Common Reasons for a Denial
- Insufficient medical evidence including lack of detail about the medical condition;
- Failing to meet the severity requirements of the medical condition required for disability benefits:
- Lack of ongoing medical treatment implies that the medical condition isn’t too severe
- Inadequate supporting documents clearly showing symptoms of the medical condition;
- Late filing of the application including missing a deadline;
- Not having sufficient work credits or recent work history which is normally needed to qualify for Social Security Disability Insurance (SSDI).
- The applicant’s earnings exceed the SSA’s limit for substantial gainful activity so they may not qualify.
Receiving Your Denial Notice
A disability benefits denial letter is an official document sent by the Social Security Administration (SSA) to notify applicants that their claim for disability benefits has been denied. This letter is crucial, as it contains detailed information that applicants will need to know if they wish to appeal the decision.
What the Denial Letter Includes
The letter will outline specific reasons why your claim was denied such as not enough medical evidence, failing to have accumulated sufficient work credits, missing a deadline, or a decision that the applicant’s condition does not meet the SSA’s definition of a disability.
The denial letter gives clear instructions on how to appeal the denial. There are several steps which are:
- Reconsideration which is a new review of the case by a different SSA assessor;
- Hearing by an Administrative Law Judge (ALJ);
- Review by the Appeals Council if the claim is still denied by the ALJ;
- Claimants can file a lawsuit in federal court if all other stages have been unsuccessful.
In New York, claimants have sixty days from the date of receiving the denial letter to filing an appeal. The letter may also indicate if any additional information or documents are required for the appeal. This may include up to date medical records or details of recent treatment.
Step 1: Request for Reconsideration
The first stage in the disability benefits appeals process is requesting reconsideration. At this point, the Social Security Administration (SSA) will re-evaluate the original claim by reviewing all initial evidence submitted and any new evidence provided. A different claims examiner who did not participate in the first decision will make this decision. A claimant can strengthen their case by providing the most updated medical records and any information that supports the disability benefits claim. In New York, applicants have 60 days from the date of the denial letter to file for reconsideration, so that means acting promptly to avoid missing the deadlines.
Step 2: Hearing Before an Administrative Law Judge (ALJ)
If you are not approved after the reconsideration stage, you can appear before an ALJ at a hearing office in New York.
The judge will consider all the evidence presented to it as well as new documents or testimonies from reliable witnesses that haven’t been previously reviewed. To prepare, a claimant should concentrate on three main areas which are:
- Gathering more medical evidence such as updated medical records, letters from treating doctors, or new test results that can significantly help to strengthen the case;
- Inviting more witnesses including family members, caregivers, or vocational experts who can provide a useful insight into how the disability impacts your daily life and your lack of opportunity to take up employment;
- Preparing for ALJ questions including practicing answers to questions about your symptoms, treatment, and day-to-day limitations due to your current medical condition which will help present a clear case of your situation.
Step 3: Appeals Council Review
If you are still denied access to disability benefits after your ALJ hearing, you can file with the SSA appeals council. The Council will examine the case and identify any mistakes in the ALJ’s decision, such as the misinterpretation of evidence or the failure to follow SSA regulations. The Appeals Council does not conduct a new hearing but reviews the existing record to determine if the decision was the best. The Council can respond in three ways: it may deny the appeal which means upholding the ALJ decision, send the case back to the ALJ for a further review, or issue a favorable decision immediately.
Step 4: Federal Court Review
If the Appeals Council denies the claim, the final step in the disability appeals process is to file a lawsuit in federal court. This step involves suing the Social Security Administration (SSA) to overturn its denial decision. Unlike previous stages, this process requires filing legal documents, following strict court procedures, and presenting a well-structured case to a federal judge. In this stage, no new evidence can be introduced; instead, the judge reviews the SSA’s previous decisions to determine if legal errors had an effect on the outcome.
Hiring an attorney is important at this stage, especially one with experience in New York’s federal courts and Social Security law. Attorneys have the expertise to draft legal arguments, navigate court processes, and increase the chances of success. They will be quick to identify any procedural or evidentiary errors that the SSA or previous judges may have overlooked and help to build a solid argument on the claimant’s behalf.
Deadlines for Filing an Appeal in New York
Each stage of the appeals process has time limitations. These are:
- 60 days to request reconsideration after receiving a denial in New York
- 60 days to request ALJ hearing after reconsideration is denied in New York
Consequences of Missing a Deadline
Applicants who miss any appeal deadline in New York could result in the loss of their right to appeal. This could force them to restart the application process. There is no limit to the amount of new applications you submit
How Long Does the Appeals Process Take in New York?
Average Time for Each Stage
The time it takes for each stage of the Social Security disability appeals process can vary widely, but here are average timelines for each stage:
- Reconsideration average time: 3 to 6 months.
- Administrative Law Judge (ALJ) hearing average time: 9 to 18 months.
- Appeals Council Review average time: 6 months to 1 year.
- Federal Court Lawsuit, average time: 1 to 2 years.
Factors that Impact the Timeline
The factors that can influence the length of the appeals process are the complexity of the case, how long the backlog is in local Social Security offices, and the availability of ALJs in New York.
Working with a Disability Lawyer in New York
Benefits of Hiring a New York Lawyer
The advantages of working with a disability lawyer in New York are their familiarity with local Social Security offices, their familiarity with ALJs and their knowledge of the state-specific disability process
How a Lawyer Can Help with Appeals
A lawyer can assist with the following:
- Gathering useful evidence;
- Preparing for all the different hearings.
