Denied Social Security Benefits Appeal Process: 5 Easy Steps

Being denied Social Security benefits can be disheartening, but it’s important not to lose hope. By understanding the process and taking the appropriate steps, individuals can increase their chances of having their claims approved on appeal.

The Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) offers the highest percentage, 85%, of its benefits to disabled workers. In 2021, the program disbursed over $11.9 billion in payments to disabled beneficiaries, representing a slight increase compared to the $11.6 billion disbursed in 2020.

In this article, we’ll explain what to do if denied social security benefits and the reasons for denial. We’ll also discuss the benefits of seeking legal representation and more.

Denied Social Security Benefits Appeal Strategies

If you receive a denial for social security benefits, don’t lose hope; you may appeal the decision. The time frame for filing an appeal‌ is 60 days from the date you receive the denial letter. You can file an appeal online, in person, or by mail.

There are four strategies to follow while filing an appeal:

Request a reconsideration
Request Judge hearing
Request Appeal Council Review
Filling a Federal Court Review

1. Request a Reconsideration

When you request a reconsideration, someone who wasn’t involved in the first decision will review your claim, including any new evidence you provide.

If you’re disputing a determination related to your disability, your request will go to the Disability Determination Services (DDS) in your state, and you may receive letters from them during the review process.

If you’re appealing a non-medical issue, like an overpayment, your local SSA office or payment center will handle your reconsideration. The person handling your appeal may reach out to you for additional evidence.

2. Hearing by an Administrative Law Judge

If you’re not satisfied with the results, you may request a hearing on your claim. An administrative law judge who wasn’t involved in the initial decision will review your case and examine all the evidence.

Your local office will send your hearing request to one of the SSA offices, and you’ll receive information about the hearing process. The SSA will notify you once they schedule your hearing.

Visit the SSA official website to learn more about the hearing process.

3. Request Appeal Council Review

If you disagree with the decision made at your hearing, you can request a review by the Appeals Council using Form HA-520. The Council can either deny or grant your request for review.

If they grant it, they will either issue a new decision or send your case back to an administrative law judge for further action.

4. Filling a Federal Court Review

If you don’t agree with the decision made by the Appeals Council or if they deny your request for review, you can take your case to Federal district court by filing a civil action. Here, you’ll need to seek a legal professional to guide you through.

Reasons Why You Might be Denied Social Security Benefits

While applying for SSDI or SSI benefits, it’s wise to think of reasons that might disqualify you from getting disability benefits. Knowing weakness in your disability application will help you work on how to strengthen your claim.

In some instances, reasons for denial are beyond your control. However, knowing the reasons behind it will increase your chances of approval.

Below are some reasons why you might be denied SSDI or SSI benefits:

Incomplete or inaccurate information on your application

Incomplete or inaccurate information on your disability application may led to denied social security benefits. When applying for social security disability benefits, your state agency that determines your medical eligibility – Disability Determination Services (DDS) must be able to contact you regarding disability applications.

The DDS ease application process for Social Security Disability at the initial and reconsideration levels. If the DDS or SSA can’t reach or contact you due to incomplete or inaccurate information to schedule examination, it’ll lead to denied social security benefits.

Majority of disability claimants get denied most because DDS or SSA can’t reach or contact them. Ensure your details are complete, accurate and up-to-date such that SSA can reach you especially during hearing level.

Your Disability Based on Alcoholism or Drug Addiction

Disability that is only based on drug or alcohol abuse (DAA) lead to denied social security benefits. Social Security don’t approve disability applications if the only impairment is drug or alcohol abuse, it’s not allowed.

However, that does not mean any evidence of DAA will deny your claim. In such cases, recipients will need to prove the substance abuse is immaterial to their claims – meaning that if they stop the DAA they’ll still be disabled.

To prove, recipients need to provide medical records showing that they still have disabling symptoms from the underlying problem.

Insufficient medical evidence

In addition, insufficient medical evidence will cause denied social security benefits. If your application is for disability benefits, the SSA will require medical documentation to support your claim. Your benefits may be denied if your medical evidence is incomplete or doesn’t meet the SSA’s criteria.

Also, if you don’t attend consultative examination (CE) as scheduled by Social Security, your application may be denied. Social Security may sometimes need you to attend CE to get more details about your disability. CEs expense and transportation costs are covered by the Government.

