Social Security Disability: Deciding Whether to Appeal a Denied Claim

Should you appeal a denial of SSDI disability benefits?

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If the Social Security Administration (SSA) decides that you are not eligible for Social Security disability (SSDI) benefits, that your current benefits will end, or that the amount of your payments should change, you'll be sent a letter explaining the decision. If you don't agree with the denial of or change in SSDI benefits, you can appeal the decision. 

Before you file an appeal, you should ask yourself some questions.

  • Are you able to physically and mentally do the paperwork that an appeal requires?
  • Do you want to get involved in reviewing your file and commit a significant amount of your time to the appeal process?
  • Or, if you win, are you willing to pay part of your backpay benefits to a lawyer who will help you?
  • Has your medical condition has improved enough for you to work?
  • What was the reason Social Security denied you benefits, and was it valid?

In your notice of denial, Social Security should have included an explanation of the denial along with the impairments and medical records that were considered. You can also request your file from Social Security so that you can review the technical rationale for denial, which will include more detail. After reviewing your SSA file, can you see incorrect statements or opinions that you can challenge? What does the file say about your impairment severity, your age, your education, your work experience? Are any of these statements in your file wrong? Does the denial notice show that important medical records were not considered? If you can find any mistakes made by Social Security, your chances of winning an appeal go up. (For more information about why claims are denied, see Nolo's article Social Security Disability: Eight Reasons You May Be Denied Benefits.)

In most cases, it does make sense to appeal, because you have a fairly good chance of winning your appeal at the hearing stage. Plus, there are no costs for filing an appeal if it's within the SSA, such as an initial request for reconsideration or appeal hearing. However, if you file an appeal in federal court, you will need to pay court fees and other costs. (See Nolo's article Social Security Disability: Five Levels of Appeal for more information on the process).

Here are some more questions to ask yourself when deciding whether to appeal a denial of disability benefits.

How Medically Severe Are Your Impairments?

If you have an impairment that qualifies under the Listing of Impairments -- such as chronic heart failure that meets the requirements of the cardiovascular listing -- then your claim should not have been denied and you have a very good chance of prevailing on appeal. The closer your disability fits into a medical listing, the greater chance you have of winning an appeal.

Is Your Impairment Going to Last at Least a Year?

Often, claimants apply for disability benefits based on bone fractures or other injuries associated with accidents. Most often these kinds of disabilities will not last a year, and year-long impairment is a requirement to obtain disability.

How Old Are You?

The probability of getting benefits increases with age. If you are 55 or older, your chances are generally much better than if you are younger. However, the more severe your disability, the less your age matters. If you have a very severe disability, you are likely to get benefits even if you are young. But if you are younger than age 55, speak English, and don't qualify under an impairment listing, then you are most likely facing denial on appeal.

What Is Your Education Level?

A higher level of education can lower your chance of being allowed benefits in some situations. If you have a high school education or more, your chances of obtaining benefits radically decrease, because the more education you have, the more likely it is you can do sedentary work. But if you have not worked for many years in a field for which you are educated, this may not be a factor. Also, if your medical condition is so severe that your disability leaves you unable to do sedentary or unskilled work, you can still be granted disability benefits.

What Is Your Work Experience?

The more work experience you have -- especially more skilled experience -- the greater the chances that the SSA will decide you can do some kind of work and will deny your benefits.

Is It in Your Best Interests to Appeal?

If you appeal, the SSA may grant you benefits even though you are capable of doing some sort of work. But some people still do rewarding and fulfilling jobs even if they could qualify for disability. For example, there are many legally blind or totally deaf people with rewarding jobs making many times the amount of money they would make on disability, although they would easily qualify for benefits.

Next Steps

Your decision to appeal should not be based on any one of the above factors, but on a consideration of all of them together. A disability lawyer can look over your denial notice and file with you and give you an idea of what your chances of winning on appeal are.

Many, many applicants whose claims were initially denied have success on appeal. If you decide you want to appeal a denial of benefits, read Nolo's article Social Security Disability: Appealing Denied Claims and consider hiring a disability lawyer.

For more information in general about Social Security disability, including applying for benefits, appealing a denial of benefits, and detailed medical listings, see Nolo's Guide to Social Security Disability: Getting & Keeping Your Benefits, by David A. Morton III, M.D. (Nolo).

by: David Morton

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