After waiting months to hear back from the federal government regarding your initial disability benefits, you receive a letter that you have been denied SSDI benefits. There are many reasons you could have been denied SSDI by the SSA that can be corrected in an appealIn the event you disagree with a decision, you can appeal it. Appeals are common after the initial and reconsideration levels..
People who are denied Disability benefits usually experience a flood of negative emotions, and those emotions are normal. If you are unable to work, the worst thing you can do right now is give up. In this article, we are going to address the many steps you can take to ensure that you win your SSDI federal court appeal.
What are the Odds of Winning an SSDI Appeal
“What are the odd of winning my SSDI appeal?” is my least favorite question because the answer is always, “It depends”.
Things like; your ailment, whether or not your medical treatment is consistent, having a favorable RFC in the file, your age and your past work are the biggest factors that go into making a determination as to whether or not someone is disabled.
As a result, all those factors can and do drastically alter your individual odds of winning at each level. What I can provide; however, are overall denial rates.
These numbers look bad, but if you stay in the game and do not quit, your odds of winning are actually very good. They are even better if you hire a representative. In fact, hiring someone to represent you doubles your odds of winning.
2019 Denial Rates
| Total Applications | Approved | Denied | Denial Rate | |
|---|---|---|---|---|
| Initial | 748,737 | 340,188 | 408,549 | 55% |
| Reconsideration | 165,484 | 25,954 | 139,530 | 84% |
| Hearing | 19,500 | 12,035 | 7,465 | 38% |
- 59% of disability claim applicants drop out of the process between the initial determination and the reconsideration levels.
- 86% of disability claim applicants drop out of the process between the reconsideration level and the hearing level.
How to Win an SSDI Appeal at the Reconsideration Level
If you are unable to work after being denied disability benefits at the initial level, the most important thing you can do is file a disability claim appeal. As noted above, almost 60% of people denied SSDI at the initial level fail to submit an appeal for disability benefits reconsideration. 100% of the folks who fail to appeal their SSDI claim will not receive their benefits.
If you would like assistance with your SSDI appeal, start with this free SSDI claim assessment. If you qualify, DisabilityQualification.com will attempt to match you with an SSDI claim specialist for a free consultation. After asking and answering a few questions, your SSDI specialist may offer to represent you which mean your SSDI appeal case will be handled by their law firm. Regardless if you win or lose, you will never have to pay anything out-of-pocketWhen using an SSD attorney, an applicant does not pay unless their SSD claim is approved. If it is not approved, you do not owe any money to your SSD lawyer.. See if you qualify for a free SSDI appeal consultation.
How to File Request for Reconsideration
In order to appeal an Initial Denial, you will need to make a Request for Reconsideration
This appeal can be done online. If you do not wish to appeal a medical decision online, you can use the Form SSA-561, Request for Reconsideration. You will also need to submit forms SSA-3441, Disability Report – Appeal, and SSA-827,Authorization to Disclose Information to the Social Security Administration.
You should ensure that these forms are completed timely, completely, and accurately.
Was the Decision Based on a Complete Medical Record?
After deciding to appeal, you should completely read your denial letter. At this stage you need to look specifically at what medical information was reviewed in making the determination. You must ensure that SSA had a complete medical record when making their decision.
Specifically look to ensure that every one of your medical providers (Examples: primary care physician, specialists, hospital records, mental health care providers) are in the list of records that were obtained prior to making the decision.
If a provider is missing, you need to help make sure that it is included next time. Usually, it only takes a phone call, but there are extreme situations where you may need to physically go to a provider to obtain those missing records and submit them to DDS on your own.
Do you have new Medical Providers?
If you have obtained a new medical provider since your initial application and that provider is not listed in your initial denial, you will need to make sure that the new provider is listed in your appeal.
Did you do all you Could to Obtain Opinion Evidence?
[RFCs] are extremely helpful in proving your disability claim. Your doctors are not required to fill these out and many will refuse, but you should do all that you can to convince any or all of your providers to fill out favorable RFCs.
