Common Causes of Claim Denials and How to Appeal

Table Of Contents

What Are Common Social Security Disability Claim Denials?

Common Social Security Disability Claim Denials include a lack of sufficient medical evidence. The Social Security Administration requires extensive medical documentation. Your application needs detailed reports from treating doctors. The Social Security Administration also requires comprehensive test results. Insufficient medical evidence often leads to a denial.
Another common Social Security Disability Claim Denial involves a failure to follow prescribed treatment. The Social Security Administration expects claimants to follow doctor's orders. Refusing treatment without good reason raises questions. Your claim may be denied for non-compliance. The Social Security Administration looks for cooperation with medical professionals.

Why Does the Social Security Administration Deny Claims?

The Social Security Administration denies claims for several reasons. The Social Security Administration denies claims when medical conditions do not meet severity requirements. Your condition must significantly limit basic work activities. The Social Security Administration uses specific criteria for disability. Your medical condition must prevent substantial gainful activity.
The Social Security Administration also denies claims due to prior work history. You may have earned too much income recently. Your income level affects eligibility for Social Security Disability benefits. The Social Security Administration assesses your ability to perform past work.

What Is the Social Security Disability Appeal Process?

The Social Security Disability Appeal Process involves several stages. The first stage is Reconsideration. You request Reconsideration after an initial denial. A different claims examiner reviews your case during Reconsideration. The claims examiner considers any new evidence. You submit new medical records with your Reconsideration request.
The Social Security Disability Appeal Process continues with a hearing. You request a hearing before an Administrative Law Judge (ALJ). The ALJ hearing provides an opportunity to present your case. You present testimony and medical evidence at the hearing. The ALJ hearing represents a important step in the appeal process.

How to Appeal Claim Denials: Reconsideration?

How to Appeal Claim Denials: Reconsideration is a formal request for a review of a claim denial. One requests a Reconsideration by filing a specific form. One files the "Request for Reconsideration" form. One files the form within 60 days of receiving a denial letter. The denial letter provides instructions for Reconsideration. One submits new medical evidence with the form.
The Social Security Administration reviews your appeal for Reconsideration. A new claims examiner reviews your application. The claims examiner looks at all existing evidence. The claims examiner also considers the new medical evidence. The Reconsideration stage offers a chance to correct omissions.

What Are the Steps After a Reconsideration Denial?

The steps after a Reconsideration denial involve requesting a hearing. You file this request within 60 days of receiving your Reconsideration denial. The ALJ hearing represents the next level of appeal. You present your case directly to a judge.
The steps after a Reconsideration denial may also include further appeals. An unfavourable ALJ decision allows for an Appeals Council review. The Appeals Council reviews the ALJ's decision. The Appeals Council looks for legal errors. The final step involves filing a lawsuit in federal court.

How Can an Attorney Help with Social Security Disability Appeals?

An attorney helps with Social Security Disability Appeals by gathering medical evidence. An attorney understands the specific evidence needed. An attorney communicates with your doctors. An attorney makes sure all relevant medical records are included. Proper evidence strengthens your appeal.
An attorney also helps with Social Security Disability Appeals by representing you at hearings. An attorney prepares you for questioning. An attorney questions witnesses at the hearing. An attorney presents legal arguments to the judge. An attorney advocates for your rights throughout the appeal process.

FAQS

What is the first step after a Social Security Disability claim denial?

The first step after a Social Security Disability claim denial is to request Reconsideration. You submit a "Request for Reconsideration" form. You also provide any new medical evidence.

How long does one have to appeal a Social Security Disability denial?

One has 60 days to appeal a Social Security Disability denial. The 60-day period starts from the date you receive the denial letter. You must act promptly.

What evidence improves a Social Security Disability appeal?

Evidence that improves a Social Security Disability appeal includes detailed medical records. Medical records from specialists offer strong support. Doctor's opinions on your functional limitations also help.

What happens at an Administrative Law Judge hearing?

At an Administrative Law Judge hearing, you present your case. The judge asks questions about your condition. Your attorney presents evidence. The judge makes a decision on your claim.

Can one appeal an Administrative Law Judge's decision?

One can appeal an Administrative Law Judge's decision. You request a review by the Appeals Council. The Appeals Council looks for errors in the ALJ's decision.

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