Overcoming the Rejection of Social Security Disability Benefits

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The Social Security Administration (SSA) tries hard to make certain that every decision regarding Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) is correct. The agency considers all documentation and information linked to a case before assessing an applicant’s eligibility for benefits.Once the SSA makes a ruling on a particular claim, it sends an explanation of its decision. If the applicant does not agree, he or she may appeal and ask the SSA to look at the case again.

Appealing a disability decision in Illinois

Reconsideration

To appeal in Illinois, the applicant must complete a “Request for Reconsideration” form and submit this to the SSA. This written request must be completed within 60-65 days of the date on the actual denial document.

“Reconsideration” is the review of a denied claim by another SSA official (one who did not take part in the first ruling). The SSA official will examine all evidence and materials associated with the original application. An applicant can provide additional, new evidence at this time, too.

The reconsideration process involves a review of the applicant’s files. In most cases, the applicant does not need to be there for this process. There are limited situations where an applicant might meet with a SSA representative, however.

Administrative law judge

If the applicant’s reconsideration is denied, the next step in the Social Security Disability appeals process is to appear in front of an administrative law judge (ALJ). This person had no part in the original determination or the reconsideration portion of the case.

The hearing takes place usually within a certain distance of the applicant’s home. The ALJ will notify the applicant of the time and location of the hearing. Before the appearance, the applicant may need to provide more evidence or further clarification regarding the claim.

The ALJ may question the applicant and any personal witnesses that attend the small trial. The hearing may include medical or vocational experts. Such persons might serve as witnesses for the court and comment on the applicant’s particular condition. The applicant and his or her legal representative may question any witnesses that testify before the ALJ.

After the hearing, the ALJ will rule on the case based on all provided and available information. Then, the SSA will send a copy of the judge’s decision in the mail roughly one month after the hearing.

Social Security Appeals Council

If the ALJ does not rule in the applicant’s favor, he or she may ask for an additional review by the Social Security’s Appeals Council. The Council looks at all requests for review; however, it may deny a request if it believes the ALJ’s decision was correct. If the Council agrees to investigate the applicant’s case, it will assess the case on its own or send the file back to a different ALJ.

If the Council denies the applicant’s request for further review, he or she will receive a letter explaining why this happened. If the Council does make a decision, the applicant will receive a copy. Moreover, if the case is sent back to a judge, the applicant will receive a copy of the order.

Federal court

If the applicant is denied benefits by the Council (or the Council does not review the case), the applicant may file a lawsuit in a federal district court.

As one can see, there are many stages of the appeals process. It is best to work with an attorney regarding benefits, as a professional can help an applicant supplement his or her overall file. The more information that is provided to the SSA, the easier it is to prove a case for benefits.

What can make a Social Security Disability application stronger?

Employment record: When attempting to retain SSDI benefits, it helps to supplement an application with a solid record of employment. For example, if an applicant worked for several years before the disability appeared, it is important to paint a picture of one’s employment history.

This is a good idea because a strong work history tends to suggest that an applicant is not trying to simply take advantage of the program. In other words, documentation of one’s previous employment can help demonstrate that the applicant wants to work and would, if possible.

Third-party report: A report from a third party can also help. For example, a written statement provided by a former co-worker or employer, which focuses on the individual’s observations of the applicant, can help. Specifically, one might include a statement from a supervisor that details the applicant’s struggles. Such reports can help verify the disabled person’s limitations and symptoms.

Medical evidence: Most importantly, it helps to provide proof of the applicant’s history of medical problems. A disability applicant is responsible for providing medical evidence, which suggests that he or she has a disability. The information must also detail the severity of the impairment.

The information should be evinced by licensed medical professionals. Specifically, the SSA will want information to be accurate and timely.

The applicant should provide information from treating health facilities, including hospitals and clinics where the claimant has been briefly examined. While tests and examinations should be included in the materials, the medical information should detail how particular conditions can affect one’s ability to work. For example, instead of simply sending an x-ray of a tumor, the treating professionals should include information on the type of cancer, how the cancer affects the person and relevant symptoms. This information can help explain why a person cannot work.

In many cases, an application includes the following medical information:

  • The medical history of the applicant
  • Clinical findings or results of an examination
  • Laboratory work
  • A diagnosis from a medical professional
  • Prescribed treatment, which includes a prognosis
  • A statement regarding what an applicant can (or cannot) do with the impairment, based on medical findings (for example, standing, lifting, sitting, typing, comprehension, speaking, etc.)

If an applicant is unsure about what to include in the application, he or she can prepare materials with the help of a seasoned Social Security attorney.

Applying for Social Security Disability benefits is not an easy process. More than half of all claims are typically denied on the first attempt for compensation. Fortunately, the appeals process provides potential recourse for those whose claims are initially denied.

If you are interested in applying for benefits or your application was recently rejected, speak with an experienced SSDI or SSI attorney. A legal professional can help ensure your application is ready for review.