Many workers spend years earning a living, only to experience a disabling illness or injury that leaves them unable to maintain themselves and their families. If this happens to you, you may be able to apply for Social Security Disability Insurance (SSDI) benefits to help meet your living expenses and access medical care.
While these benefits are a lifeline when you can no longer work, getting approved for them isn’t as straightforward as it should be: SSA statistics show that denied disability claims have averaged 67% in recent years. Fortunately, you can appeal a denied disability claim, with the first step being a request for reconsideration.
Bross & Frankel, PA, is dedicated to helping clients throughout Southern New Jersey, Pennsylvania, and Delaware get the SSDI benefits they have rightfully earned. With the right disability attorney by your side, you’ll receive informed representation and caring personal service during the SSDI reconsideration process. As your legal counsel, we are dedicated to one goal: making sure you are ultimately approved for the disability benefits you need.
Why Are SSDI Disability Claims Denied?
Although every SSDI claim is different, there are some common reasons for denial. They include but may not be limited to:
- Prior Denial: When their initial application is denied, some people make the mistake of just filing a new one instead of appealing. This approach increases the chances of an application being rejected, as nothing has been done to correct previous errors or omissions.
- Insufficient Medical Evidence: Your disability must be documented by strong medical evidence that makes it clear you cannot work. If the medical documentation doesn’t make your functional limitations clear, you will almost certainly be denied.
- You Did Not Cooperate With the SSA: Sometimes the SSA needs additional information before it can make a decision. Your SSDI claim will not be approved if you ignore requests for more medical or financial information.
- You Make Too Much Money: SSDI benefits are for people who can’t maintain gainful employment. If you earn above a certain amount, it may be taken as evidence that you are not too disabled to support yourself financially.
- You Didn’t Follow Treatment Advice: If you don’t follow your doctor’s advice or there are gaps in your medical care, the SSA may deny your claim due to noncompliance with treatment instructions.
Addressing these issues at the reconsideration stage can increase your chances of a successful appeal. The fact that your claim was denied does not necessarily mean that you aren’t disabled and don’t qualify for benefits. Due to a stringent review process, most legitimate claims are not initially approved which is why there is a multi-stage appeals process that starts with a request for reconsideration.
The Reconsideration Stage Explained
If the SSA sends you a denial letter, you have to request reconsideration within 60 days of the date on the letter. If you miss this deadline, you’ll have to start all over again.
Once you file a reconsideration request, your application will be sent back to the SSA for review. Although your appeal will be handled by the same field office that reviewed your initial application, the examiner will be different. They will review your claim to determine whether you do in fact qualify for benefits, but remember: they will be following the same determination rules as the previous examiner, so if you haven’t addressed any deficiencies in your application, it’s likely to be denied again.
How to Understand Your SSDI Denial Letter
Your denial letter will indicate why your claim was not approved. Although everyone’s case is different, you may notice phrases like the following:
- ‘Non-Severe’: This means that the SSA does not believe that your medical condition is severe enough to leave you disabled.
- ‘Does Not Meet an Impairment Listing’: This means your condition is not listed in the SSA’s Blue Book as a disability or impairment. Nevertheless, just because your condition does not meet an impairment listing does not mean you are not disabled. Neither does it mean that you are ineligible for benefits.
Specific language will also be used to talk about whether you are able to return to your previous job or whether you may be able to find other employment. If the SSA determines that you are capable of doing your past job or can perform “other work” (any work that takes your age, education, and functional limitations into consideration), it will deny your disability claim.
Whatever reasons you are given, you’ll want to address them in your request for SSDI reconsideration.
Why File a Request for SSDI Reconsideration?
Clients sometimes wonder whether they should simply file a new, amended application instead of appealing. While this may seem simpler than getting into the appeals process, the reality is that if you opt to refile, it can affect your back pay.
“Back pay” refers to past-due disability benefits, which are payments for periods during which you were medically eligible to receive SSDI benefits but not yet approved. If you appeal your denial and win (a process that can take a year or more), the SSA will pay you the benefits you would have received had you initially been approved.
So what does this look like in practice? Let’s assume that you had to leave your factory job on October 1, 2020, due to pain and leg weakness from degenerative disc disease. You applied for SSDI on October 15 but your claim was denied. After an unsuccessful request for reconsideration, you hired an SSDI attorney, appeared before an administrative law judge in February 2022, and were finally approved, with the judge determining that your disability did begin in October 2020.
The Social Security Administration calculates that you have an SSDI benefit of $1,300 a month based on your earnings history. Fourteen months have passed since the onset of your disability. The waiting period for SSDI benefits is five months – they begin the sixth full month after your onset date – so you’re entitled to nine months’ past-due benefits. If you opted to file a new claim instead of appealing back in October 2020, your back pay would be less.
