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How Do I Appeal my Social Security Denial?

How Do I Appeal my Social Security Denial?

How Do I Appeal my Social Security Denial? Social Security may deny your Social Security disability claim for several reasons.  Social Security could deny your claim for non-medical reasons.  They could also deny your claim for medical reasons.  However, you can only appeal a denial for medical reasons.

Non-medical denials

Social Security offers two types of disability benefits.  First, Social Security offers disability insurance benefits (SSDI).  To qualify for SSDI, you must have worked and earned enough work credits.  You cannot appeal a denial based on not having enough work credits.  Second, Social Security offers Supplemental Security Income (SSI) benefits.  To qualify for SSI, you must meet certain financial requirements.  You cannot appeal a denial for SSI based on exceeding the financial requirements. 

How can I appeal a medical denial? 

You can file an appeal several ways.  First, you can appeal your denial online.  This can be the easiest way to appeal an unfavorable decision.  Second, you can file an appeal with your local Social Security office.  If you have a representative, they can help you file an appeal of your SSDI denial. 

When should I appeal my Social Security denial?

You have 60 days to appeal a Social Security denial from the date on the denial letter.  Social Security gives you an extra 5 days to allow you to receive your denial in the mail.  Therefore, you have a total of 65 days from the date on your denial to appeal your claim.  If you don’t file within the 65 days, you may have to re-file your claim.  Social Security allows you to file an appeal in more than 65 days if you have good cause for missing your deadline.

What is good cause for missing my appeal deadline?

Good cause can include several reasons.  Social Security considers:

  • What circumstances kept you from making the request on time;
  • Whether Social Security’s action misled you or you didn’t understand what you needed to do to appeal
  • Whether you had any physical, mental, education or language limitations that prevented you from appealing on time

Examples of good cause for missing your deadline

  • You were very sick when the appeal was due and couldn’t have contacted Social Security yourself or through someone else.  You would need proof that you were seriously ill.
  • There was a death or serious illness in your family
  • Records needed for your appeal were destroyed by an accident or fire.
  • You never received your denial notice
  • Some other type of unusual or unavoidable circumstances and you could not reasonably be expected to have met the deadline

Why was my Social Security claim denied?

Many people receive a denial for SSDI benefits the first time they apply. Understanding why Social Security denied your claim can help increase your chances on appeal.  Specifically, you will know what your claim was missing or where your claim can be improved.  Common reasons include:

  • Firstly, You are working
  • Secondly, Lack of medical evidence
  • Thirdly, Not following your doctor’s orders
  • Finally, Ignoring requests

Appealing a denial for working

Social Security considers disability as the inability to work for at least 12 months.   Not all work activity prevents you from filing for disability.  Social Security considers earnings over a certain amount “substantial gainful activity” or “SGA.”  If you earn over the SGA amount, you won’t qualify for Social Security disability benefits.  For 2021, Social Security considers $1310 SGA for non-blind individuals.  Additionally, you must be out of work for at least 12 months to qualify for Social Security benefits. 

Appealing a denial for lack of medical evidence

Frequently, Social Security denies claims because there was not enough medical proof to show your condition keeps you from working.  Important medical records might be missing from your claim.  On appeal, you need to tell Social Security about all the doctors you’ve seen since becoming unable to work.   You should see your doctors regularly so that you have documentation of your conditions and limitations.  Additionally, you should see specialists for your conditions.  Often, specialists keep better records about your symptoms and problems better than a general doctor.

Appealing a denial for not following your doctor’s orders

When you don’t follow your doctor’s recommendations, Social Security can decide that your limitations would be less serious than if you followed their orders.  This includes refusing or declining certain treatment.  For example, your doctor recommended physical therapy but you didn’t go.  Additionally, it includes taking your medications as prescribed.  It can also include certain lifestyle changes such as diet or exercise.  You should speak with your doctors directly about any difficulty you have following their recommendations.

Appealing a denial for ignoring Social Security’s requests

Social Security often asks for additional information when processing your claim.  Generally, this includes additional forms about your daily activities and work history.  However, it also includes medical examinations with a Social Security doctor.  Social Security may not be able to make a decision without this information.  Social Security denies your claim when you don’t respond to their requests. 

Why should I appeal my Social Security denial?

Appealing a denial improves your chances for approval.  In fact, most cases have the best chance for approval at the hearing level.  Re-filing a new application won’t increase your chances for getting approved.  Actually, it only delays the appeals process. 

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