What to Do If Your SSDI Claim Is Denied
Appeal instead of starting over. You generally have 60 days from receiving the denial to request reconsideration, the first of four appeal levels. If that fails, request a hearing before an administrative law judge, where many claimants have their best chance. After that come the Appeals Council and federal court. Keep treating, submit updated medical evidence, and consider a disability lawyer, who is paid only if you win.
Many disability claims are denied at the first stage. A denial is a reason to appeal, not to give up.
The four levels of appeal
| Level | What happens | Deadline |
|---|---|---|
| 1. Reconsideration | A different examiner reviews the file plus new evidence | 60 days from receiving the notice (20 CFR 404.909) |
| 2. ALJ hearing | An administrative law judge holds a hearing, often by video or phone; you and witnesses can testify, and vocational or medical experts may testify | 60 days |
| 3. Appeals Council | Reviews the judge's decision for errors | 60 days (20 CFR 404.968) |
| 4. Federal court | A civil lawsuit in US district court | 60 days |
SSA presumes you received a notice five days after its date. If you miss a deadline, you can ask for an extension by showing good cause.
Why claims are denied
- Not enough medical evidence of how your condition limits your ability to work
- Earnings above the substantial gainful activity level
- Not following prescribed treatment
- The examiner believes you can do your past work or other work
- Insufficient work credits for SSDI
- Missing a consultative exam or not returning forms
How to strengthen an appeal
- Keep treating and get updated records.
- Ask your doctors for detailed opinions on functional limits: sitting, standing, lifting, concentration, absences.
- Write down how symptoms affect daily activities.
- Include records from therapists, specialists and hospital visits.
- Correct errors in the denial's description of your work history.
SSDI denied: can you get SSI?
SSI has the same medical standard but different financial rules. If you were denied SSDI for lack of work credits, you may qualify for SSI if your income and resources are low.
Starting a new application
Filing a new application instead of appealing can lose back pay and restart the clock. In most cases, appealing is better.
Lawyers and fees
Disability representatives' fees generally must be approved by SSA and are usually taken from past-due benefits under a fee agreement, with a cap set by SSA (42 U.S.C. 406(a)). You usually pay nothing if you lose, aside from possible costs.
See also how to apply. Find employment lawyers who handle disability appeals.
Sources
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This article is general legal information, not legal advice, and reading it does not create an attorney-client relationship. Laws differ by state and change over time; talk to a licensed attorney in your state about your situation.
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