Why Are Disability Benefit Claims Denied in New Jersey?
Common Reasons for Denial
It is quite common for disability benefit applications to be initially denied by the Social Security Administration (SSA). In fact, up to two-thirds of claims are denied initially. There are several reasons why a claim may be rejected, but this doesn’t mean that you would have no chance of obtaining disability benefits at all. As long as you understand the reasons for a denied benefits claim you still have the chance of overturning the decision by making an appeal.
The most common reasons why your disability benefits claim might be denied include the following:
- Insufficient evidence that the symptoms of your disability match the exact criteria that the SSA uses in the Blue Book to establish whether to offer benefits payments;
- Insufficient evidence of your medical history, onset of your symptoms, medical evidence showing how your condition has worsened, including documentation showing doctor’s assessment and diagnosis, results of tests and scans, prognosis for future development of your condition;
- Failure to demonstrate that you are unable to continue working for at least the next 12 months or that you have a terminal condition;
- Failure to show that you have sufficient work history and work credits to prove that you match the criteria for Social Security Disability Insurance (SSDI);
- Failure to demonstrate that your assets and income are less than the limit set by the SSA for Supplemental Security Income (SSI) claims if this is what you applied for;
- You may have missed deadlines to submit information requested by the SSA.
Receiving Your Denial Notice
Once the SSA has assessed your claim, a process that can take several months, you will either receive a letter stating that your claim has been accepted or has been denied. This is known as the “initial determination”. If you receive a denial letter, you should also be told why your claim was denied (e.g. any of the reasons listed above) and how you can appeal the decision.
The appeal process is a step-by-step process. Your denied benefits application may be accepted at any of these steps if the SSA determines that you have now provided sufficient information to back up your claim for benefits. Every disability benefits applicant in New Jersey has the right to file an appeal following receipt of a benefits denial letter. You have 60 days from the date you received the denial letter to file an appeal. It is essential that at each stage of the appeal process, you understand the existing time limit and make sure that you keep to the disability appeal time limit otherwise your appeal may be rejected.
The following are the steps involved in the SSA’s appeal process.
Step 1: Request for Reconsideration
Within 60 days of receiving a denial letter, you can file a reconsideration of the decision. Once the SSA has received your request, your case will be re-examined by another examiner in New Jersey. You can file your request for reconsideration online on the relevant part of the SSA’s website. You need to go to the “Appeal a Decision” page, then select “Start Disability Appeal” and file your request for reconsideration. You can also download a Request for Reconsideration (SSA-561-U2) form, fill it in, and then send it off to the nearest SSA office in your state.
Note that you should submit any information which you believe may help you with your appeal. The denial letter may give some idea of what may have been missing and you can also ask for help from a disability appeal attorney who can assess your claim and give advice about what might help your appeal.
Step 2: Hearing Before an Administrative Law Judge (ALJ)
If your benefits claim is still rejected after reconsideration, you then have 60 days to file a request for a hearing before an administrative law judge (ALJ). At the hearing, the ALJ will review your claim and in particular assess the evidence you submitted to support your claim which is still in contention by the SSA. You can appear in person, or appoint a representative such as your disability appeal attorney to be present at the hearing. You may also be told that your hearing may take place online or by phone.
As with the reconsideration, you may be able to obtain further evidence and information that supports your claim for benefits before you have the hearing. You may also be able to request that additional witnesses be present at the hearing who you think are relevant to your claim such as medical personnel.
If you have asked a disability benefits appeal lawyer to help you with your appeal, the lawyer will be able to assist with additional evidence and prepare for any likely questions asked by the ALJ.
Step 3: Appeals Council Review
If your ALJ hearing doesn’t change the SSA’s decision, you then have another 60 days to file a request for a review by the SSA’s Appeal Council. Again, you should make sure that you submit any further information you think may help your case. The Appeals Council will review the appeal process so far and decide whether there were any errors in the process. Your claim may now be approved or rejected again. The Appeals Council may also set a date for another hearing
Step 4: Federal Court Review
The final chance of overturning a denial of benefits after all other appeal steps have been unsuccessful is to file an appeal in the federal court. An appeal to the federal court is independent from the SSA’s Appeals Court and it is advisable that you have a disability appeal lawyer to advise you and represent you in court, even if you haven’t relied on a lawyer up to now.
Deadlines for Filing an Appeal in New Jersey
Time Limits for Each Stage
There are strict deadlines imposed on each step of the appeal process. The SSA gives you 60 days after receipt of a letter advising you that your claim has been denied. This 60-day limit applies to each of the four steps in the appeal process.
Consequences of Missing a Deadline
If you do miss a deadline at any stage of the appeal process, the SSA may mean that you will lose the chance of your right to appeal and you may then have to start the whole application process all over again. The SSA does not limit the number of new applications you decide to make.
How Long Does the Appeals Process Take in New Jersey?
Average Time for Each Stage
The appeal process can take anywhere from 4 weeks to more than a year from the date of a request to appeal. The average time is 7.1 months for a reconsideration decision, 8.8 months waiting for a hearing, and 1- 3 months for a gearing decision. These times vary somewhat from state to state. The process timing in New Jersey is close to the average, e.g. it takes around 9 months waiting for an ALJ hearing, just a bit longer than the national average.
Factors that Impact the Timeline
The timeline stated above is affected by various factors which may or may not have anything directly related to the applicant’s case. For example, all these things can affect the time taken at each stage of an appeal:
- the complexity of the applicant’s case;
- a backlog that might exist in the individual social security offices;
- whether a suitably qualified ALJ is available to hear the appeal.
Working with a Disability Lawyer in New Jersey
Benefits of Hiring a New Jersey Lawyer
There are many benefits of working with a disability appeal attorney if you decide to appeal a denied application for disability benefits. Attorneys know the disability benefits application process and appeal stages well and will be able to assess your claim to see what more you need to do to convince the SSA that your application should be approved.
A disability appeal attorney will also be familiar with the local security offices in New Jersey as well be familiar with the ALJs who may be called upon to hear an appeal.
How a Lawyer Can Help with Appeals
A disability appeal lawyer can help with any stage of an appeal, and if the appeal eventually ends up in a federal court it would be hard to do this without a lawyer.
If you do end up appealing a denied decision, it would be advisable to at least discuss your claim for benefits first with a lawyer before filing a request for a hearing. The lawyer will be able to help with gathering evidence, preparing you for ALJ hearings, and representing you if necessary at any stage of the process.
