Getting Your Denied Disability Claim Appealed Through Social Security’s System
By David A. Morton III, M.D.
To appeal a denial of Social Security disability or Supplemental Security Income benefits, you’ll need to follow the instructions included in your notice of denial from the Social Security Administration . The first step is to file a request for reconsideration. If that fails, you may want to take your case to the next level of appeal. This article covers the various levels of appeal after denial of Social Security disability benefits.
How Can You Speed Up The Social Security Disability Process
Several ways exist to qualify for a faster decision:
- TERI: If the applicant has a terminal disease or condition. You dont need to report that you have a terminal disease, although you can. The SSA can determine this from your medical reports. A field officer can identify a condition as terminal during an interview or the condition can be brought to the attention of the SSA by anyone helping you with your claim.
- Quick Disability Determination : Allows you to file your initial claim electronically. The SSA uses a predictive model that helps it analyze this claim to see if it warrants fast-tracking. You must be suffering from a serious condition and have medical evidence to prove it. If a claim meets the requirements, it will receive a faster decision.
- Compassionate Allowances : Helps Social Security evaluate claims more quickly based on certain conditions. The SSA receives information from the public and a variety of different groups to determine what conditions qualify for a CAL. If your application meets the requirements, it will receive a faster decision.
Disability Application To Hearing
First, some background on the procedure of applying for SSI or SSDI: After you submit an application, the Social Security Administration will start out by deciding whether you meet the financial and/or work-history requirements. If you don’t, you’ll receive a nonmedical, or “technical,” denial. If you advance to the next stage, a disability examiner will then put your application through a five-step medical evaluation.
Few applicants make it through both of these stages successfully. In fact, more than three-quarters of our readers told us their applications were denied at the initial application level. It’s worth pointing out that these results included technical denials as well as denials based on medical eligibility for disability benefits. According to government statistics for applications filed in 2018, many people receive technical denials: 45% for SSDI applicants and 18% for SSI. In that same year, approval rates at the application level based on medical eligibility alone were 41% for SSDI and 37% for SSI. This means that applicants who meet the nonmedical requirements of SSDI or the financial requirements of SSI have a better chance of winning benefits.
When the initial denial is for a medical reason, applicants can appeal the decision by requesting a hearing. Our survey showed that approval rates at the hearing level were nearly twice as high as at the initial application stage.
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What Is Quality Review With Social Security Disability
The focus of a Social Security quality review may affect a benefit decision, but it doesn’t target you specifically. Instead, the focus is on the claims examiner in charge of evaluating your application for Social Security disability or supplemental security income benefits. The reason is that claims examiners are third-party contractors, not employees of the Social Security Administration. A quality assurance review conducted by an SSA employee helps to ensure that third-party examiners follow federal guidelines in processing applications.
Social Security Disability Back Payments
Most new beneficiaries are eligible to receive back payments from Social Security at the time their payments begin. This is because the benefit approval process is a lengthy one. For SSDI, your disability onset date could be up to 17 months before your application date, meaning you could receive payments for up to 12 months before your application date . For SSI, you can’t receive benefits before your application date; you will be owed benefits starting the month after the application date . For more information, see our section on disability backpay.
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What Is A Protective Filing Date
A protective filing date is a date before your application was officially submitted that the SSA can use to calculate your backpayments or your eligibility for SSDI. PFD for SSI is the date on which you either first call the SSA to apply or go to a field office to ask about applying. Your protective filing date for SSDI is when you make a written statement to the SSA saying that you are going to apply for benefits.
An Extra Consideration For Ssi
Keep in mind that SSI takes into account not just your income, but your household income as well.
That means that in addition to not engaging in SGA, you also have to meet certain household income limitations to qualify for SSI.
You could be under SGA, but if your spouse or roommate is making more money than SSI allows, then you will likely not qualify for SSI.
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Evaluating Your Claim For Social Security Disability Benefits
Once you have submitted your application, the Social Security office will check to see whether or not you have worked enough to qualify for Social Security Disability benefits and whether your current employment status disqualifies you from receiving disability benefits. If you meet the necessary criteria, the Social Security office will send your application to the Disability Determination Services department for a full review. It is this department that will be making the actual decision as to whether or not your disability claim is approved.
