Why Was My SSD or SSI Claim Denied?

Before we dive into the appeals process, it’s important to understand why your claim may have been denied. Some of the most common reasons for denial include:

• Lack of Medical Evidence: If the SSA does not have enough medical documentation to support your disability claim, they may deny your application.
• Income or Resources Over the Limit: For SSI, your claim could be denied if your income or resources exceed the SSA’s eligibility limits.
• Failure to Meet the SSA’s Disability Definition: The SSA has strict criteria for what qualifies as a disability, and if they believe you can still perform some type of work, your claim may be denied.
• Failure to Follow Medical Advice: Not attending medical appointments or following prescribed treatments may result in a denial.

While this may be disappointing, it’s important to know that an appeal can often turn a denial into an approval.

The SSD and SSI Appeals Process:

If your claim is denied, you have the right to appeal the decision. The appeals process consists of several levels, and you must follow them in order. Let’s go through each step:

1. Reconsideration

The first step in the appeals process is Reconsideration, where your case is reviewed by someone who didn’t take part in the initial decision.

• What Happens: You can submit new medical evidence or additional information to support your claim, such as doctors' statements, medical records, or updated work history.
• Timeline: The Reconsideration process usually takes 3-4 months.
• What to Expect: A different SSA examiner will review your case, but many claims are still denied at this stage. If your claim is denied again, you can move on to the next step.

2. Request for a Hearing Before an Administrative Law Judge (ALJ)

If your claim is denied during Reconsideration, your next step is to request a hearing before an Administrative Law Judge (ALJ). This is a crucial stage in the appeals process because it gives you the opportunity to present your case in person.

• What Happens: You will have the chance to present new evidence, testify about your disability, and call witnesses, such as doctors or vocational experts, to support your case. An experienced attorney can be incredibly helpful at this stage, as they can cross-examine witnesses and help ensure the judge sees the full picture.
• Timeline: Hearings before an ALJ can take 6-12 months to schedule, depending on the caseload in your area. The hearing itself usually takes about 1-2 hours.
• What to Expect: The ALJ will listen to the evidence and testimony before making a ruling. In many cases, the ALJ will issue a decision within a few weeks or months after the hearing.

3. Appeals Council

If the ALJ denies your claim, you have the right to request a review by the Appeals Council. The Appeals Council reviews your case to determine if there were any errors made during the hearing.

• What Happens: The Appeals Council can either deny your request, send your case back to an ALJ for further review, or in rare cases, reverse the ALJ’s decision. The Council does not hold a new hearing or take additional testimony.
• Timeline: The Appeals Council review process can take up to 12 months, or even longer in some cases.
• What to Expect: The Appeals Council’s decision is final unless they refer the case back to an ALJ for further review.

4. Federal Court

If the Appeals Council denies your request for review or upholds the ALJ’s decision, your last option is to file a lawsuit in federal court. At this point, you’ll be working with a lawyer who specializes in Social Security disability law.

• What Happens: A federal judge will review the SSA’s decision and determine if there were any legal errors. The judge may send your case back for further proceedings, order a new hearing, or issue a ruling in your favor.
• Timeline: The timeline for a federal court case can vary, but it often takes 1-2 years or longer before you get a final decision.
• What to Expect: Federal court appeals are complex, and having an experienced attorney is essential. The judge will make a final ruling based on the SSA’s records and legal arguments, so having legal representation can be vital at this stage.