Help If You Have Been Denied Social Security Disability Benefits

If you have worked, or your spouse has worked in the United States and paid into social security, you have earned benefits. If you or your spouse have been denied Social Security disability benefits, or have been denied these benefits for a medical disability, you need an attorney to help fight government lawyers to receive the help you deserve.

Spouses of retired workers and workers themselves who have paid into Social Security during their working years are entitled to receive monthly payments. Qualifying individuals who have become permanently disabled and fall under the specific set of criteria set up by Social Security also deserve Social Security Disability Benefits. If these benefits have been denied, you will need an attorney on your side to receive the monthly payments you are entitled.

What are Social Security Disability Benefits?

OASDI (Old-Age, Survivors and Disability Insurance Program) is thename for Social Security in the United States. This program encompasses the benefits given to disabled persons, retirees, and survivors. It was designed to replace part of the income lost due to a qualifying disability, old age, or the lost revenue of a spouse.

The money paid out through this program comes from payroll taxes the government collects. It appears asFICAon employee pay stubs as part of their tax deductions. Social Security was initiated in 1935 by President Franklin D. Roosevelt during the depression which occurred in the United States.

Disability payments through this program are paid out to persons who are not able to participate in active employment to earn a living wage. There are certain medical conditions necessary to qualify an individual for disability benefits:

  • Mental disorders including schizophrenia, intellectual disability, depression, anxiety, an autism

  • Speech and senses issues including hearing and vision loss

  • Neurological disorders including Parkinson's disease, cerebral palsy, epilepsy, and multiple sclerosis

  • Immune system disorders including kidney disease, rheumatoid arthritis, lupus, and HIV/AIDS

  • Musculoskeletal problems including dysfunctions of the bones and joints and back conditions

  • Respiratory illnesses including cystic fibrosis and asthma

  • Blood disorders including hemophilia and sickle cell disease

  • Cardiovascular conditions including coronary artery disease and chronic heart failure

  • Digestive tract problems including inflammatory bowel disease and liver disease

For children under the age of 18

  • Special senses and speech

  • Digestive system

  • Skin disorders

  • Genitourinary disorders

  • Hematological disorders

  • Low birth weight and failure to thrive

  • Musculoskeletal system

  • Respiratory disorders

  • Immune system disorders

  • Mental disorders

  • Cancer

  • Cardiovascular system

  • Endocrine disorders

  • Congenital disorders that affect multiple body systems

  • Neurological disorders

What if Your Disability is Not Listed?

You may still qualify for Social Security Disability Insurance (SSDI) if your medical condition is not listed. If you have a state that has been determined to be a medical impairment through clinical and laboratory testing, you may qualify if you have supporting clinical reports.

You may also qualify if your condition limits yourRFC(residual functional capacity). This capacity is determined by what the most challenging function is that you are capable of performing despite your medical condition. An examiner in charge of claims determines your exertional level from sedentary work to heavy work and bases their findings on how much weight you can carry and lift.

The RFC also includes non-exertional limits such as the ability to benddown, climb stairs, or limitations of using your hands. It can also include your lack of being able to cope with depression, environmental restrictions, or anxiety. The examiner will take your medical history and your RFC capacity into consideration and determine if your condition qualifies for benefits under the Social Security Disability program.

The evidence you will be asked for from your physician includes:

  • Blood work panels

  • CAT scan

  • Physician examination

  • Mental health records

  • Treatment notes or reports

  • X-rays

  • MRI

These test reports and other documents have to be recent and cover the time you became disabled to the time you file your claim. These records must also prove your condition is severe enough to keep you from performing regular work-related duties.

It is very confusing to determine if your condition qualifies under government guidelines. You need an experienced attorney to work with you through the enormous amount of paperwork and legal language to help you receive the benefits you deserve.

There are millions of people each year who apply for Social Security Disability Benefits; however, only about thirty percent of them receive approval on their first attempt at filing. The reasons vary for denials, but there are five common ones that affectmost people. Having an attorney work with you through a denial will help you through the process much quicker.

Five Common Reasons Social Security Disability Benefits are Denied

  1. You Were Denied Before

    Some believe that if they've been denied a claim, it would be better to file a new disability claim rather than appeal the denial. When an examiner comes across a file they see has been denied once, in some situations, they will deny it automatically, so it's essential to go through the appeal process if yourfirst claim is turned down.

  2. You Have Not Followed Prescribed Treatment Plan

    If it is found you have not followed a treatment plan set up by your doctor, the Social Security Administration will not accept your claim. If you have not followed the treatment,then the examiner will be unable to determine if your condition indeed prevents you from being able to work. You have to be willing to cooperate with a treatment plan and follow through as requested by your doctor.

    If you can prove there is a valid reasonfor not complying with the treatment plan, you can present this evidence at your appeals process. Make sure your attorney is aware of all the conditions and has the proper documentation to submit for your case.

  3. You Do Not Have Sufficient Medical Evidence

    The examiners look for solid medical evidence when they process Social Security Disability claims. When you file a claim, you want to be sure to have medical evidence that proves you are unable to work due to one of their listed conditions.

    Your medical documents have to prove your disability prevents you from working and has interfered with your ability to earn an income. You can be seeing a physician for back pains on a regular basis, but if the condition does not prevent you from working, you do not qualify for benefits.

    Do not expect the Social Security Administration to provide medical doctors for you, or send you to physicians for verification of your disability. You are responsible for providing medical records from your primary care physician. You must talk with your doctor and make sure they understand you are filing for Social Security Disability, so they fill out the paperwork correctly to prove your inability to work.

