Why Your Claim Could Be Denied | Your Options When Your Claim Is Denied
You’ve suffered some type of injury or contracted an illness that makes it impossible for you to work. You’ve filed for benefits under the Social Security Disability Insurance (SSDI) program, but your claim has been denied. What might cause your claim to be denied? What are your options when your claim is initially rejected? What steps should you take to protect your interests?
Common Reasons for the Denial of an SSDI Claim?
If your claim is initially rejected, you’re not alone. The Social Security Administration estimates that nearly half of all first-time claims (approximately 40%) are turned down. The factors that most often lead to denial include:
- Insufficient medical evidence to support your disability—You must present compelling evidence that you suffer from a qualified injury or illness and that your disability prevents you from having gainful employment.
- Your claim has already been denied—Far too often, an applicant, instead of taking a claim through the appeals process, will simply refile the same claim as though it were a new claim.
- You didn’t fall within the income restrictions—You may have an injury or illness that limits, but does not prevent, you from working. If you continue to be employed while your application for benefits is in process, you will be subject to limits on the amount you can earn.
- You went against medical advice—To qualify for benefits, you must do what your doctor prescribes.
- You failed to supply requested information—If, as part of the investigation, the Social Security Administration asked for additional documentation, and you failed to provide it, that can be a legitimate basis for rejecting your claim.
What Are the Steps to Appeal the Denial of an SSDI Application?
When the Social Security Administration rejects your application for benefits, they must send you a written communication stating the reasons for the decision. Your first response should be to ask for a reconsideration (Form SSA-561). Technically, this isn’t taking your claim to a higher level—it’s simply asking the Social Security Administration to review your file one more time. You can (and will potentially benefit from) submitting new evidence for consideration.
If the Social Security Administration has taken another look at the facts and circumstances of your case, and still rejects your claim, it’s time to file a formal appeal. You must submit a request for appeal and request a hearing by an administrative law judge (Form HA-501). The administrative law judge will carefully consider your appeal, often taking testimony from witnesses or otherwise considering evidence.
If the administrative law judge issues an adverse ruling, you can ask that your claim be considered by the Appeals Council (Form HA-520).
If the Appeals Council rejects your claim, you still have recourse in the federal courts. You must file your claim in the U.S. District Court and will be subject to the Federal Rules of Civil Procedure.
Contact the Proven SSDI Attorneys at Bailey & Galyen
At the law offices of Bailey & Galyen, we have decades of experience helping people in Texas who seek disability insurance benefits through the Social Security Administration. We understand the unique challenges involved in the SSDI process, and we can help you take the right steps to streamline the process and improve the likelihood of getting the benefits you need. To learn how we can help you secure SSDI benefits, contact us by e-mail or call our offices at one of the convenient locations listed below. Our phones are answered 24 hours a day, seven days a week.
