Social Security Disability Appeals in Denver, CO

Navigating the Appeals Process to Strengthen Your Disability Claim

The Social Security Administration provides two primary programs for those unable to work due to a disability. These are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both programs require claimants to submit a detailed application with information on their medical condition, financial resources, and work history.

While the majority of Social Security Disability (SSD) claims are denied on the first attempt, there is an appeals process in place so that applicants can request further review.

If you’ve received a denial notice after applying for Social Security Disability benefits, the social security attorneys at Roeschke Law, LLC, can answer your questions about how to appeal and the next steps. You have limited time to submit your appeal, so contact our law firm today to start the process.

What Are Some Common Reasons a Social Security Disability Claim May Be Denied?

Social Security Disability claims can be denied for various reasons, from technical errors to the strength of the medical evidence. Understanding the most common reasons for denial can help you identify potential issues early on and mitigate their effect.

An Incomplete Application

Applications for both Social Security Disability Insurance and Supplemental Security Income are detailed and lengthy. So, it’s easy to miss a line, transpose numbers, or forget to include a piece of documentation. Around 30 to 40 percent of SSD applications are denied for technical reasons. You may be able to submit corrected paperwork or reapply if this is your situation.

Sometimes, the Social Security Administration may contact you to request more information when reviewing your claim. The reviewer may need additional medical documentation or require you to attend a consultative examination with an approved physician.

Failing to comply with these requests promptly can result in your claim being denied.

Lack of Evidence for a Medical Condition

Incomplete medical documentation is one of the most common reasons claims are denied. The SSA relies on detailed records, including physicians’ notes and test results, to determine if you have a qualifying medical condition. If there’s not enough evidence to show that your medical condition rises to the SSA’s definition of disability, a denial is likely.

To strengthen your claim, it is essential to gather comprehensive and consistent medical records that clearly demonstrate the severity and impact of your condition. This includes detailed reports from your primary care physician and any specialists involved in your treatment. Test results, imaging studies, and laboratory findings should be included to provide objective evidence supporting your diagnosis.

Additionally, the SSA looks for evidence that your condition has lasted or is expected to last at least 12 months or result in death. Therefore, medical documentation should reflect the chronic nature or expected duration of your disability. It is also important to show how your condition limits your ability to perform work-related activities, such as walking, sitting, lifting, or concentrating.

If your initial application lacked sufficient medical evidence, the appeals process offers an opportunity to submit new documentation. This can include updated medical records, specialist evaluations, or statements from treating doctors explaining how your condition affects your daily functioning.

Working with a social security disability attorney can be beneficial in this stage. They can help you identify gaps in your medical evidence, coordinate with your healthcare providers to obtain necessary documentation, and ensure that your medical records are presented clearly and persuasively to the SSA.

Remember, the quality and completeness of your medical evidence play a crucial role in the success of your disability appeal. Taking proactive steps to obtain thorough documentation can significantly improve your chances of a favorable decision.

Earning Too Much Income to Receive Benefits

A key component of qualifying for Social Security Disability benefits is not being able to engage in substantial gainful activity. This is the income threshold that the Social Security Administration sets as being able to hold regular employment.

If someone applies for benefits and is able to work part-time or as an independent contractor, their earnings could exceed the allowed limit, resulting in a denial. Even a few dollars over the limit can make a difference, so it’s crucial to track your earnings if you’re working to ensure that you’re not disqualifying yourself from benefits.

It’s important to understand that the Social Security Administration (SSA) uses specific income limits to measure substantial gainful activity (SGA). For 2024, the monthly SGA limit is $1,470 for non-blind individuals and $2,460 for statutorily blind individuals. If your earnings exceed these amounts, the SSA may determine that you are capable of substantial work, which can lead to denial or termination of benefits.

Additionally, the SSA considers not only your wages but also other forms of income, such as payments for services performed, self-employment income, and certain non-cash benefits. Therefore, even if you aren’t working a traditional job, income from freelance work or side gigs could impact your eligibility.

If you are working and applying for benefits, it’s advisable to maintain detailed records of your work hours, income, and the nature of your job duties. This documentation can be critical if the SSA questions your ability to engage in substantial gainful activity.

Not Complying With the Recommended Treatment

Claimants are expected to make reasonable efforts to improve their condition. This includes complying with the recommended course of treatment, whether that’s physical therapy or taking medication.

If medical records show that the applicant hasn’t followed through with what a doctor recommended, it could affect the claim. If there is a legitimate reason for the noncompliance, such as cost or debilitating side effects, an attorney may be able to help you overcome this issue.

Noncompliance with prescribed treatment can be viewed by the SSA as a failure to cooperate in your own recovery. This may lead to a denial or discontinuation of benefits because the SSA might conclude that your condition could improve if you followed medical advice.

However, the SSA also recognizes that some treatments can be prohibitively expensive, cause severe side effects, or be otherwise impractical. In such cases, it is important to document these issues thoroughly. Your social security attorney can help gather evidence such as statements from your healthcare providers explaining why you cannot comply with treatment and advocate on your behalf.

Moreover, if you have a mental impairment or other condition that affects your ability to understand or follow treatment plans, this should be clearly documented in your medical records. This can be a critical factor in explaining noncompliance to the SSA.

Overall, demonstrating a good faith effort to follow treatment recommendations, or providing valid reasons for noncompliance, can significantly strengthen your disability claim during the appeals process.

How Does the Appeals Process Work?

Requesting an appeal means you’re asking the Social Security Administration to take another look at your claim and see if there was an error with the initial determination. You can present new or additional evidence at this stage, such as including additional medical records or documents to support your work history.

Depending on the reason for denial, it can also help if you write a letter to clarify any misunderstandings or errors.