How to Apply for SSDI Reconsideration
Start by reviewing your denial letter to understand why you were denied. If the SSA concluded that your condition was not severe enough, you may need more medical documentation and letters from friends, family, and colleagues who can describe the impact of your disability on your life.
Reconsideration appeals require a specific form called SSA-561. You will also have to submit the following:
- A Reconsideration Disability Report that augments your original claim by providing the SSA with new and relevant information, such as treatments that you have undergone and your response to them.
- An Authorization to Disclose Information to the SSA. The purpose of this form is to allow the Social Security Administration access to your disability-related medical records.
In general, it takes three to five months for the SSA to complete the SSDI reconsideration process. Once the SSA has decided on your reconsideration appeal, you will be notified in writing. This letter will explain whether or not your appeal was successful as well as how the SSA made its decision.
If your claim is approved, the approval letter will contain all the information necessary for you to understand your benefits. This includes:
- Benefits Amount: A benefit payment is calculated based on your highest-earning years and divided into monthly payments.
- Payment Dates: You will be notified in the approval letter when you can expect to receive your benefits each month. Depending on the payment method you chose, you will get your payments via direct deposit, electronic transfer, or an SSA debit card.
- Back Pay Amounts: Back payments will be made for benefits the SSA would have granted had the application been approved sooner. SSDI back payments are usually issued in a lump sum within 60 days of approval.
- Tax Consequences: Depending on the recipient’s financial circumstances, SSDI benefits may or may not be taxable. In the approval letter, you will be informed whether or not the benefits are taxable.
If your reconsideration request is denied, you may appeal the decision and present your case to an administrative law judge. If you have not yet hired an attorney, you should consider hiring one to represent you during the hearing process. With proper representation at your hearing, your chances of successfully appealing your disability claim are greatly increased.
Do You Need an Attorney for an SSDI Reconsideration?
You are not legally required to use an attorney for an SSDI request for reconsideration, but it certainly makes a difference.
Your lawyer can assist you in filling out and submitting SSA forms, gathering evidence, and managing other activities related to your appeal. Due to the complexity of the process, you may feel overwhelmed on your own. Your lawyer can help you avoid mistakes and ensure that your appeal is filed without delay. In fact, studies suggest that when you are represented by an attorney, you are three times more likely to win your disability claim.
Clients often wonder whether they can afford to hire a lawyer to help them appeal a denial. The answer is that when you hire a disability lawyer, you don’t make an advance payment such as a retainer. SSD lawyers handle claims on a contingency basis, which means that they only get paid if they win benefits for you.
Social Security typically pays past-due benefits in a lump sum within 60 days of approval, and if you have a lawyer, the SSA will pay their fee out of this back pay. Fee agreements must be approved by the SSA in advance, and the amount is generally capped at $6,000 or 25% of back pay, whichever is less. The attorney will not recover compensation if your disability claim is denied.
How to Win an SSDI Appeal
While nothing is ever guaranteed, your chances of winning an SSDI appeal go up when you submit a complete application, accompanied by compelling medical and witness evidence, and hire an SSD attorney to guide you through the process.
Your request for reconsideration should include all of the following:
- An appeal letter that states your position and explains why you are unable to work and won’t expect to return to work for at least 12 months.
- Supporting medical evidence. Depending on your disability, this may include x-rays, CAT scans, and lab results in addition to treatment notes. If any medical records were missing from your initial application, include them now.
- A complete list of all your medical providers, along with their contact information.
- A thorough Residual Functional Capacity (RFC) form. Your doctor will fill out this form, detailing your condition and how it impacts your ability to work.
At Bross & Frankel, PA, our SSDI attorneys are highly experienced in handling disability appeals. We have a proven track record of success and a solid reputation as committed advocates for the disabled. As our client, we will work tirelessly to get you the benefits you deserve.
Was Your Disability Claim Denied? Get a Free Consultation From an SSDI Reconsideration Lawyer
At Bross & Frankel, PA, we know that becoming disabled completely changes your life. Medical bills and income loss can quickly become a burden. SSA benefits provide vital financial resources to disabled individuals, but there are strict eligibility requirements, and most initial claims are denied. This can lead to more frustration and worry about your future.
We understand. Disability determinations can be appealed, but obtaining benefits often requires the assistance of a disability lawyer. We can guide you through every step of your SSDI appeal and will work tirelessly to protect your rights whether you are filing a request for reconsideration or approaching the SSA Appeals Council. We know disability law and will use that knowledge to get the best results for you. To schedule your free consultation with an SSDI reconsideration lawyer at our firm, call 856-210-3345 or contact us online.