When someone is no longer able to work due to an injury, illness, or other disability, Social Security disability payments may be available to provide them with an income on which to live.
Many people file for disability on their own, without a lawyer, because they believe that it is so clear that they are disabled that they will not be denied these payments (they are known as Social Security disability insurance (SSDI). However, there are many reasons why an individual may be barred from receiving SSDI. Only 35% of the applications filed in a year are granted on the first submission.
The denials are because the application was completed incorrectly or they did not submit sufficient medical evidence proving their disability. One of the most important benefits of hiring a lawyer is ensuring the claim is properly submitted. While it is always best to have an attorney from the beginning of the claims process, an attorney can assist an applicant at any time.
If a claim is denied, that decision can be appealed. These cases often require adherence to specific rules and regulations and the ability to analyze and present complex and substantial medical evidence. This is a complicated process, and it helps greatly to have an attorney’s assistance. An experienced lawyer will be familiar with the Social Security appeals process and will be able to present the case best.
What Disabilities Qualify for Disability Benefits?
For an individual to qualify for disability benefits, they must meet the Social Security Administration’s definition of disability. The Social Security Administration (SSA) follows a five-step sequential disability analysis to determine if an individual is disabled. The steps are:
- Is the individual working? If they are currently working, that suggests that they do not have an impairment or illness that prevents them from working.
- Does the individual have a “severe” impairment? That is partially measured by whether or not the impairment is permanent; SSA requires that the disability has lasted a year or more, is expected to last a year or more, or is expected to lead to the claimant’s death.
- Does the individual have an impairment that is on the government’s list of impairments that are automatically considered “severe”? Some conditions automatically qualify for SSDI income without a showing of other evidence. The claimant must provide sufficient medical evidence that they have one of those conditions.
- Can the individual perform past relevant work? “Past relevant work” includes any present work. The SSA will determine whether or not the individual can perform the same kind of work or profession they engaged in before the disability occurred.
- Can the individual perform other work? If the individual cannot perform their normal work, the SSA will then determine whether or not they could perform a new job given their age, education, and work experience.
Can I Be Denied Disability Benefits for Making Too Much Money?
Yes, an individual can be denied benefits because they make too much money. This Is a common reason many individuals are denied SSDI benefits. Each year, the SSA sets a maximum income level that an individual can receive through their substantial gainful activity or SGA thresholds are set every year.
For 2023, the monthly figure is $1,470 (it is higher for blind people). Not all work is considered SGA – some work is excluded – and a lawyer will be able to analyze an applicant’s work situation better and provide advice on whether their work may not be SGA.
Can I Be Denied Benefits Because of My Work History?
Yes, an individual’s application may be denied because of their work history. This occurs if the individual has not worked enough to qualify for services.
Throughout a working life, people pay a certain percentage of their income to the government in social security taxes. Once they become disabled, the government may provide benefits, but they must have paid enough taxes to qualify. This is known as “work credits,” people must have a certain number of work credits to get benefits. The number that is required varies on how long they’ve worked and how recently they’ve worked.
Can a Criminal Conviction Impact My Eligibility for Benefits?
In some cases, an individual may be denied benefits if they were convicted of a crime that is connected to their becoming disabled. For example, if the individual were injured while committing a felony, their benefits would be denied. They may also be denied if their disability occurred when they were incarcerated.
What Are Other Reasons Why I Can be Denied Disability Benefits?
Other reasons why an individual may be denied disability benefits include:
- The SSA cannot locate the individual because they moved and did not update the SSA with the new address
- When the SSA asks for more information or evidence, the claimant does not cooperate (this could mean not submitting the requested information)
- If the claimant’s doctor prescribes a therapy to attempt to treat the condition (this could be a trial of medicine), and the claimant does or does not follow the therapy, their application will be denied.
- The disability claimed is for an alcohol or drug addiction, although a medical consultant would have to make that determination.
- The claimant has committed Social Security fraud
What Happens if My Disability Claim is Denied?
As mentioned earlier, it is very common for disability claims to be denied. Only 35% are granted on the first request. If your claim is denied, it is important not to get discouraged. You can hire an attorney to help with an appeal.
When you receive a denial, it will include a summary of the reasons for the denial and information on the appeal process. There are generally four steps to contesting a denial of benefits. These include:
- Making a written request for reconsideration
- There will be a hearing before an Administrative Law Judge (ALJ)
- If the ALJ made some kind of mistake, you can raise the appeal to the Appeals Council
- As a last resort, you can file a lawsuit against the SSA in federal court
Request for Reconsideration: Most states require a written request for reconsideration. After the request is made, the SSA will do a new review of the claim. The individual(s) for denying the claim do not participate in the review – the case gets a set of fresh eyes. A medical consultant and an examiner will review the claim. A few claims at this stage may get overturned, and the person will begin to receive benefits. However, most will be denied again at this stage. If denied at reconsideration, you should receive another written notice of the denial and the next steps to appeal.
Hearing before a judge: The second phase is a hearing before an ALJ. An ALJ is an attorney who holds a hearing in which the applicant must appear and have their claim heard. The ALJ determines whether the denial should stand or should be overturned. If the denial is overturned, the applicant will begin receiving benefits. Approximately half of the applicants who appear before an ALJ will receive benefits following the hearing.
Appealing to the Appeals Council: The third phase is appealing to the Appeals Council. If the applicant’s claim is denied following a hearing with an ALJ, they may appeal to the council. It is important to note, however, that the council is not required to hear a case. They may hear a case if they believe the ALJ committed an error or wrongdoing. Having a case heard by the council is difficult. Winning a case before the council is unlikely.
Sue the SSA: The last option for appeal is to file a lawsuit against the SSA in federal court. This option is only available after completing the first three options. A lawsuit is a time-consuming and expensive process. There are, however, a few cases that may be remanded to an ALJ for reconsideration as a result of a lawsuit.
Can a Lawyer Help Me Challenge the Denial of My Request for Benefits?
Yes, an experienced Social Security disability lawyer can assist you if your Social Security disability claim has been denied. A lawyer will be able to review your case, review the reason for the denial, and assist you in appealing the denial.
It is essential to have an attorney representing you during any appeals to have the best chance of securing benefits. There are technical rules regarding an appeal that must be adhered to. In addition, some deadlines must be followed in each appeal process, and an attorney will be familiar with these.
This is extremely important because if you fail to follow any appeal requirements, your claim will be denied, and you may be barred from seeking further appeal. The help of an attorney may be the difference between an unsuccessful and a successful appeal.
