Foolproof Framework to Follow for the SSDI Appeals Process

Nothing is more discouraging than going through the time-consuming, stressful Social Security Disability claim application process only to discover your application is denied. Sadly, two-thirds of the applications processed are denied the first time around. Although you can avoid denial by working with a disability advocate who understands the complicated process, if you already applied and were denied, you’ll need to understand where you went wrong so you can be successful when you face the Social Security Disability Insurance (SSDI) appeals process.

Here we offer a foolproof framework for you to follow during the appeals process to increase the odds of positive outcomes the second time around.

Understand Non-Medical vs Medical Eligibility

The approval process for SSDI is quite complicated. There is a field office, which is often your local Social Security Administration, that verifies non-medical eligibility requirements such as your age, employment, marital status, or Social Security coverage information and from there the application is sent to the Disability Determination Services (DDS) team for your state, to evaluate your actual disability. Things can go wrong at both offices, which can contribute to whether your application for SSDI benefits is accepted or denied.

Once the DDS makes the determination, it returns your initial application to the field office. If the DDS determines you don’t meet the disability standards, it is the field office that has your file in case you request an appeal. So regardless of whether you are denied by the field office due to non-medical reasons, or the DDS due to medical reasons, your file ends up at the field office.

Understand the Four Levels of Appeal

There are four levels of appeal for the SSDI appeals process:

1. Request for Reconsideration
2. Disability Hearing by an Administrative Law Judge
3. Appeals Council Review
4. Federal District Court Review

If your case is denied at the reconsideration process when they review your case, you can make your way through the remaining levels in the hopes your claim is approved.

Reconsideration

A reconsideration can be requested online. Reconsideration is just that, reconsideration of your case. This process provides a review of your claim with a “new set of eyes.” The opportunity lies in the fact the new team looks at not just the original evidence you submitted, but any new evidence you feel is relevant. There are two types of Reconsideration appeals:

1. Non-Medical Reconsideration: If you received a non-medical determination letter it means the decision is not based on your disability but other information you provided. Often this is related to a denial due to income, overpayments, living arrangements or resources.
2. Medical Reconsideration: In this case, your denial is based on your medical condition. You can request an appeal and present further proof you do in fact have a disability that stops you from working.

In both situations, your challenge is creating a compelling argument that shows you are in fact eligible and that your case should not have been denied.

Contact a Disability Advocate

No one knows what evidence is most likely to help you win your appeal better than a disability advocate. They will review the original evidence, in hand with the determination notice and put together a suitable appeal to ensure all the proper information is provided.

Letter of Appeal

You have 60 days to file an appeal, from the date listed on the denial letter. Therefore you have to act fast to avoid missing the deadline for your reconsideration. If the deadline is missed you can still refile your claim, but this means you have to start the entire process from scratch wasting valuable time. An appeal can often be filed online, but must at least be done in writing by the deadline.

Your disability advocate will start working on your letter of appeal right away and ensure the proper paperwork and information are all filed to get the ball rolling for your appeal. The sooner you get the letter submitted, and the more thorough the information provided, the more likely it is you’ll win your appeal.

Submit the Right Medical Evidence

If your claim was denied due to medical reasons, you’ll need all the factual medical evidence to make it clear you have a disability that is eligible for benefits. If the DDS once again does not have enough information to confidently overrule the original determination, you’ll have to take the appeal to the next level.

Each level you face for your appeal adds more time to the process, further delaying receipt of the money you need for medical care and to cover the cost of living. Therefore, you’ll need as much proof from your physician as possible to show you do in fact suffer from a legitimate disability that makes you eligible to receive compensation. This supplementary evidence is key to winning your appeal. This is why having the appropriate medical treatment for your conditions is so important. It’s also important to communicate to your physician the issues you are having due to your conditions. The evidence must support the allegations of disability.

Follow the Proper Appeal Claims Process

As with your first application, missed information, or not following the proper process will lead to a denied appeal. Your disability advocate will help ensure you win your disability reconsideration appeal by filing the proper paperwork including:

• A Form SSA-561: This is the formal Request for Reconsideration, which can be done online in most cases, or filed via the paper form.
• A complete Reconsideration Disability Report: Your report includes all the new information you have available in hand with any original medical information that accompanied your claim.
• Proper Authorization to Disclose Information to the SSA: This is a medical release form allowing the SSA to access all relevant health information.

By ensuring all of these documents are completed and submitted properly, you can greatly increase the odds of winning your appeal.

Why You Need a Disability Advocate

Unfortunately, the reconsideration appeal process is not much different than the initial process. Since you were denied the first time, this reduces your odds of having your appeal approved. Having a disability advocate in your corner provides you with the support you need from a knowledgeable expert who understands the system.

They will fight for your rights to get the benefits you deserve. Their job is to assure that SSA receives your medical records and any other documentation SSA requests in consideration of your case. They also keep the process moving forward to ensure you don’t miss the deadline. Should your reconsideration be denied, they quickly take your case to the next level and represent you every step of the way.

When our team of experienced advocates file your appeal, we collect the necessary medical documents and test results to prove you suffer from a severe medical condition. This can help increase the possibility of winning your appeal so you can receive the insurance you are entitled to collect.

Don’t wait any longer, get in touch with Princeton Disability today for a free consultation!