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What To Do If Your Claim is Denied


 

Including Resources to Help You Find Reputable Attorneys at Reduced Rates

 


 

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If your initial claim application for Social Security Disability benefits or SSI benefits is denied, and you believe that you are disabled from working your past job or any job, then you should file for reconsideration or an appeal, depending on what level of the process you are.

In the Notice of Decision letter, there should be a brochure that explains the timelines for filing for reconsideration or an appeal. Be sure to file for the reconsideration, ALJ hearing or Appeal as soon as possible. You will be surprised how quickly that time will slip away if you do not act on it right away.

Filing for reconsideration on a denial decision or an appeal versus just filing a new application can mean thousands of dollars in retroactive benefits to you if your claim is later approved. So you should read the brochure and follow all instructions to allow for a timely appeal application.

If you read the clues included in your “Notice of Decision” letter as outlined in Step 8, you will be able to assess just how far you will have to go to eventually land a positive outcome.

Denials based on an assessment of “non-severe” have the greatest chance of repeat denials, and in my opinion are not worth pursuing. Denials based on “can do other work” will be the easiest to pursue and win because you only have one more hurdle to cross, i.e. you only have to prove that there are no other jobs out there that you can do, given your physical or mental limitations.

 

Getting Help with Your Appeal

When should you start to look for a professional or a disability advocate to help you with your claim?

That is a good question, and the answer depends on your temperament as well as how the professionals operate in your locality.

If you are extremely nervous about the process, you might consider beginning your search for an attorney or disability paralegal after you have received your first denial. You may or may not be able to find a local attorney who will do any work on your case prior to your Administrative Law Judge hearing or appeals level, or after you have received a denial on your reconsideration.

From an examiner’s perspective, I can tell you that having an attorney at the reconsideration level—unless you have a mental disability—does not really influence the decision. This is because you are essentially dealing with the same group of people who processed your initial denial. They are all trained the same way, and unless you have new medical evidence that is somewhat different from the old, you will more than likely get a similar decision.

At the higher appeals levels, however, your claim leaves the hands of the DDS office and is placed in the hands of an Administrative Law Judge (ALJ) for review or the Courts. The ALJ has more discretion than examiners do in deciding your claim, and you can actually be seen by the ALJ during the hearing, unlike the situation with the examiner and medical consultant staff who will never see you at the reconsideration level.

Another reason to consider holding off on getting an attorney until after your reconsideration denial is that you will get to keep all your back/retroactive benefits if your claim is approved at this stage. This is more than a little deal because attorneys typically can charged up to 25% of back benefits, up to a maximum of $5200 to represent you in the claim.

As an examiner, I used to loathe seeing claimants being represented at the initial application level who had medical conditions that were obviously going to be an allowance. But in claims of mental disability, having a representative was extremely beneficial because these persons serve as relay messengers and helped to get patients to keep CE appointments.

 

Does Having an Attorney Increase Your Chances of Receiving Disability Benefits?

There are statistics that show having an attorney increases a claimant’s chance of receiving benefits, but I think it refers to having an attorney at the ALJ and Appeals level, not at initial or reconsideration levels.

Whether a claimant had an attorney listed on his application never influenced my decision on a claim or altered the process in any way. While notices were sent to attorneys or representatives in addition to the claimant, that was basically the only difference, and that was done automatically if a certain form was in the file.

 

Consider Finding an Attorney If You Have Any of These Conditions

You should certainly consider getting an attorney or representative as soon as possible if you have a mental impairment just because your rep can assist you in taking care of routine matters. In addition, if you suffer from CFS or Fibromyalgia, or have issues with disabling pain due to any cause other than a structural abnormality, you should try to find a rep at the earliest possible time to help you present your evidence in the most favorable way.

 

Attorneys are Good to Obtain Immediately after You Get Your Reconsideration Denial

Other than those scenarios described above, you should consider getting an attorney the moment you have received your reconsideration denial letter, i.e. after SSA has denied your claim two times: at initial application and at reconsideration. That is when your attorney will have the most opportunity to shine and to help you shine as you prepare to go before an Administrative Law Judge.

Talking to an attorney after you get your reconsideration denial letter is a good idea for another reason as well. It is a good screening mechanism. Since attorneys only get paid if they help you win your claim, they are not likely to accept claims that do not have some chance of winning. So if they accept your claim, it is a good indication that your condition is at least a severe one.

Next: How to Find a Disability Attorney and Reduce Fees Simultaneously

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