One of the criteria to qualify for Social Security Disability benefits is that your disabling condition has lasted or is predicted to last at least twelve months. If you have not suffered from your condition for at least twelve months and if your doctors cannot predict with certainty that your disability will last for at least twelve months, your claim may be denied. Denials based on the duration of a disability are called durational denials. There is an exception to durational requirements in cases of blindness.
While the time period you have had your condition is fairly easy to determine, based on your medical records, the period over which your condition is expected to continue requires a subjective opinion. Your doctor’s opinion factors into this decision, but the determining vote is cast by the Disability Determination Services (DDS) examiner and the DDS medical consultant assigned to your Social Security disability claim. Because whether or not your condition will last for at least twelve months is a subjective opinion, the decision regarding your condition is really a judgment call on the part of the DDS examiner and medical consultant.
Durational denials are particularly common in cases of car accidents or other traumatic injuries and disability following serious surgery. While accepting that you will be totally disabled during the recovery period, SSA requires that you somehow prove you will be totally disabled for a year or more in order to receive Social Security disability benefits.
DDS decisions on this matter are routinely called into question and reversed at the hearing level (when you appeal a denial). Therefore, if your case has been denied because of lack of duration, it is very important that you appeal the decision promptly.
Every decision made with respect to your Social Security Disability claim can be appealed. When you appeal a denial decision, your entire case will be reviewed. You must act promptly to file your appeal within sixty days of the date you receive your denial letter. The vast majority of Social Security Disability claims is denied at the initial level and must be appealed.
There are four levels of appeals you can make with respect to your Social Security Disability claims:
- Reconsideration
- Hearing by an administrative law judge
- A review by the Appeals Council
- A Federal Court review
