Understand Why Your Claim Was Denied

The first step in deciding whether to appeal is to thoroughly review the denial notice you received from the SSA. The letter will explain why your claim was denied, which can include factors such as:

• Failure to meet SSA’s definition of disability: If the SSA determines that your medical condition doesn’t prevent you from doing substantial gainful activity (SGA), your claim may be denied.
• Insufficient medical evidence: If the SSA believes that your medical records don’t fully support the severity of your disability, they may deny your claim.
• Work history or income issues: In some cases, your work history or income may not meet the requirements for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
• Failure to follow treatment: If the SSA believes that you are not following prescribed medical treatments or therapies, it could negatively impact your case.

If you disagree with the SSA’s reasons for denial and believe that you do meet the criteria for disability benefits, appealing the decision may be the right choice.

Know the Appeal Options

If you decide to appeal your disability claim denial, there are four main stages in the appeals process:

• Request for Reconsideration: This is the first step of the appeal process. The SSA will review your case again, but this time, a different person will look at the evidence. You can submit new medical evidence or clarify any information that may have been unclear in your initial application.
• Hearing Before an Administrative Law Judge (ALJ): If your claim is still denied after reconsideration, you can request a hearing in front of an ALJ. This is a more formal process where you can present your case, provide additional evidence, and have a chance to testify in person.
• Appeals Council Review: If the ALJ denies your claim, you can request a review by the Appeals Council. They will look over your case to determine if the ALJ made any errors in judgment.
• Federal Court: If all else fails, you can file a lawsuit in federal court. This is the final stage of the appeal process, but it’s rare and generally only pursued when all other options have been exhausted.

How Strong Is Your Case?

Before deciding to appeal, it’s important to assess whether you have a strong case. Consider the following:

• Medical Evidence: Do you have sufficient medical documentation to prove the severity of your condition? If the SSA denied your claim due to insufficient medical evidence, gathering additional records or obtaining more detailed opinions from your healthcare providers could strengthen your case.
• Vocational Factors: Did the SSA find that you are capable of performing other types of work? If your condition prevents you from performing your past job or any other work, be sure to provide evidence to show that your disability limits your ability to engage in substantial gainful activity.
• Other Factors: Was there a technical issue, such as incorrect income reporting or a missing document, that caused your claim to be denied? If so, appealing might be the right course of action.

What Are the Chances of Success in an Appeal?

While appealing a disability claim can be a lengthy and challenging process, it’s important to note that many claims are successful during the appeal process. In fact, about 60-70% of claims are approved after a hearing before an ALJ, especially if you present new and compelling medical evidence.

However, not every case is guaranteed to be successful, and the appeals process can take several months or even years to resolve. It’s important to weigh the time and effort involved in appealing against the potential benefits of a successful outcome.

How to Strengthen Your Appeal

If you choose to appeal your disability claim, there are several steps you can take to improve your chances of success:

• Get More Medical Evidence: Work closely with your doctors to gather updated and detailed medical records. Your healthcare provider’s opinion on how your condition affects your ability to work is crucial.
• Consult with a Disability Lawyer or Advocate: A disability lawyer or advocate can significantly improve your chances of winning your appeal. They can help you understand the process, gather evidence, and represent you at the hearing. Lawyers usually work on a contingency fee basis, meaning they only get paid if you win the case.
• Submit Additional Documentation: If there’s any new evidence, such as medical tests or a change in your condition, submit this information with your appeal. It’s crucial to keep the SSA informed of any updates that may affect your case.

Should You Appeal or Start a New Claim?

In some cases, it may be better to start a new claim rather than appealing, especially if your medical condition has worsened significantly or if there were issues with your initial claim that are difficult to resolve.

However, if your medical condition is consistent with the reasons for denial, and you have strong new evidence to present, filing an appeal is usually the best option.