In addition to favorable RFCs, in some instances, it is helpful to get letters of support from former employers. If you were a good employee prior to the onset of your disability, a letter of support from an employer can be a great piece of opinion evidenceAll documents you submit to Social Security to support your case for disability, retirement benefits or payment amount..
It will show that when you were capable of working, you did, but through no fault of your own, you are no longer capable of performing your past work.
Respond to DDS Requests both timely and accurately.
In many instances, the Disability Determination Services (or “DDS”) will make requests of you. DDS may ask you to complete additional forms, answer specific questions about your Disability case, or even go to a Consultative Examination (or “CE”), CE’s are independent medical examinations performed by a doctor contracted through DDS. It is in your best interest to complete these DDS requests accurately and in a timely manner.
None of the above will ensure that you will win at the Request for Reconsideration level but doing these things will ensure that you have the best chance at winning.
How to Win an SSDI Appeal at a Hearing in Front of an Administrative Law Judge
If you just received a denial at the Request for Reconsideration level, you are undoubtedly disappointed. There is not much that can be said to take the sting out of receiving your second denial.
Again, if you cannot work, you really need to swing the bat at least one more time and appeal your Disability insurance claim. Your best chance at winning at any time throughout this Disability appeal process is at your next stop, the Hearing Level.
Disability Appeal Process: The Hearing Level
What happens if I am Denied Disability Benefits at the Reconsideration Level?
If you do not agree with the judge’s reconsideration decision that was made on your application for Disability benefits, the first thing you need to do is request a Disability claim hearing before an Administrative Law Judge.
Fill Out These Disability Appeal Forms to Request a Disability Hearing
You can submit a request a Disability claim hearing online, or you can print and complete this SSA disability hearing request form PDF. You can also write a letter stating your desire to have your SSDI appeal heard by an ALJ. As a Disability lawyer, I highly recommend you complete the form instead of writing a letter.
In addition to that ALJ hearing request form, you must also complete and sign two more forms:
Again, all of these forms need to be completed both timely & accurately.
Ensure your Medical Record is Complete for your Disability Hearing
After deciding to appeal, you should completely read your denial letter. In your denial letter you can see what medical evidence the decision-maker used in denying your Request for Reconsideration. At this point in time the best thing you can do is make a list of anything that is missing.
There could be varying opinions as to when your record should be updated, but I’m comfortable advising you to wait until your hearing is scheduled. Social Security is required to give you 75 days notice prior to your hearing. I think this is plenty of time to prepare for your hearing.
Upon receiving notice of your hearing, you should request your complete disability file. You should review that file to determine what medical information it contains. At this point you should fill in any gaps and be certain to update the file with any medical evidence that has occurred after your last denial. At this level, you are responsible for obtaining medical evidence.
Try Hard to Obtain Opinion Evidence to Support Your Disability Claim
[RFCs] are extremely helpful in proving your disability claim. Your doctors are not required to fill these out and many will refuse, but you should do all that you can to convince any or all of your providers to fill out favorable RFCs.
In addition to favorable RFCs, in some instances, it is helpful to get letters of support from former employers. If you were a good employee prior to the onset of your disability, a letter of support from an employer can be a great piece of opinion evidence.
It will show that you worked when you were capable of working, but through no fault of your own, you are no longer capable of performing your past work. This will factor into the Judge’s decision.
Respond to any Request from an ALJ
In many instances, the ALJ assigned to your case will ask you to complete additional forms, answer specific questions or even go to a CE. It is in your best interest to complete these timely and accurately.
Write a Summary Argument for Disability
Upon completing the medical record, you should summarize this evidence in a written brief. This brief should lay out a legal argument for your disability.
Present your Disability Case in Front of an ALJ
The final step at this level is to present your disability benefits case in front of an ALJ. This will include pointing to medical evidence and making legal arguments as to your disability. You will also have an opportunity to question a Vocation Expert and any expert testimony that individual makes at your Disability hearing.
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