The Disability Determination Services office will review the information and medical records you have provided with your application for disability benefits. If the examiner reviewing your case does not have enough medical documentation to prove your disability, he or she may require you to attend a consultative exam. In some cases, more than one consultative exam may be requested.
After the Disability Determination Services have received all of the information needed to process your claim the employees with gather to evaluate the information within your file and will make a decision based on that information. They will approve or deny your claim based on the medical evidence provided, whether or not your specific disability is included in the Social Security Listing of Impairments, if you are able to perform the work you were doing prior to your disability and whether or not you are capable of performing any type of work at all.
What Happens After My Disability Hearing
After you have your hearing, the Administrative Law Judge will issue their decision.; Claimants typically wait one to three months for the decision to be issued.; The ALJ has three possible choices. The options are a fully favorable decision, partially favorable decision or unfavorable decision.
A fully favorable decision means the ALJ finds you disabled and agrees that you became disabled on the same date you alleged on your application. There are two types of partially favorable decisions. A partially favorable decision may be issued if the ALJ agrees you are disabled but that you did not become disabled as early as you alleged. The other type of partially favorable decision is what is called a closed period of disability. In a closed period an ALJ would find you disabled for at least a 12 month period of time, but not eligible for ongoing payments.
If you receive either a fully favorable or partially favorable decision your claim will be forwarded to one of the payment centers to begin the processing of your benefits. The payment center will issue what is called the Notice of Award. The Notice of Award will outline how much your back payment is and how much your monthly benefits will be .; The Notice of Award will also list any deductions that may be taken out, for example an attorneys fee.
For more information on the hearing process, please review the SSAs website page titled Social Securitys Hearing Process.
SSDI & SSI Information
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Continuing An Ssi Claim
Compared to SSDI claims, the rules regarding continuing SSI cases are much more straightforward but also more narrow. A surviving spouse who was living with the disability applicant at the time of the applicant’s death, or within six months of the applicant’s death, may continue an already-filed SSI claim. The residency requirement is waived if the surviving spouse receives SSI.
Parents of a child who has died with an SSI application pending may also collect an underpayment, as long as the parents resided with the child within six months of that child’s death.
If an individual dies before filing an SSI claim, another family member usually cannot file a new SSI claim on the deceased person’s behalf. The lone exception occurs when the deceased individual was given a “protective filing date” because he had contacted Social Security about starting a disability claim. In that case, a family member generally has 60 days from the protective filing date to file for SSI benefits.
Why Disability Checks Are Delayed
Your disability payment schedule depends on your date of birth. People born from the 1st to the 11th of the month receive payments every second Wednesday of the month. If your birthday falls from the 12th until the 20th, you can expect payments every third Wednesday of the month. While those born from the 21st to the 31st will receive their disability checks every last Wednesday.
If your disability check didnt arrive at your expected date, it could be because of:
- Outdated Records. If you fail to update the SSA of a change in address or banking details, it can affect your disability payments. Obviously, the SSA wont be able to send you the payments if they dont know where to send them.
- Backlog in SSA Processing. Due to the huge number of claims, it can take a lot longer for the SSA to process your first payment.
- Banking Error. If there are changes in the bank account which the SSA will use to send you payments, the agency will give you notice to confirm such before sending your check.
To avoid any hitches and ensure that you receive your benefits on time, make sure to update your bank records and other personal details with the SSA.
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How Will You Receive Your Disability Check
Until fairly recently, most Social Security disability recipients received a paper check in the mail. Prior to 1997 , those checks were sent to arrive on the 3rd of each month. For those who have made claims since 1997, the exact date on which Social Security checks were sent depends on your date of birth.
- Those with birthdays on the 1st-10th of the month receive checks on the second Wednesday of the month.
- Those with birthdays on the 11th through 20th of the month receive checks on the third Wednesday of the month.
- Those with birthdays on the 21st through the 30th receive checks on the fourth Wednesday of the month.
These days, most Social Security Disability recipients dont actually receive a paper check at all. The majority of Social Security Disability Insurance and Supplemental Security Income recipients receive their benefits check through direct deposit into their bank account. The government is in the process of requiring beneficiaries to receive their benefits electronically. For those who dont want to receive their benefits through direct deposit, the SSA offers a debit card.
When you are approved for Social Security Disability benefits, the SSA will ask you which payment option you prefer and it will be up to you.
