Appealing a Denied Disability Claim for Developmental Delay
The basics of the reasons and appeals process for a denial of SSI benefits.
Children who have developmental delays, which can include learning disabilities, mental retardation, cerebral palsy, and other impairments that prevent a child from developing at a rate equal to others their age, often require additional assistance to function well at school, including medical treatments or therapies to increase their functioning. These additional treatments and therapies can be financial straining on families. Supplemental Security Income (SSI) is available to children who qualify.
Reasons for Denial of SSI Benefits
When your child is struggling with a disability and is denied disability benefits through SSI, it can be very frustrating as a parent. There are several reasons why children are denied benefits, and the reason they are denied will affect the actions that you take. Below are some of the reasons children are denied benefits.
- Your child does not meet the financial requirements for SSI. The income and asset requirements of the SSI program are based on the income of the child’s family. These limits are set by the Social Security Administration (SSA) and are based strictly on financial statements. Appeals are not generally an option if your child is denied for this reason.
- SSA did not receive records prior to making a decision. This situation happens rather often. While SSA has the responsibility to get medical records for your child's case if they are not provided with the application, the agency has a lot of claims and limited manpower. In addition, requests often go unanswered by medical professionals, so records are not received by SSA.
- Your child's medical records do not prove the extent of disability or how the disability limits your child’s ability to function. SSA finds that many children are simply not limited enough by a learning disability or low IQ to qualify for benefits. Providing medical evidence that clearly meets the requirements of a disability listing can be difficult. Please see the discussion below on evidence for children’s cases.
- Your child has had little to no medical treatment. It is difficult to prove a case for disability when there is no evidence of a disability. Luckily, for children, there are other sources of records beyond those of their treating physician. Please see the discussion below on evidence for children’s cases.
Overview of the Appeals Process
Once you understand why your child was denied benefits, you must make a decision as to whether or not you are going to appeal the decision. Please be mindful that you need to give Social Security notice of your intention to appeal in writing. You have 60 days to do this from the day you received the denial notice, or you will lose the ability to appeal your decision. If you fail to appeal, you will need to reapply in order for your child to receive disability benefits.
When your child is denied SSI benefits, there are four steps that can be taken in order to get SSA's decision reversed. Hopefully, the first step will be successful and you will not need to further appeal the benefits decision.
- Reconsideration. In most states, you must file a request for reconsideration to get your child’s case reviewed by an individual at your state disability determination agency who had no role in making the initial determination on your case.
- Hearing before an administrative law judge (ALJ). In this step, you and your child will attend an informal hearing with an ALJ. You can provide new medical evidence or school records before this hearing, and you will be given the opportunity to answer questions directly for the ALJ about your child and his or her condition.
- Appeals Council. In this step, the Disability Appeals Council will review your child’s case only if the ALJ made a legal or technical error in making your child’s determination. If the Appeals Council determines there was an error, the council can either hear the case themselves or send the case back to the ALJ to be reheard.
- File in lawsuit in federal court. In this final step, you can file a lawsuit in federal court on behalf of your child. Your child's case will then be handled in the court system and not by the Social Security Administration.
For more information on each level of appeal, see our article on the four levels of Social Security appeals.
What to Do Before Your SSI Appeal
For children who are denied disability claims for developmental delays, the key area of concern for winning an appeal is the medical record. Whether the record was not properly "developed" (meaning SSA did not collect all of the needed medical records) or the records do not say what is needed (because the child did not receive treatment or visit a psychologist or psychiatrist frequently) or the records failed to show the extent of your child's impairments or limitations, it is essential that you take the time to collect the medical records that you need to support your child’s case. This may include asking your child's doctor or psychologist to write a statement about how your child's delays negatively affect his academic and social functioning.
For children, there are other records that can be used beyond medical records to prove a child’s functional limitations. These other records include:
- teacher observations
- evaluations from school programs, including early intervention for younger children
- Individual Education Program (IEP) plans
- formal and informal assessments
- reports from individuals who are with your children day to day, including family, friends, and people at school
- interviews with individuals who interact with the child, including parents and teachers, and
- standardized test results, such as IQ tests.
It is important to provide your records to Social Security prior to your child's hearing in order to allow the ALJ time to review and properly consider the new evidence in your case.
To decide if your child should receive SSI benefits, the ALJ will compare your child level of functioning to teachers' expectations of your child, to others with similar limitations (such as other children in special education classes), and to other children the same age who have no limitations. For more information on this analysis, see our articles on: