Tuesday, July 15, 2008

Denial on a disability application - What comes next?

A question was recently broached in a medical issues forum, one that I've seen more times than I can count, but almost always feel compelled to address. The question was "I've been denied on my disability application, what do I do next?

My answer to this question usually spells out two different scenarios. The first involves something known as a technical denial. What is a technical denial? A technical, or informal, denial occurs when a claimant applies for disability but is clearly ineligible at the very outset. In such an instance, the claim is never assigned to a disability examiner and medical records are never gathered. In other words, the case is never processed.

What is the basis for a technical denial? Here are several possibilities. One, a claimant who applies for social security disability but is working and earning more than the limit for substantial gainful activity. Obviously, there is no reason to process such a claim because the claim will not meet the social security definition of disability. Two, a claimant who is only eligible for SSI but has too much in assets (SSI is based on need and individuals who have more than two thousand dollars in countable assets, known as resources, are not eligible). Three, a spouse with a very limited work history applies for SSI but is ineligible because her spouse earns too much (for SSI, a spouse's income can be deemed, or partially counted, and can make an SSI applicant ineligible).

Technical denials are simply denials that are made because there is no reason to evaluate a claimant's medical records. Consequently, there is never a reason to appeal a technical denial. Why? Because no medical determination has been made, i.e. there is nothing to appeal.

Cases that have been denied following a medical determination are a different matter entirely. In this scenario, a claimant has filed for disability, their claim has actually been sent to the state agency and assigned to a disability examiner, and medical records have been requested and then evaluated. In other words, there is something to appeal, which is the denial decision that was based on the disability examiner's reading of the medical evidence.

Aside from the filing of a frivolous claim, I really can't think of a single reason for a claimant to not file an appeal following a denial on a disability application. Unfortunately, many claimants do (choose not to appeal). Why this happens is something nebulous, but in my years of contact with disability claimants I've learned that many claimants fail to appeal for the following reasons:

1. They have confused filing a new application with the act of appealing. Let me state that starting a new disability application is NOT the same as appealing. And in nearly all cases, it will be extremely counter-productive and will typically result in a long string of denials.

2. They have missed the deadline to appeal. Yes, social security does give you 60 days to appeal (and even five more days to allow for mailing the appeal forms). Yet, just the same, many many claimants miss the appeal deadline. Why does this happen? In cases involving cognitive disorders, affective disorders, or mood disorders, the cause may be fairly apparent. However, in many instances, a claimant who has waited several months without income for an answer on a claim and then has been denied will feel despondent and dejected. In other words, they may give up. This is understandable. However, it is a terrible mistake to make in handling one's claim.

In the vast majority of all situations, there is only one practical and logical path to follow after receiving a denial on a disability application. And that is to file a request for reconsideration, the first appeal available to claimants. The following two pages will provide information on reconsiderations and below this is a list of past posts that are related to denials and appeals (some of which will sound repetitive, but which have been written over the course of this blog).

Request for reconsideration

Request for reconsideration

Return to the Social Security Disability SSI Benefits Blog

Past Posts regardings denials and denied claims

1. I was denied the second time for Social Security Disability

2. Appealing a denial of Social Security Disability Benefits when the denial is non-medical

3. How many Social Security Disability and SSI cases get denied?

4. Appealing a Denied Disability Claim

5. Should you appeal a disability denial ? How do you do it ?

6. Should you appeal a disability denial if your condition is improving ?

7. If Denied Social Security Disability ...

8. Denial of Disability, Pain, and Medical Records

9. Social Security Disability SSI and the technical denial

10. Disability Claim Denied

11. If your disability reconsideration is denied

12. Are you automatically denied for Social Security Disability or SSI when you first apply with an initial application ?

13. Denied for Social Security Disability — What do I do?

14. How many times will they deny you for Social Security Disability or SSI before they approve you ?

15. How many people win Disability Benefits from Social Security ?

16. Appealing a denial of Social Security Disability Benefits

17. Can you Appeal a Denial from Social Security

18. What do you do if you get denied for Social Security Disability or SSI?

19. What to do after a Disability Claim is Denied

20. Social Security Disability Claim Denied the Second Time


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