Social security disability insurance (SSDI) is a federal program designed to support people who cannot work due to severe, long-term disabilities. Funded by payroll taxes, SSDI provides monthly financial assistance to eligible individuals who have paid into the system through their work history.
Unlike social security retirement benefits, SSDI is available at any age, provided you meet the strict criteria. The complex application process, however, often leads to denials, especially at the initial application stage.
If you’re reading this, you’re probably wondering what to do if SSDI denies your claim. It may surprise you to learn that SSDI denials are common. But with the right legal guidance, you can improve your chances of securing the benefits you deserve.
Bailey & Galyen’s Texas social security disability attorneys can help demystify the SSDI claims process, explain why social security denies so many claims, and tell you what you can do about it.
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Understanding the Social Security Disability Program
The SSDI program was created to provide financial stability to those under full retirement age (65-67 years) who cannot work due to disabilities that are expected to last at least a year or result in death.
Benefits are intended to replace part of the income you would have earned if you could work, helping with basic needs such as housing, healthcare, and other living expenses. For individuals and families who rely on this support, receiving a notice of denial can be incredibly overwhelming and stressful.
To qualify for SSDI, you must have worked long enough to gain sufficient work credits and meet the Social Security Administration’s (SSA) definition of disability. Providing extensive medical documentation to demonstrate that your condition significantly impairs your ability to work is central to this process.
The SSDI system presents many challenges to applicants, especially when dealing with a denied claim. Bailey & Galyen is dedicated to helping clients through the re-application and appeals process, helping them obtain the necessary benefits to move forward.
Why Many SSDI Claims Are Denied Initially
An SSDI denial isn’t uncommon. In fact, most SSDI applications are initially denied. A denial isn’t necessarily a reflection of your condition or your eligibility. Minor oversights, incomplete paperwork, or lack of sufficient medical evidence can result in denials.
Social security often bases denials on strict procedural and technical issues rather than the validity of the disability itself. Understanding why denials happen is the first step in addressing them effectively.
Typical reasons for SSDI denials include:
- Insufficient medical evidence or records
- Incomplete paperwork or failure to meet SSA deadlines
- Engaging in substantial gainful activity (SGA) above SSA’s income limits
- Not following prescribed treatments or attending required medical appointments
By identifying the cause of your denial, you can start addressing any gaps that may strengthen your case during an appeal.
Your Options After an SSDI Denial
If the SSA denies your SSDI claim, you can continue pursuing benefits.
First, you’ll receive a notice from the SSA explaining why it denied your application, along with instructions for appealing the decision. Act quickly, as the appeals process is time-sensitive. Generally, you have a short time after receiving the denial notice to request reconsideration.
Rather than starting a new application, which can result in more delays, filing an appeal allows you to present additional evidence and make necessary corrections to your original claim. This approach often leads to better results than reapplying. An experienced SSDI lawyer can evaluate your options and help you determine the most effective path forward.
How Long After a Denial Can You Reapply or Appeal?
Once denied, you have two main options: appeal or reapply. If you miss the 60-day window to appeal, reapplying may be your next choice, especially if you have new medical documentation or if your condition has worsened. Reapplying with fresh information can strengthen your case, but it’s often better to stay within the appeals process.
Appealing preserves your original application date, which may allow for backpay of benefits, while reapplying starts the process over. Deciding between these options is not always straightforward, but an attorney can advise you on the best approach for your situation.
Steps in the SSDI Reconsideration Process
The SSDI appeal process has several stages, each offering a new opportunity to build a stronger case:
- Reconsideration: A fresh review of your case by someone at the SSA who wasn’t involved in the initial decision.
- Administrative Law Judge (ALJ) Hearing: If reconsideration is denied, you can request a hearing where you present your case before an ALJ.
- Appeals Council Review: If the ALJ hearing does not yield a favorable outcome, you may request a review by the Social Security Appeals Council.
- Federal Court Review: In rare cases, you may take your case to a federal district court if all other levels of appeal are unsuccessful.
Each stage allows you to present additional evidence, address SSA’s concerns, and improve your chances of approval.
Common Reasons for SSDI Ineligibility
Understanding what may disqualify you from SSDI can help prevent issues in your application or appeal.
The SSA has specific requirements that you must meet, and denial may be based on the failure to meet one of those requirements:
- Substantial Gainful Activity (SGA): Earning above a certain amount may disqualify you from receiving SSDI benefits.
- Temporary Conditions: SSDI is designed for long-term disabilities; temporary conditions typically do not qualify.
- Failure to Meet Medical Compliance: Neglecting to follow prescribed treatments, missing appointments, or failing to provide adequate documentation may result in denial.
Improving Your Odds of Success on Appeal
If your SSDI claim was denied, remember that the odds of approval improve during the appeals process. Administrative Law Judge hearings, in particular, allow you to present your case in person, answer questions, and provide a fuller picture of how your condition affects your life. Judges can often consider evidence that the initial application did not make apparent.
Ten Signs That You Will Be Approved for Disability
While no outcome is guaranteed, certain aspects of your case suggest a strong SSDI application, including:
Severe, Documented Medical Condition: If your medical condition is severe and well-documented by healthcare providers, this can strengthen your case significantly.- Long-Term Disability: Conditions expected to last at least a year or result in death meet the SSA’s duration requirements.
- Inability to Perform Any Work: If your disability prevents you from performing any substantial gainful activity, that weighs in your favor.
- Extensive Medical Records: Having comprehensive, detailed medical records that show consistent treatment and limitations can be persuasive evidence.
- Supportive Doctor’s Statement: You should try to include a statement from your doctor confirming that you are unable to work due to your condition.
- Consistent Treatment History: A history of regular, consistent treatment for your condition indicates that you are doing everything possible to manage your disability.
- Approval for Other Disability Programs: If you’ve already been approved for state or private disability programs, the SSA may consider this supportive evidence.
- Qualifying Listing on the SSA Blue Book: If your condition meets a specific disability listing in the SSA’s Blue Book, it may simplify the approval process.
- Evidence of Severe Functional Limitations: You should present evidence that your condition affects daily activities, mobility, or cognitive functioning.
- Experienced Legal Representation: A knowledgeable attorney who understands SSDI requirements and can help present a strong case improves your chances.
If you recognize these signs in your own case, it could mean you’re well-positioned for approval.
Partner With Bailey & Galyen for Your SSDI Appeal
A denial doesn’t mean your SSDI journey is over. With careful preparation, thorough documentation, and guidance from a trusted law firm, you can move forward with a strong case. Our mission is to lift the stress of a denied social security disability claim from you and fight for the benefits you need.
Bailey & Galyen has a long and proven track record of securing life-changing results. Our commitment to complete client satisfaction is reflected in our five-star Google rating from nearly 1,000 clients.
Let our Texas personal injury attorneys help you secure the benefits that can provide stability and peace of mind. Call us today at (817) 345-0580 for a consultation with one of our SSDI attorneys.