Applying for Social Security Disability Insurance (SSDI) benefits can be a complex and challenging process. Strict criteria must be met and claim denials are frequent. In fact, more than two-thirds of SSDI applications are initially denied. If you have received a denial letter after applying for SSDI, you will have options for supplementing your application or for correcting deficiencies. 

Understanding why SSDI claims are denied can significantly improve your chances of success on appeal. The Social Security Administration (SSA) can reject your claim if it does not believe that your medical condition will last for at least 12 months, the minimum period required. The SSA may find that your condition is not severe enough to qualify as a disability. Another ground for denial could be that you are still engaging in “substantial gainful activity,” that is, earning wages at a high-enough level that your condition does not make you disabled. A denial also might be based on an alleged failure to comply with your prescribed treatment plan.

If your claim is denied, you should retain attorney. You will receive a letter from the SSA explaining the reasons and your right to file an appeal. Here are the steps you should take:

  1. Review the denial letter — Carefully read the letter and try to spot errors or omissions. Pay close attention to the section addressing the medical sources that support your claim. Check if the letter references all the medical information and evidence you provided. Errors in this section could be a basis for appeal.

  2. File your appeal promptly — You have 60 days from the date on the denial letter to file an appeal. The first level of appeal is known as "reconsideration," where your case is reviewed by a different SSA representative. It is crucial to submit your Appeal Request and Appeal Disability Report within the deadline, along with any additional evidence or clarifications that could strengthen your case.

  3. Prepare for your appeal hearing — If your claim is denied again at the reconsideration stage, the next step is to request a hearing before an Administrative Law Judge (ALJ). The ALJ is an attorney who will review your case independently. You may be asked to attend this hearing in person, by telephone, or via video conference, especially during times such as the COVID-19 pandemic. Preparing thoroughly for this hearing is essential, as this is often the best opportunity to present your case directly to a decision-maker.

  4. Request review by the appeals council — If the ALJ denies your claim, you can request a review by the SSA's Appeals Council. The Appeals Council is based in Northern Virginia and has the authority to either review the ALJ's decision, remand the case for another hearing, or deny your request. A remand gives you another chance to argue your case before an ALJ.

Having an experienced Social Security Disability appeals attorney by your side can significantly improve your chances of success. An attorney can evaluate your case, help gather necessary medical evidence, and represent you effectively at all stages of the process outlined above.

At Massengill, Caldwell & Coughlin, P.C., we assist clients in pursuing their SSDI claims from the initial application through the hearing stage and even the Appeals Council at times. Located in Bristol, we proudly serve clients in Kingsport, Johnson City, Upper East Tennessee, and much of Southwest Virginia. Call us at 423-797-6022 or contact us online to schedule a consultation.