    Keep all your records including notes that had excused you from work or any fromyour doctor that suggested you have a modified work schedule and file them with your claim. These documents will help you present your case for Social Security Disability Benefits.

  4. The Amount of Money You Earn

    How much money you earn does not count when you are applying for Social Security Disability Benefits, it usually becomes a concern only when applying for Social Security Income. If you are able to earn more than $880 a month, an examiner may deny your claim.

    Remember; you are only able to file for disability benefits if you cannot work to earn an income.

  5. You Do Not Cooperate with the Social Security Administration Examiners

    Some people become frustrated with the process and begin to hinder the process of filing a claim by not cooperating with the Examiners. It is essential for you to provide all the documents requested and to show up for all scheduled appointments or the examiner can deny your claim.

    Keep in touch with the person in charge of your case and make sure they have all the information needed and it is received in a timely manner.

Knowing some of the common reasons Social Security Disability claims are denied may help you when filing your request to avoid receiving a rejection of benefits. If you follow all these tips and still receive a denial of benefits, you need to contact an attorney.

If You Have Been Denied Social Security Disability Benefits

If the Social Security Administration denies your disability benefits, you will receive a letter explaining their reasons with instructions on how to file an appeal. Speak with an attorney about your rights and submit a request for reconsideration. The State of California does not require you to make this request, and if you live in California, you can go right to the hearing stage.

  1. ALJ (Administrative Law Judge) Hearing

    If your initial claim for disability benefits has been denied, you will want to file an appeal by requesting a hearing in front of an administrative law judge (ALJ). This request should be made within sixty days after receiving your letter of denial.

    Contact your attorney; you will want legal advice to ensure you follow all the necessary steps in the appeals process and receive the benefits you deserve. There are attorneys (ALJs) who work for the Social Security Administration Office of Hearings Operations (OHO), and it is their responsibility to uphold or overturn decisions made to deny disability benefits. It is estimated the ALJs grant about half of the claims they evaluate.

  2. Appeals Council

    If the ALJ does not approve your request, your next step is to request the Appeals Council review your file. The Council selects cases randomly to evaluate, and they have the power to dismiss, deny, or grant your review request. The Council does not even have to review your case unless they find one of the following:

    • The ALJ in your case based their decision without substantial evidence

    • A procedural issue or a broad policy comes to light, for example, the ALJ did not notify you there was going to be an expert witness at your hearing

    • A discretion, abuse, or error of law occurred by the ALJ such as you were not allowed to cross-examine a witness during your hearing

    The Appeals Council can also dismiss a case without review if you file late, ask for a dismissal, or if the claimant dies. The Council looks first for a flaw in the ALJ's decision before they will grant you a review. This is a good time to have your attorney working with you to help ensure the Council reviews your case adequately.

  3. Federal Court Review

    This step in your denial process will definitely require the help of an attorney. It is where you will have to file a lawsuit in the United States District Court. A Federal judge will hear your case without a jury present. They will reviewyour case to look for any legal errors, but some will also rule on factual questions.

    The District court judge can reverse decisions of an ALJ or AC in some cases, but they usually send back about half of the cases for disability to the Social Security Administration they hear for:

    • No consideration being given to a treating doctor's opinion sufficiently

    • Not considering pain and other symptoms

    • Not having asked for assessments of your abilities from your treating docto

    This option is difficult, but you havea fair chance of winning with proper representation so make sure all your facts are adequately filed. When you face suing the Social Security Administration, you are facing an expensive and time-consuming venture. Having an attorney working with you will help your case goes more smoothly and increase your chances of a positive outcome.

When it is Time to Appeal a Denial of Social Security Disability Benefits

When the SSA (Social Security Administration) decides you have not presented valid proof making youeligible for disability benefits, you should ask these questions before filing an appeal:

  • Are you ready to commit a significant amount of time with an appeal process and are you ready to become involved in the review of your case?

  • Has there been any changes in your medical condition since original filing that makes you more or less able to work for an income?

  • Was the reason for denying your request a valid one?

  • Will you be able to mentally and physically complete the paperwork required for an appeal?

An appeal process is challenging. Having an attorney working with you will relieve a lot of the pressure of knowing what information you need, when it is due, and where it should be sent during the entire process. Attorneys have the experience to understand an appeal process and will be able to advise whether or not you have a chance of reversing a denial.

You are able to ask the Social Security Administration for your files, so you and your attorney are able to review the technical rationale that caused the denial. Having a chance to review the records will show if there was any incorrect information submitted or if there are any opinions included that you and your lawyer can challenge. Look over the documents to see how your impairment is described and howit affects your ability to earn an income.

The file should be double-checked to ensure all your important medical records have been included, your age is recorded correctly, as well as your education level, and all other personal information. Everything should be filed in the right areas and recorded with proper medical verification.

Most denials are appealed, but knowing what caused your denial and making sure paperwork is correct before beginning will increase the chances of a positive outcome. Contact an attorney in your area to begin the appeal process as soon as your letter of denial is received as you have a specific amount of time to file.

Attorney Near Me for Social Security Disability Benefits Denial Help

When you receive a letter of denial from the Social Security Administration denying you benefits for a disability, call 310-695-5241. Stop Health Insurance Denial is ready to help you through the appeal process to ensure you get the benefits you deserve. Stop Health Insurance Denial has the experience working with insurance companies and the Social Security Administration to help you through the appeals system. Stop in and talk with a representative at 554 S. San Vicente Blvd. Suite 160-L Los Angeles, CA 90048. You can visit our website to see all the services we can provide for you.