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I was denied SSDI a second time, so what are my options?

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Q:

I was denied SSDI a second time, so what are my options?

A:

Unfortunately, many disability applicants are denied Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) several times before they are finally approved for benefits. If you are denied benefits, you have several options: filing a second disability application, requesting a reconsideration or requesting a hearing.

Each of these actions, however, can lead to a second SSDI denial. Below, we will discuss what a claimant should do if one of the following occurs:

  • The claimant was denied a second time after filing a second application.
  • The claimant was denied a second time after filing a reconsideration.
  • The claimant was denied a second time after filing an administrative hearing.

Denied a Second Time after Filing a Second Application

Many SSDI claimants receive a denial of their initial disability application and simply file a second application. Reasons for this vary: claimants do not understand the reason they were denied, claimants do not understand the appeals process, or claimants wait too long to file the appeal and have no other option but to file a second claim.

If you are denied a second time after filing a second application, it’s time to take a step back and make sure that you understand why you were denied. Filing over and over again is generally not productive. Reasons for a second denial can include any of the following:

  • The claimant is working too many hours and/or making too much money.
  • The claimant does not have sufficient work credits to qualify for SSDI benefits.
  • The SSA does not think that the claimant’s condition is severe or will last 12 continuous months.
  • The claimant did not provide sufficient medical evidence to prove that they are disabled.
  • The SSA believes the claimant can retrain for new work.
  • The claimant does not meet the age requirements.
  • The claimant does not meet other non-medical requirements.

Some of the denials may be challenged; others cannot. For example, if the SSA states that the claimant’s condition is not severe and that they can retrain for new work, the claimant may be able to file an appeal after the second application denial and provide additional medical evidence that they are disabled and cannot work.

However, let's say that the SSA denied the claimant’s case because they had insufficient work credits; unless the claimant can prove that the SSA miscalculated their work credits, they will not win benefits until they return to work and earn more credits. In this case, challenging the second SSDI application denial by filing another application or appealing the denial decision will not be successful.

Denied after the Reconsideration

The second option after an application denial is to file an appeal within 60 days from the date of the denial notice. In most states, the second appeal is called a reconsideration, which is simply another review of the disability case by a second disability examiner at the Disability Determination Services office (DDS). The reconsideration is similar to the first review and will include a review of the claimant’s application and medical records from their treating doctors.

Claimants who file a reconsideration and are denied a second time can appeal their denial by requesting a disability hearing before an administrative law judge. Requests must be made within 60 days from the date of the denial. Claimants who miss the denial and cannot prove “good cause” (i.e. hospitalization or serious illness) will have to begin the SSDI process again from the very beginning by filing a new claim.

Disability hearings generally give claimants the best chance to win their case, but claimants may have to wait a year or longer for their hearing to be scheduled. During this time, it’s important for claimants to talk to a disability lawyer, review their medical files to ensure that they have sufficient information to prove they are disabled, and continue to get good medical care.

Denied a Second Time after a Disability Hearing

Several states have eliminated the reconsideration appeal. These states include Alabama, Alaska, parts of California, Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York and Pennsylvania. Claimants who are denied at the application level in these states do not have to request a reconsideration after their initial application denial. Instead, they can immediately request an administrative hearing before a law judge.

Claimants who requested a hearing may be denied a second time for a variety of reasons: judges are not convinced that the claimant cannot retrain for new work, the judge is not convinced the claimant’s condition is severe or will last 12 continuous months, or the claimant may have returned to work.

If the claimant’s case was denied a second time at the hearing level, the claimant generally has the right to appeal it a third time. The third appeal is performed by the Appeals Council.

The Appeals Councils will “look at” all requests for review, but they may not make a decision on every case. For example, they may decide that the hearing decision was correct, review the case and make a decision (deny or grant benefits), or send the case back to the judge for another review.

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