How to Appeal a Social Security Denial

 
Social Security Disability Denied How to appeal Lyme Advise
 

Most initial Social Security Disability claims are denied.   If you received a denial you should promptly file your appeal. You should not file a new application, unless the denial was for a technical reason, such as earning over the income limits.

The denial notice tells you the steps you need to take to appeal your decision.

When your initial claim for benefits is denied, the next step for claimants in most states, is to file a “Request for Reconsideration”.    The request for reconsideration must be filed within 60 days.  The case is then reviewed for the second time and a new decision is made.   Unfortunately, the majority of cases are also denied at the reconsideration level.  If your reconsideration request is denied, your next level of appeal is to file a “Request for a Hearing before an Administrative Law Judge”.   

Some states, such as New York, no longer have a reconsideration level of appeal.    In these states you will file a “Request for a Hearing before an Administrative Law Judge” within 60 days of your denial.  Likewise, if your reconsideration request is denied, you will also file a request for a hearing before an Administrative Law Judge.   

Processing times vary by hearing office, but the national average processing time for an ALJ hearing was approximately 595 days in 2017.

If your claim is denied at the ALJ hearing stage, you have the right to appeal to Social Security Appeals Council.   The Appeals Council will review the hearing decision, and has the power to remand or send cases back to Judges when they make mistakes.   It also reverses decisions in a small amount of cases.   It can take about a year to get a decision from the Appeal’s Council.

If your claim is still denied at the Appeal’s Council Level, you can file an appeal in Federal Court for the United States District Court where you reside.

It is very important to have a medical evidence to support your claim.   Medical evidence takes many forms, including a physician’s examination and treatment notes, mental health records, blood work panels, reports of any imaging studies, etc.    Sufficient medical records containing enough information from your treating physician to allow Social Security to make a judgement regarding the nature and severity of your condition.   The more thorough your medical records, the better your chances.

It is also important to include all the conditions for which you are treating in your claim. For example, if you have physical impairments and you are treating for mental health condition, you want to include the mental health condition and provide information about your treatment.

Some individuals have medical conditions that are so severe that their conditions meet Social Security Disability standards.  Social Security has published a list of compassionate allowances, or conditions that will qualify for benefits base upon a minimal evaluation and official medical records. There are also fourteen categories of “listed impairments” where SSA will consider specific medical tests and limitations to make a faster Disability determination.  Most types of illnesses can vary, making proving Disability tricky as it depends on how badly the illness or condition has affected your ability to function.

If your condition does not meet a listed impairment, that doesn’t mean you can’t win your case.  You can also be awarded disability benefits if Social Security considers the aspects of your illness or condition medically equivalent to the criteria in a related listing.

You can also qualify for Disability benefits even if you don’t meet or equal a listing, if your illness or condition limits your functioning so that you cannot work.    Social Security will consider the effect of your condition on your ability to perform routine daily activities, as well as work and will determine whether there is any other type of job that you are able to perform.

It is very important to have a medical evidence to support your claim.   Medical evidence takes many forms, including a physician’s examination and treatment notes, mental health records, blood work panels, reports of any imaging studies, etc.    Sufficient medical records containing enough information from your treating physician to allow Social Security to make a judgement regarding the nature and severity of your condition.   The more thorough your medical records, the better your chances.

You have the right to representation at all stages of the process.   You can certainly represent yourself, but statistics prove that individuals that are represented by people who routinely handle Social Security Disability claims fair better, especially if your condition is complicated.  In addition, a knowledgeable Social Security Disability attorney can help you formulate a strategy in your claim, help you to obtain proper evidence and limitations from your providers as well as present your case to an Administrative Law Judge. In most cases, attorneys do not charge fees unless you win your Social Security claim.

Kimberly A. Slimbaugh, Esq.
Meggesto, Crossett & Valerino, LLP
313 E. Willow Street, Suite 201
Syracuse, New York 13202
(315)471-1664
kslimbaugh@mcvlaw.com
www.mcvlaw.com

Meggesto Crossett & Valerino disability lawyers lyme advise