In case you know in advance you can’t make it to a scheduled CE, it’s advisable you contact your claims examiner at DDS to do a reschedule at your convenient time. Failing to attend a scheduled CE will deny you Social Security disability benefits.

Failure to follow prescribed treatment

Also, failure to follow prescribed treatment will result to denied social security benefits. If the SSA determines that you’re not following the prescribed treatment for your condition, they may deny your benefits. However, they are certain justifications SSA may consider such as:

You don’t have money to pay for prescribed treatment
You’re having intense fear of prescribed treatment as indicated by your follow-up doctor
Your religion prohibit the treatment
Or maybe you’ve a severe mental illness that’s preventing you from getting the prescribed treatment.

Note that for Social Security to deny your claim due to failure to follow prescribed treatment, it must have been expected to restore your ability to perform SGA.

Earning too much income to qualify for SSI or SSDI

SSI and SSDI are two different benefits. SSI is the needs based benefit for individual below a set low income threshold while SSDI is the benefit program for recipients who have been paying Social Security system for continuous years.

Each benefit has its eligibility criteria that you must attain before you legally qualify to receive the benefits. Such as not earning above the set threshold limit considered as substantial gainful activity when filing for disability applications.

If you’re working and earning too much income, you may not be eligible for Social Security benefits. The SSA has specific income limits for each type of benefit. The SGA Limit 2024 is $1,550 per month adjusted each year.

How Social Security Disability Works

Social Security disability works by providing financial help to individuals who cannot work because of a severe disability. Applicants must meet specific Social Security Administration (SSA) criteria to qualify.

The disability must be expected to last at least one year or result in death. Applicants must also have earned enough work credits through previous employment.

It’s important to note that SSDI has a mandatory waiting period of at least five months before receiving benefits, except for cases of amyotrophic lateral sclerosis. For SSI, they receive the first payment for the first entire month after applying or becoming eligible.

Upon approval, beneficiaries receive monthly disability payments based on their average lifetime earnings. Social Security Disability aims to provide a safety net for individuals facing long-term disabilities, offering financial support to help cover living expenses and medical costs.

Benefits of Seeking Legal Representation for Denied Social Security Benefits

Hiring a Social Security attorney benefits those applying for disability benefits or appealing a denied claim. An attorney provides valuable legal expertise and guidance throughout the process and represents you at hearings or in court if necessary.

It’s essential to consider hiring an attorney if your claim is complex or if you need to become more familiar with the Social Security system. To find a qualified Social Security attorney, ask for referrals from friends or family or search online.

Look for an attorney who specializes in Social Security law and has experience with cases similar to yours. Also, check with your local bar association or legal aid organization for recommendations. Ensure to research potential attorneys and read reviews from past clients before deciding.

Tips for speeding up appeal process for Denied Social Security Benefits

If DDS denies your disability benefits, you may appeal for reconsideration. There are some tips for speeding up the appeal process:

Fill out a list of all your medical providers. Include their contact information and addresses.
Have a legal letter from a professional medical doctor detailing your disabled conditions and why you qualify for disability benefits.
Have a Residual Functional Capacity form filled out by a doctor detailing your condition and how it affects your workability.
Get a disability attorney to guide you.

chances of being approved for Denied social security benefits

After a denial of Social Security benefits, the chances of being approved for disability benefits ‌increase at the reconsideration level. 79.3% of disability applications get rejected by DDS at this level, leaving room for appeals.

However, the Social Security Administration states that 85% of reconsideration requests are still denied.

Legal representation, such as an attorney or advocate, can improve the odds, with approval rates around 60%. More than half of the claims get approved at the hearing level, and approval rates are higher during the appeals process than during the initial review.

Approval rates vary by state, for example; Arkansas has a 72.2% approval rate for appeals, New York has a 78.9% approval rate, and California has a 70% approval rate. However, the average approval chances for reconsideration are only 13%.

The Bottom Line

Applying for and receiving Social Security benefits can be complex and challenging. If you’re denied Social Security Benefits, you’ve got the right to appeal. The process has four strategies; requesting a reconsideration, a hearing, a review, and a federal court review.

Some reasons for being denied Social Security Benefits may include not meeting the eligibility requirements, insufficient medical evidence, not following medical treatments, etc.

If you’re struggling with the process, ‌seek help from qualified professionals or support from friends and family. Remember, you may appeal and receive the benefits you’re entitled to within 60 days after receiving the denial letter.