giving you the best chance of success. Attorney James Armstrong also serves Seattle, Tacoma, and Renton, Washington. If your claim has been denied, call today for a free consultation.