It’s Not Easy To Get Ssdi Or Ssi But Our Survey Highlighted Several Factors That Can Increase Your Chances Of Being Approved For Benefits
How hard is it to get Social Security Disability Insurance or Supplemental Security Income benefits if you have a serious medical condition that makes it hard for you to work? We surveyed readers across the U.S. who recently went through the process of applying for SSDI or SSI to learn more about their experiences. Here’s what we learned about the outcome of their disability claims, as well as some of the things that made a difference in their chances of success.
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What Does This Mean
Essentially, this status message means that the SSA has made a medical decision about whether or not you are disabled, but they’re not going to tell you what that decision is yet. Your file is likely to be sent to your local Social Security office, and when that’s completed, the decision will appear in a letter sent to you and/or on a website . You may see the decision in the letter first, or you may see it online first.
Taxes On Social Security Disability Benefits
If you have just begun receiving Social Security disability, or you do not receive it yet, you may have questions about whether or not your disability income can be taxed. It is possible that up to 85% of your Social Security disability could be taxed.
If you and your spouse have a combined income of more than $44,000 and you file jointly, you will likely pay taxes on 85% of your disability benefits.
If you and your spouse have a combined income between $32,000 and $44,000, you will likely pay taxes on 50% of your disability benefits.
If you file as an individual, you will pay taxes on 85% of your benefits if your income is more than $34,000 and will pay taxes on 50% of your benefits if your income is between $25,000 and $34,000.
For more information, see our article on whether Social Security disability benefits are taxable.
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What Are Social Security Benefits
There are 3 primary kinds of Social Security benefits distributed by the federal Social Security Administration to eligible members of the American public:
Supplemental Social Security Income â Payments to disabled persons and adults over the age of 65 who meet income limits
Social Security Disability Insurance â Payments to adults who are restricted in their ability to work due to notable disability
Social Security Retirement Benefits â Replacement income for eligible retirees and their families
All Social Security checks are issued by the federal government to eligible individuals who meet strict regulatory criteria. Nowadays, monthly payments are directly deposited into a bank account or onto a debit card issued by the federal government.
Timing Of Lump Sum Payments Of Backpay
It can take a couple months for Social Security to issue backpay, especially for concurrent claims and in other special situations. Although delays in payment can be frustrating, disability recipients should try to be patient with the SSA offices that are processing payments. However, if you haven’t received any backpay after three or four months, contact Social Security to make sure your payment is being processed.
When It Is Worth Appealing An Eod
If you appeal your EOD, you do run the risk of losing all of your benefits. This is because when you appeal any Social Security disability decision, your entire claim gets reviewed, not just your established onset date. This means that if the reviewer thinks the prior decision maker awarded benefits incorrectly, your award could be revoked.
In some cases, it won’t matter if the SSA gave you an EOD different than your AOD, because your AOD was also less than 17 months prior to your application date. In this case, your retroactive payment amount wouldn’t change, and you should not appeal the decision.
However, if there is a significant difference in the EOD and your AOD, then appealing the decision may be worth the risk. Make sure, though, that the additional evidence you provide to support your claim is solid. It’s usually only worth it to appeal an EOD if the SSA has made a clear error or if you have new medical evidence regarding your EOD. We will talk more about this on the next page, good reasons to appeal an EOD. It’s always a good idea to talk to a disability lawyer before appealing a partially favorable decision .
When Volunteer Work May Be Considered Sga
Although the SSA doesnt have specific guidelines to use in deciding whether doing volunteer work demonstrates the ability to work full time, here are some examples that the SSA might use as evidence that you can work at the SGA level:
- You volunteer more than a few hours a week.
- The volunteer work you do would be above the SGA level if you received fair payment for it.
- The physical requirements of the volunteer work indicate you could work at the SGA level, or
- You are volunteering at a small business that is owned by a relative.
In one case, for example, a disability recipient who past work was as a certified public account began to volunteer at a local organization. He worked as the organizations bookkeeper for five hours per week. When the recipients case underwent a continuing disability review , the SSA determined that he was able to work at the SGA level. This is because bookkeeping was the kind of work usually done for pay, and the amount of pay the recipient could have received for the services he provided to the organization were at the SGA level.
By Melissa Linebaugh, Contributing Author
Volunteer work may or may not disqualify you for disability benefits, depending on the circumstances. The main rule is that you cant receive Social Security disability benefits if you are doing what the Social Security Administration considers a substantial amount of work.
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