You generally have 60 days from the date you receive your denial letter to file an appeal. Unless you have documentation to show otherwise, the Social Security Administration assumes you received the denial letter within five days of it being mailed out. This is true for all levels of appeal.

Because of the quick timeframe, it’s critical to immediately contact a disability benefits attorney once you’re aware that your claim has been denied. They can help you understand the reason for denial and file your appeal to ensure you get a chance to present your case.

What Are the Different Levels of Appeal?

There are four levels of appeals for SSD benefits. In general, you must work your way through the levels of appeal, waiting for the decision at one level before you can proceed to the next.

Reconsideration

The first step in the appeals process for Social Security benefits is a reconsideration. At this level, another claims examiner who was not part of the original decision-making process reviews your application.

They will also look at any additional documentation or supporting evidence you submit. If the claims examiner believes that the initial reviewer made a mistake with your application, they can reverse the decision and approve your benefits.

Hearing Before an Administrative Law Judge

If the reconsideration doesn’t result in a change of decision, the next step is to request a hearing before an administrative law judge. This is a formal hearing, and you will have the opportunity to testify, present evidence, and answer any questions the judge may have about your claim.

You are allowed to have your attorney with you during this process, and you should. The legal procedures at the hearing can be intimidating for those who aren’t familiar with the process, and a disability appeals attorney knows how to present your evidence and testimony in a persuasive way. Most denials are overturned at this level.

Appeals Council Review

If the administrative law judge agrees that your application should have been denied, the next option is an Appeals Council review. At this stage, the council generally doesn’t look at any new evidence. Instead, it is focused on determining if there was an error in how the case was handled.

If the Appeals Council believes that the administrative law judge made a mistake, it can send the case back for another hearing. Otherwise, the council will uphold the denial.

The Appeals Council review is an important step because it acts as a quality control mechanism for the decisions made by administrative law judges. The council reviews the entire case record, including the judge’s decision and the evidence presented, to ensure that the law was applied correctly and that the decision is supported by substantial evidence. While the council typically does not accept new evidence, there are limited circumstances where additional information may be considered if it is new, material, and relates to the period before the judge’s decision.

Applicants or their representatives can submit a written request for the Appeals Council to review the case, usually within 60 days of receiving the administrative law judge’s decision. It is crucial to meet this deadline to preserve your appeal rights. If the Appeals Council denies the request for review, the judge’s decision becomes final.

Filing a Lawsuit in Federal Court

The last appeal option is to file a lawsuit in the federal court system. As with the Appeals Council review, the court must determine if there was a legal issue with the way the case was handled or the law was interpreted.

The federal court doesn’t make decisions about medical conditions or whether someone is, in fact, disabled. Instead, the court reviews the administrative record to ensure that the Social Security Administration followed proper procedures and applied the law correctly. If the court finds legal errors or that the decision was not supported by substantial evidence, it may remand the case back to the agency for a new hearing or decision.

Filing a lawsuit in federal court requires submitting a civil action within a specific timeframe, typically within 60 days after receiving the Appeals Council’s decision or denial of review. This step often involves legal complexities, so it is highly advisable to have an experienced attorney represent you to navigate the process effectively.

Though the federal court process can be lengthy and complex, it provides a final opportunity to challenge a denial of social security disability benefits when all administrative remedies have been exhausted. It is important to understand that once the federal court issues its decision, there are very limited options for further appeal.

In summary, the Appeals Council review and federal court lawsuit represent the final two stages in the social security disability appeals process. Each stage serves to ensure fairness and legal correctness in the handling of disability claims, offering applicants multiple opportunities to have their cases thoroughly reviewed.

How Long Does a Social Security Disability Benefits Appeal Take?

The appeals process is lengthy, and there isn’t a lot you can do to speed up the process other than ensure your request is filed promptly and that you include any additional supporting documentation for review. Each appeal level can take several months to get through, and the length of time each case takes depends on the reason for denial, what stage the appeal is in, and how many other Social Security Disability claimants are waiting in the backlog.

The reconsideration stage is generally the shortest because it doesn’t involve outside factors and can take anywhere from three to 12 months. Waiting for a hearing with an administrative law judge typically takes the longest, with many applicants waiting for over a year.

An average timeframe for an Appeals Council review is anywhere from six months to well over a year, depending on the schedule and how many cases are waiting to be reviewed. Filing a lawsuit in federal court can be done relatively quickly, but it often takes one to two years for the case to actually be heard. An attorney can provide more information on these timelines and what you can expect as you wait.

It’s important to note that while waiting can be frustrating, having an experienced social security disability attorney by your side can make a significant difference. They can help ensure all paperwork is properly completed and submitted on time, gather and present new evidence effectively, and prepare you thoroughly for hearings. This can help avoid unnecessary delays and improve the chances of a favorable outcome.

Additionally, each stage of the appeals process serves a specific purpose in reviewing your case. The initial reconsideration is a complete review by disability determination services, looking at your claim with fresh eyes.

The hearing before an administrative law judge allows for a more in-depth examination, including testimony and legal arguments. The Appeals Council primarily reviews the legal correctness of the ALJ’s decision, and the federal court review focuses on legal errors rather than medical facts.

Social Security Disability Appeals Lawyers in Denver

Understanding these stages and their timelines can help you set realistic expectations and plan accordingly. Throughout the entire process, staying in contact with your Denver disability lawyer and promptly responding to any requests from the social security office or your attorney can help keep your appeal moving forward.

If your claim for SSDI or SSI benefits was denied, Roeschke Law, LLC, is here to help you understand your options. We know that the appeals process can seem daunting, but we’re here to ensure you don’t have to go through it alone. Contact our firm to discuss your case and get legal representation as you start your appeal.