Key Takeaways:
- Most disability claims are denied because the evidence does not meet the Social Security Administration’s (SSA) strict definition of disability.
- The appeals process moves from “reconsideration” to a hearing, Appeals Council review, and federal court.
- Each appeal stage has a 60-day deadline.
- An appeals lawyer can identify the reason for a denial and build a stronger record.
A denied Social Security Disability insurance claim is not the end. You can appeal by requesting reconsideration within 60 days, then asking for a hearing before an administrative law judge if you are denied again. Strong medical evidence, timely filings, and a clear explanation of why the denial was wrong give you the best chance of winning benefits.
Why Most Disability Claims Are Denied
Most disability claims are denied because the application does not prove the person meets the Social Security Administration’s strict definition of disability. The condition must prevent substantial work and last at least 12 months or be expected to result in death. Common reasons for denial include:
- Medical records that are missing, outdated, or too vague
- Earnings above the substantial gainful activity limit
- Not following treatment a doctor prescribed
- Missing a consultative exam scheduled by SSA
- A finding that you can still do other types of work
The SSD Appeals Process: Reconsideration to Hearing
The first step in the SSDI appeals process is filing a request for “reconsideration.” The agency that reviewed and denied your initial claim will consider it again with a different person making the decision. They will review the same file that was presented, along with any additional evidence that you added to the file in the wake of the initial denial.
If the request for reconsideration results in another denial, you then have the ability to request a hearing in front of an Administrative Law Judge. While the judge may be a government employee, they have the full authority to rule against the agency in an appeal. This is often the stage at which claimants win their case.
Appeals Council review is the third level of the Social Security disability appeals process, after reconsideration and the ALJ hearing. If you still are not successful, you can then take your case to federal court. Here, you do not get an entirely new hearing along with the ability to add evidence. The judge will rule on the briefs and the record that they see in front of them.
Deadlines You Cannot Miss
Most SSDI appeal deadlines are 60 days from the date you receive a denial notice. The Social Security Administration assumes you received the letter five days after the date printed on it, unless you can prove otherwise. The same 60-day window applies at each stage:
- Request reconsideration after an initial denial
- Request a hearing before an administrative law judge after a reconsideration denial
- Ask the Appeals Council to review a hearing decision
- File a lawsuit in federal district court after the Appeals Council rules
You must also submit “written evidence” at least five business days before your hearing under 20 CFR 404.935. If you miss a deadline without good cause, the last decision can become final.
How an Appeals Lawyer Strengthens Your Case
When you file an SSDI appeal, you need to have a plan ahead of time. First, you need to understand the reason for the denial and be able to either add evidence or explain the issue during the Appeals process. An appeals lawyer will review your case to determine how you can strengthen your claim going forward. Then, they will draft the relevant filings, whether you are seeking reconsideration or appealing your case to an administrative law judge. Along the way, they will argue why the government made a mistake in denying your claim and can represent you throughout the process, including if your case ends up in federal court.
Our Experienced Sacramento Social Security Disability Lawyers at Walters & Zinn, Attorneys at Law, Will Help You Fight for Your Denied Social Security Disability Benefits
If your claim for benefits has been denied, our Sacramento Social Security disability lawyers at Walters & Zinn, Attorneys at Law, can help. Learn more about filing an appeal during a free consultation; contact us online or call today at 916-610-4706. With office locations in Folsom and Fairfield, California, we proudly serve clients in the surrounding areas.