Navigating the complex landscape of Social Security Disability Insurance (SSDI) can be overwhelming, particularly when a claim is denied. Denials can be disheartening, but they are not the end of the road. With proper guidance and understanding of the appeals process, many applicants can eventually secure the benefits they deserve.

At PLBH, our expert team is committed to helping individuals understand their rights and the steps necessary to challenge a denied SSDI claim. This blog provides an outline of the key actions to take if your Social Security disability claim has been denied. Contact us at (800) 435-7542 for a free legal consultation.

Understanding Why SSDI Claims Are Denied

The first step in addressing a denied SSDI claim is to understand the common reasons for denial:

  • Insufficient Medical Evidence: One of the most common reasons for denial, where the evidence does not adequately demonstrate that the disability is severe enough to prevent you from working.
  • Non-compliance with Therapy: If medical records indicate that you have not followed prescribed therapy or treatment, this can affect your claim.
  • Previous Denials: Reapplying for SSDI using the same information that led to previous denials without presenting new evidence or information.
  • Short-term Disability: Disabilities that are not expected to last at least 12 months or result in death might not meet SSDI requirements.

Step-by-Step Guide to the Appeals Process

When a SSDI claim is denied, understanding the structured appeals process is crucial. Here’s what you need to do:

Step 1: Reconsideration

  • What It Involves: This is the first level of the appeals process. You can request that your case be re-examined by someone who did not take part in the original decision.
  • Action Required: File a request for reconsideration within 60 days of receiving your denial notice.

Step 2: Hearing by an Administrative Law Judge (ALJ)

  • What It Involves: If the reconsideration stage still results in a denial, you can request a hearing before an Administrative Law Judge.
  • Preparation: It’s crucial to prepare thoroughly for this hearing. This may include gathering additional medical evidence, detailed statements from your treating physicians, and possibly expert testimonies.
  • Timing: The request for a hearing must be made within 60 days after the reconsideration decision.

Step 3: Review by the Appeals Council

  • What It Involves: If the judge also denies your claim, you can ask for a review by the Social Security’s Appeals Council.
  • Action Required: The Council can either decide your case itself or return it to an ALJ for further review.

Step 4: Federal Court Review

  • What It Involves: The final step in the appeals process. If the Appeals Council denies your claim or decides not to review your case, you can file a lawsuit in a federal district court.
  • Legal Representation: This stage is complex and having experienced legal representation is strongly recommended.

Tips for a Successful Appeal

  • Gather Comprehensive Medical Evidence: Continuously update and organize your medical records, doctor’s notes, and related documents.
  • Adhere to Deadlines: Missing deadlines can be detrimental to your appeal. Ensure all paperwork is submitted on time.
  • Consult with a Disability Attorney: Specialized attorneys can provide invaluable assistance by ensuring your case is as strong as possible.

How PLBH Can Help

At PLBH, we specialize in Social Security disability claims and understand the stress and frustration that comes with a denied claim. Our experienced attorneys are ready to review your case, guide you through the appeals process, and help you present the strongest possible case. If you have received a denial for your SSDI claim, contact us at (800) 435-7542 for a consultation. Let us help you navigate this challenging process and work towards securing the benefits you need and deserve.