Scales of Justice

How To Appeal a Denied SSD Claim

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Social Security disability benefits can help many individuals and families regain financial stability after a serious disease or injury. If you can’t work anymore due to a long-term disability, you may be eligible for Social Security disability (SSD) payments. Unfortunately, the application process is complicated and approximately 55 to 60 percent of initial SSD claims are denied. However, if your claim isn’t successful, you have the right to appeal.

The personal injury attorneys at Scott Carr Law Firm have helped many San Francisco clients successfully appeal denied SSD claims. When you schedule a consultation, we’ll discuss your situation and help you figure out the best way to proceed. To get started on your Social Security disability appeal, call us at 415-799-2229. You can also reach us through our online form.

A Step-by-Step Guide to Appealing a Denied SSD Claim

Unfortunately, more than half of all initial SSD applications are denied. This means there is a good chance that you will have to go through the appeals process even if you meet the eligibility requirements for Social Security disability benefits.

If your SSD claim is denied, you can appeal the decision. There are four different levels of appeal, and if your first appeal fails, you can proceed to the next level. 

Request reconsideration

If your SSD claim gets denied, the first level of appeal is a request for reconsideration. In this process, your claim is thoroughly reviewed by a Social Security Administration employee who was not involved in the initial decision on your claim. 

You can request a reconsideration appeal online, or you can mail the completed forms to your local Social Security office. If necessary, you can add new or updated medical information that wasn’t included in your initial application.

Attend a hearing

If your claim isn’t approved through the reconsideration request, the next step is to request a hearing. You can initiate the hearing request online. This hearing is conducted by an administrative law judge (ALJ) who was not involved in the decision on your initial claim or your reconsideration request.

The judge reviews your case and makes a decision based on evidence and witness testimony. Your hearing may be held in person at a local hearing office or via video conferencing.

Request an Appeals Council review

Even if the ALJ denies your appeal during a hearing, you may still be able to get your claim approved. The next step is to request that your case be reviewed by the Appeals Council. You can make the request online. The Council decides whether to review your case, and there are three possible outcomes:

  • Your case is reviewed by the Appeals Council
  • Your case is returned to an ALJ for further review
  • Your request for review is denied

If the Appeals Council determines that the previous decision on your case complied with Social Security regulations, it may deny your request. 

Pursue a federal court review

The final appeal option is a federal court review of your claim. To pursue this option, you must act with 60 days of when you received the decision from the Appeals Council. It is not possible to request a federal court review online; you must file a civil lawsuit in a federal district court. This process can be complicated and take a long time, but you might get a positive decision on your claim.

If your initial SSD claim is denied, a lawyer can help you through the appeals process. Working with an experienced attorney may help reduce the time and stress of your appeal.

Why Do SSD Claims Get Denied?

If your SSD claim gets denied, the letter you receive should indicate the reason. There are many common issues that can cause an SSD claim to be rejected. 

Lack of adequate work history

To qualify for Social Security disability benefits, you must have worked long enough to pay into the program. This is similar to how Social Security retirement benefits work. To be eligible for SSD payments, you must have built up at least 40 work credits and have earned 20 of them within the last 10 years leading up to your disability.

No qualifying long-term disability

SSD benefits aren’t available for short-term conditions or partial disability. To be eligible, you must have a condition that meets these requirements:

  • Significantly limits your ability to perform work-related tasks
  • Is expected to last for at least 12 months or is terminal
  • Is found on the SSA’s list of disabling medical conditions

If your condition isn’t included in the list of impairments, you may still qualify for SSD benefits if you can prove that your disability prevents you from working.

Too much income

You can only qualify for disability payments if your condition prevents you from being engaged in “substantial gainful activity” (SGA). The SSA has an income threshold; if you exceed that amount, you don’t qualify for SSD benefits. For 2021, the SGA limit for non-blind individuals is $1,310 per month. For blind individuals, the monthly SGA threshold is $2,190.

Ability to find other work

Even if your disability prevents you from working in your chosen career, you may not be eligible for SSD benefits if the SSA determines that you can get a different job. When reviewing your claim, the SSA considers your age, education, career history, skills, and medical condition to determine whether you are able to work. If it determines you can get work in a new industry, you may be denied SSD benefits.

Failure to work with medical professionals

The SSA makes a determination about your condition based on medical records. If you don’t have an adequate record of your medical history, your application may be denied. 

Your records must show that you have sought medical treatment for your condition and have been following your doctor’s orders. If you are refusing to work with medical professionals, the SSA may decide to reject your application.

Substance abuse or criminal activity

If your disability was caused or exacerbated by alcoholism or substance abuse, the SSA may deny your claim. Additionally, you may be ineligible for SSD benefits if you are convicted of certain crimes or if your injury occurred while you were committing a crime.

An experienced disability attorney can help you with your initial application to ensure you meet the eligibility requirements and have all the documentation and support you need. 

An SSD lawyer can help you appeal your denied claim

If you can no longer work due to a disability, you may qualify for SSD benefits. Unfortunately, the application and appeals processes are often overwhelming and frustrating.

At Scott Carr Law Firm, we have the knowledge and experience to guide you through any level of appeal. We’ll review the specifics of your case and give you clear guidance about your legal options.

For help appealing your denied SSD claim, call Scott Carr Law Firm. We serve clients throughout San Francisco.

To reach our team, call 415-799-2229 or use the online form.

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