Understanding the Denial Process

The Social Security Administration (SSA) has strict guidelines when determining whether someone qualifies for disability benefits. While many initial claims are denied, this does not mean your claim is over. It just means that the SSA believes there is not enough evidence to approve your case. In fact, many applicants are denied during the first stage but go on to win their case after appealing.

The Denial Stages for Disability Claims

When applying for SSDI or SSI, your claim may go through multiple stages, and each stage provides an opportunity to appeal a denial:

Initial Application Denial

• What Happens: When you first apply for disability benefits, the SSA will evaluate your medical records, work history, and other relevant information. This initial application process is where most people are denied.
• Why It Happens: Many initial denials occur because of incomplete documentation or failure to meet the SSA’s specific criteria for disability.

Reconsideration Denial

• What Happens: If your claim is denied initially, you can request a reconsideration. This means that someone else at the SSA will review your case. If the reconsideration is also denied, you will move to the next stage.
• Why It Happens: Often, reconsideration denials occur because the SSA believes your condition doesn’t meet their eligibility requirements or your medical evidence is insufficient.

Hearing Denial

• What Happens: If your reconsideration is denied, you have the option of requesting a hearing before an Administrative Law Judge (ALJ). At this stage, you present your case in person. The ALJ will evaluate your medical evidence, work history, and the severity of your condition. If the judge rules against you, your claim can still be denied.
• Why It Happens: Denial at this stage may happen if your medical evidence doesn't prove that you are unable to work or if the judge finds that you are still capable of performing other types of work.

Appeals Council Denial

• What Happens: If you lose your hearing before an ALJ, you can request a review from the Appeals Council. This review is not a new hearing, but the Appeals Council will evaluate whether the ALJ made any legal errors in your case. If the Appeals Council agrees with the ALJ’s decision, your claim is denied.
• Why It Happens: At this level, denial may occur if the Appeals Council agrees with the lower-level decision, or if there’s insufficient new evidence to support your claim.

Federal Court Denial

• What Happens: If your claim is denied at all previous levels, you have the option of appealing to federal court. At this stage, a judge will review your case and may send it back to the SSA for further review. However, if the court finds no legal error, your case will be denied.
• Why It Happens: Denials at the federal court level are rare but can happen if the court believes there is no substantial evidence to support your claim.

How Many Denials Can You Have?

While there’s no limit to how many times you can be denied, it’s important to recognize that each stage of the appeals process gives you a chance to correct issues with your case and provide more evidence. Here's a breakdown of how many times you might face a denial:

• Initial Denial: This is the most common stage for denial, with over 60% of initial claims being rejected.
• Reconsideration Denial: If your claim is denied initially, you can ask for reconsideration, but the chances of approval at this stage are low, with approval rates averaging around 10%.
• Hearing Denial: This is typically your best chance at winning your claim, but about 50% of disability applicants are still denied after the hearing.
• Appeals Council Denial: If you go this far, your chances of approval are low but not impossible.
• Federal Court Denial: This stage is rare, and your chances of a win are minimal, depending on the evidence and the specifics of your case.

What Happens After Multiple Denials?

Being denied disability benefits multiple times can be frustrating, but it’s not the end of the road. Here’s what you can do after multiple denials:

Re-evaluate Your Case

• New Medical Evidence: After multiple denials, the SSA may find that there is not enough medical evidence to support your disability claim. In this case, it’s important to gather additional documentation, including new medical records or a doctor’s statement that specifically addresses how your condition affects your ability to work.
• Consult a Lawyer: A disability lawyer can review your case and help you strengthen your claim, ensuring that you meet all the SSA’s requirements.

Appeal the Denial

• If your initial claim and reconsideration were denied, you should continue through the appeals process. The hearing before an ALJ is your best chance to present your case in person, and it’s crucial to have proper representation at this stage.

Consider a New Application

• In some cases, if you’ve been denied multiple times, it may be beneficial to reapply and submit updated medical records or new evidence that may improve your chances.

Explore Other Benefits

• If your SSDI claim is denied multiple times, you might want to check if you qualify for Supplemental Security Income (SSI) or other state programs for which you might be eligible.