SSD Denial: What You Need To Know

A good portion of our adult lives are spent working. Year after year goes by, and we continue to put in 8 hours a day, 5 days a week, so that we can put food on the table, pay the bills, and afford our mortgages. Each day, we inch closer and closer to the ultimate goal: retirement. After putting in countless of hours of work, you finally reach the age where it’s time to stop working and time to start benefiting from the social security fund you’ve been paying into your whole life.

Unfortunately, not all workers in the United States are able to work until they reach that magic retirement age. It’s usually due, at least in part, to a disease, an injury, or a deterioration in mental abilities. Regardless of the root cause, each year hundreds of thousands of employees are forced to stop working because they are no longer physically and/or mentally capable of completing their work tasks. It is in these situations that individuals find themselves exploring the complicated world of Social Security Disability (SSD).

What is Social Security Disability?

SSD is a government funded program, that is managed by the Social Security Administration. It is funded the same way regular social security benefits are, by taking a cut from every employee in the U.S., every time they receive a paycheck. But just because you’ve been disabled, doesn’t automatically mean you’ll be eligible to receive Social Security Disability Benefits. SSD is something that must be applied for, and approved, before you can start benefiting from it. The problem is that many of the individuals that apply for SSD have their claims denied and then find themselves asking, “what do I do now?”

SSD Denial Explained

There are a variety of reasons that a request for SSD benefits might be denied. Being denied is also quite common, with initial claims being denied around 65% of the time. Typically, if you’ve been denied, you’ll receive a notice of denial from the Social Security Administration (SSA). The notice will likely contain a description of your condition, what factors and medical records were considered, and a detailed explanation of why your claim was not approved.

One of the most common reasons SSD claims get denied is due to a lack of supporting medical evidence. While this is not the only factor that the SSA considers when reviewing your claim, it is certainly one of the most important. For your claim to be approved, it must not only be evident that you have a debilitating medical condition, but that you are actively and consistently seeking treatment for your ailment.

For those suffering with a disease or mental illness, this may mean making regular trips to the doctor and taking medication daily. For those who have suffered an injury, regular treatment may consist of something more like weekly physical therapy. Regardless of the disability, the more medical evidence and documentation of treatment you have, the less likely your claim is to be denied.

Lack of medical evidence is just one of the reasons claims get denied. The following factors are also reviewed as part of your claim and can contribute to a denial:

  • The length of time you’ve been in the workforce.
  • Whether or not your income is above the required threshold for SSD benefits.
  • The severity of your disability, and whether or not it is likely to be permanent or temporary.
  • How communicative and cooperative you’ve been with the SSA throughout the process.
  • Your cooperation with your doctor in going to appointments, therapy sessions, and taking your prescribed medication.
  • Whether or not your condition is the result of a drug or alcohol problem, and your history of seeking rehabilitation for such an addiction.
  • Your criminal history, if any.
  • The truthfulness of your application and your story as a whole.
  • Your paperwork and application were incomplete or you did not submit all the necessary information.

Appealing Your SSD Denial: Where to Begin

If your SSD claim has been denied, the next step is to appeal the ruling. Contrary to what you may think, appeals often have a better chance of being approved than initial applications do. The reason for that is that during the appeals process, you will have many more opportunities to make your case and share your story than you did when you submitted your original application. This also means that your story will be seen by a lot more people than the single person who ruled on your initial request.

It is for these reasons that, if your claim has been denied, you should absolutely always appeal. An appeal is much more likely to be successful than simply resubmitting your application is. More likely than not, submitting a new application will simply result in it be denied again for the same reasons as the first one was. In fact, the very first thing you need to do before you can begin the appeals process is to fully understand why your claim was denied. It’s at this stage that you may want to consider speaking with a Social Security Disability lawyer who has navigated the appeals process before.

Step One: Reconsideration

The first step in the majority of states is to apply for reconsideration. Louisiana, however, is a bit different. In early 2014, the Social Security Administration began formulating tests designed to help them improve the entire process of getting Social Security Disability benefits. One of these tests was to eliminate the reconsideration process entirely. Louisiana was just one of the ten states selected to participate in the prototype tests that remove the reconsideration step. This is just an experiment that the SSA is running, so it’s possible that the reconsideration step could reappear in the future, but for now those whose SSD claims have been denied should jump straight to step two.

Step Two: ALJ Hearing

As a resident of Louisiana, if you are dealing with SSD denial, your first step is to request a hearing with an Administrative Law Judge within 60 days of getting your denial. As employees of the SSA, ALJs are responsible for reviewing existing SSD claims. A hearing with an ALJ can be requested online, by sending in the appropriate paperwork, or by writing a letter to your local Social Security office. In 2013, it took an average of 380 days for ALJ hearings to take place. Louisiana has one of the lower weight times in the country, with most cases taking an average of 7 months between the day the hearing is requested and the day the hearing is actually held.

Typically, ALJ hearings are fairly informal with many not even being performed in an actual courtroom. Your hearing may include a vocational expert as well as a medical expert who will offer their professional opinions regarding your condition. You can also bring your own witnesses who can help strengthen your case and testify to your current physical abilities, or lack thereof.

During the course of the hearing the ALJ will either ask you questions or give you some time to speak openly about your condition and why you should be granted SSD benefits. After the hearing is over, you should receive a letter within 30 days that details the judge’s ruling. In Louisiana, about 50% of appeals at the ALJ hearing level are approved. The good news is, if yours isn’t, there are still two more steps to be explored.

Step Three: Appeals Council

If the ALJ denies your request, you’ll need to move on and file an appeal with the Social Security Appeals Council. Like before, you’ll have 60 days after receiving the ALJs decision to request a review by the Appeals Council. The request to have your case looked over by the Appeals Council must be done in writing, using a specific form.

The Appeals Council will look over every aspect of your file and will also consider the ALJ’s opinions when ruling on your case. One of three things will happen at the Appeals Council level:

  • They’ll deny your request for review, in which case you must move on to step four.
  • They’ll remand the case, sending it back to the ALJ for reconsideration.
  • They’ll approve your original request and award you SSD benefits

Unfortunately, in most cases the Appeals Council chooses either the first or second option. Only a very, very small percentage of claims are approved at the Appeals Council level. For most people, it is simply the last step that must be taken before moving on to federal court.

Step Four: Federal District Court

If the Appeals Council denies your claim without sending it back to an ALJ, you’ll be granted another 60 days to file a civil complaint with your local United State District Court. At this point, you will absolutely need to hire a Louisiana Social Security Disability attorney, if you haven’t already.

Your law suit will not be against the SSA directly, but rather against the current acting Social Security Commissioner. Once your complaint is filed you will receive a court-issued summons to serve to the SSA at your local office. Their lawyers will reply with an answer that elaborates on why your claim has been denied so far, and then the real work beings. At this point, you and your lawyer will need to write an opening brief, the SSA will reply again, and you’ll have an opportunity to construct a reply brief. Afterwards, a judge will look over your case and make a final ruling, a process which can easily take a year or more.

Getting Your Ducks in a Row

As you can see, appealing a denied disability claim is not a simple process. It can take hours upon hours of work and years of waiting to make it through even one step. You’ll be responsible for gathering tons of information, keeping track of countless medical records, and filling out endless paperwork. In short, it’s not something you want to go through alone; so why try?

The attorneys at Cox, Cox, Filo, Camel & Wilson L.L.C know that SSD denial can be difficult, time consuming, and frustrating. We know there will be times when you feel like giving up, but we also know that, as long as you’re our client, we never will. Contact us today, or call us at 337-240-9349 or toll free at 800-836-3702.