Appealing a Denied Disability Claim for Developmental Delay

Developmentally delayed children who have intellectual disabilities or neurological disorders often require additional help to thrive at school. Medical treatments or therapeutic interventions can help them function at the same level as other children their age, but often put additional financial strain on families.

Households with low income and resources who need assistance for their developmentally delayed child may qualify for Supplemental Security Income (SSI). But few SSI applications are approved at the initial level of determination, so it's likely that you'll need to appeal your child's disability claim in order to get benefits.

When Is Developmental Delay a Disability?

Social Security can award SSI benefits to children with developmental delays due to a wide range of intellectual disabilities, such as dyslexia and other learning disorders, autism, Asperger's syndrome, and neurological disorders like cerebral palsy. The agency will look to see whether your child has met developmental milestones by comparing their functional abilities to those of other children with similar limitations (such as their peers in special education classes) as well as other children the same age who have no limitations.

Why an SSI Claim for Intellectual Disability May Be Denied

As a parent of a developmentally delayed child, receiving an SSI denial notice when your child is struggling with a disability can be very frustrating. By addressing the specific reason why Social Security denied your child's claim, however, you can increase your chances of a successful appeal. Below are some common reasons why your child's initial application may not be approved.

Your child doesn't meet the financial requirements for SSI. SSI is a needs-based program for children of parents who have limited income and assets. These limits are set by Social Security and are based solely on your family's finances. If you're "over-resource," you generally can't appeal, no matter how severe your child's intellectual disability is.

The Social Security Administration (SSA) didn't receive records before making a decision. This situation happens rather often. While it's the responsibility of the SSA to get medical records for your child's case if you don't submit them with the application, the agency has a lot of claims to process and is frequently understaffed. Additionally, records requests are often lost in the shuffle of doctor's offices, so the SSA doesn't always hear back from important medical providers.

Medical records don't prove that your child's developmental delay is sufficiently limiting. Simply having a diagnosis of developmental delay or intellectual disability isn't enough for the SSA to decide that your child qualifies for benefits. Under Social Security Ruling SSR 09-1p, your child's diagnosis must cause marked and severe limitations that either meet or "functionally equal" a listed impairment. Providing medical evidence that satisfies these standards can be challenging.

Your child hasn't had much medical treatment. It's difficult to prove a case for disability when there's no medical evidence of treatment for a disability. Ideally, you'll have regular doctor's notes from your child's pediatrician, but the SSA will review records from other sources as well, such as school counselors or teachers.

How Does the Disability Appeals Process Work?

Once you understand why your child's SSI application was denied, you'll need to decide whether you wish to proceed with an appeal. At every level of appeal, you have 60 days from the date you received a denial notice to appeal the decision. If you miss this deadline, you'll need to start over by reapplying.

The first appeal stage is known as reconsideration. At the reconsideration level, another claims examiner at your state's disability determination services agency—who had no role in the initial decision—will review your child's case to see whether the original denial was correct. If your child's claim is denied again at reconsideration, you can request a hearing with an administrative law judge.

Disability hearings are conducted by Social Security's Office of Hearing Operations. You and your child will receive a notice informing you of the date and time of your scheduled hearing, which may be conducted by video conference, over the phone, or in person. At the hearing, you'll have the opportunity to answer questions directly to the judge about your child's limitations.

If you receive an unfavorable decision following a disability hearing, you can appeal further by requesting a review from the Appeals Council. The council will review your child's case only if the judge made a reversible error in their decision. If so, your child's case may be sent back to the judge with instructions to hold another hearing.

Finally, if the Appeals Council declines to review your case, you can file a lawsuit in federal court on behalf of your child. The case will then be handled in the court system, and not by the SSA.

Collecting the Records for Your Child's SSI Appeal

Medical records are the cornerstone of every disability claim. Whether your child was denied because the SSA didn't have all of the needed records, the evidence didn't support a finding of disability, or your child didn't visit the doctor frequently enough, it's crucial that you collect enough medical information to establish your child's disability.

Refer back to the denial notice to find the best way to bolster your child's claim. For example, if the SSA didn't receive important progress notes from your child's psychologist or psychiatrist, check that the agency has the correct contact information to request those records. You can choose to ask for them yourself and submit them to the SSA once you've reviewed them to make sure the records are complete.

You can also use non-medical records to establish the extent to which your child's developmental delay causes disabling limitations. Examples of other records that the SSA will review when deciding if your child qualifies for disability include:

• progress reports from teachers and school nurses
• evaluations from school programs, including early intervention for younger children
• Individual Education Program (IEP) plans
• cognitive assessments
• reports from family, friends, and classmates who regularly interact with your child, and
• standardized test results, such as IQ tests.

Social Security values opinions from doctors that provide special insight into how significantly your child's developmental delay affects their academic and social progress. Consider asking your child's pediatrician, psychologist, or other treating provider for a medical source statement detailing any functional limitations your child has in areas such as following instructions and completing tasks.

Getting Legal Help for a Developmental Delay Case

While you aren't required to hire an attorney for your child's SSI claim, it's generally a smart move. An experienced disability lawyer can make sure you don't miss any appeal deadlines, help gather the medical records you'll need to establish that your child qualifies for benefits, and cross-examine witnesses at your child's disability hearing. Most legal representatives only get paid if you win, so there's little downside to hiring an attorney—especially if you've already received a denial.