Your Disability Application Is Denied, But Can You Appeal?

One of the biggest issues concerning most disabled individuals, after finding adequate medical care, is figuring out how to financially support themselves. Social Security Disability Insurance (SSDI) is the avenue many take to obtain regular income. This option is available to individuals who worked in the past, but now find themselves unable to do so due to a mental or physical impairment. The application process to apply for disability benefits is fairly involved, and application can take days to complete depending on how extensive one’s work and/or medical history is. Consequently, when a letter denying disability benefits comes in the mail, the disabled applicant is often devastated. Thankfully, this is not the only opportunity someone has to make a disability claim. Anyone denied SSDI has the right to appeal, and the appeals process has many intermediate steps before a denial of disability benefits becomes final. Given that the approval rate for disability claims during the initial application stage is only 35 percent, the majority of those seeking SSDI will need to appeal. Thus, understanding the appeals process is very important to the successful award of disability benefits.

The Initial Application Review

While disability benefit eligibility is ultimately decided by the Social Security Administration (SSA), SSDI applications in Florida are funneled through the Florida Division of Disability Determinations, where an individual’s medical eligibility for benefits is decided. Assessments of non-medical eligibility (work history, for example) are made by the SSA. The processing time for this stage of an application is typically three to six months.

Reconsideration

Reconsideration is the first step in the appeals process, and must be requested within 60 days of a receiving a denial of SSDI benefits. If this 60-day window is missed, a new application must be filed. Reconsideration involves a review of an applicant’s file by a new examiner, but the same rules for determining whether to approve benefits apply, so approval at this stage is unlikely unless something was left off the initial application or new medical evidence is available for submission. Thus, any updates on a person’s medical condition, treatment or diagnosis should be forwarded to the SSA to give an applicant the best chance of success at this stage.

Administrative Law Judge Hearing

A hearing before an administrative law judge (ALJ) is the next step in the appeals process, and the one where an applicant is most likely to receive an approval of benefits. Again, a person has 60 days from the time a denial by the reconsideration examiner is received to request a hearing. Examiners affiliated with the SSA no longer have control over a decision, and an ALJ is permitted to make a determination based on evidence or testimony presented at a hearing. Having an attorney at this stage of the appeals process is very important to an approval of benefits by an ALJ, because the lawyer will know the types of evidence to submit, and the most effective way to present an applicant’s claim. Note that it is not uncommon for it to take over a year to a year and a half for a hearing to be scheduled.

Appeals Counsel

If a claim is still denied, the next step is to appeal to the SSA Appeals Council. Success at this stage is low because the Council only reviews whether the ALJ correctly applied the law. The Council does not review the substance of the disability claim itself. Typically, it takes six months to two years to receive a decision, and if the Council does think error occurred, it will refer the claim back to the ALJ.

Petition in Federal Court

The final step in the disability appeals process is to file a petition in federal court. At this stage, a lawyer is almost certainly needed if not already retained. The decision is entirely based on a brief filed with the court and in some cases, oral arguments before the judge. New evidence, testimony or documentation is not permitted. Federal courts are currently backlogged, and it can take well over a year for a decision to be made.

Work with a Disability Insurance Lawyer

The claim process for SSDI benefits can easily become overwhelming for an applicant, but an experienced disability insurance attorney can provide the guidance and expertise needed to get the benefits you deserve. Farrell Disability Law helps clients throughout Florida and South Georgia get the money they need. Contact us for a free consultation.

Resource:

floridahealth.gov/programs-and-services/people-with-disabilities/disability-determinations/index.html