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Can I appeal my SSDI denial?

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Q:

Can I appeal my SSDI denial?

A:

Many claimants are shocked when they receive a denial letter from the Social Security Administration (SSA). Claimants assume that SSDI benefits are readily available when they become disabled and unable to work. What they do not realize, however, is that up to 65–70% of disability applications are denied at the initial application level.

The good news is the SSA has established appeal procedures, which allow many denied applicants the opportunity to file an appeal and have their case reviewed again.

How do you know whether you can appeal your SSDI denial? Unfortunately, the answer is a bit complicated and will depend on why your claim was denied. Here are the reasons why you SSDI case may be denied by the SSA:

1. Working too much or making too much money to qualify for SSDI benefits.

Prior to evaluating a claimant’s medical condition, the SSA will review several non-medical requirements for SSDI. One of the first requirements that they will review is whether or not a claimant is performing substantial gainful activity, working too many hours or making too much money to qualify for benefits.

In 2015, claimants who are earning $1,090 or more per month from working ($1,820 for the blind) are performing what the SSA considers “gainful activity,” and will automatically be denied benefits. Claimants working too many hours, regardless of income, may also be denied benefits if the SSA determines that the work is “substantial.”

Claimants who are denied benefits for performing substantial gainful activity can appeal the denial decision or file another application only if their level of work and/or rate of pay decreases below the pre-determined limit.

2. The SSA determines that the claimant is not disabled.

Claimants are determined disabled if the SSA has sufficient medical evidence to determine that their condition is severe, will last at least 12 continuous months, and does not allow them to perform SGA work. If any of the above conditions are not met, however, the SSA will find the claimant not disabled and deny their SSDI claim.

Claimants who were denied benefits because the SSA claimed that they were not disabled may generally file an appeal. To win on appeal, the claimant must provide additional medical evidence from their treating sources that they are disabled and their disability eliminates their ability to work.

Claimants who have not seen a doctor or whose doctor failed to send medical evidence to the SSA can also appeal the denial, but they will also have to take the necessary steps to ensure that they have sufficient medical evidence to prove their case.

3. The claimant’s condition will not last 12 months.

The SSA does not provide any type of disability benefits for short-term conditions, which includes any condition that will not last at least 12 continuous months or result in the claimant’s death.

If a claimant is denied because the SSA believes that they have a short-term condition, under some conditions, the claimant may challenge this denial on appeal.

For example, if the claimant has filed for disability due to a pregnancy, the claimant will not be able to challenge this denial because pregnancy does not last more than nine months. Another claimant, however, may be able to prove that their condition will last more than 12 months through evidence provided by their treating sources.

4. The claimant was denied because they did not have sufficient work credits to qualify for SSDI benefits.

Disability claimants will be denied SSDI benefits if they have not worked and paid sufficient taxes to be insured for SSDI benefits.

According to the SSA, “In 2015, workers must earn $1,220 in covered earnings to get one Social Security or Medicare work credit and $4,880 to get the maximum four credits for the year.” The total number of work credits that a worker will need to be considered insured, however, will vary based on their age when they became disabled.

In general, most workers will need 40 work credits, 20 of which must have been earned in the last 10 years, ending with the year that the worker became disabled. Workers can access their wage information online or contact the SSA at 1-800-772-1213 to discuss their most recent SSA statement of earnings.

Claimants who are denied due to insufficient work credits can challenge the denial, but to win the challenge they will have to present evidence to the SSA that their earnings record is incorrect, and that they have enough work credits to be insured.

5. The Social Security Administration cannot get in contact with you.

Due to the length of time that it may take to process a disability claim, it’s not unusual for some claimants to move and forget to notify the SSA. Unfortunately, after multiple attempts to find a claimant, the SSA is likely to simply deny the case and stop looking.

Claimants who have been denied benefits because the SSA could not find them may challenge this denial, although they must do so within 60 days from the denial letter.

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