Article at a Glance
- Social security is a safety net for workers with long term disability.
- Social security claims can be denied, especially when medical records are incomplete.
- If your claim has been denied, a lawyer can help you through an appeals process.
Social Security Disability benefits are intended to ensure a source of income for U.S. workers who become unable to work due to a long-term or terminal illness. Unfortunately, taking advantage of that safety net isn’t as straightforward as you might hope. Nationwide, fewer than 1/3 of applicants for Social Security Disability benefits are approved at the initial application stage. In Ohio, the rate is even lower.
It’s easy to get discouraged and abandon the process after the initial rejection, but in most cases, it’s a mistake to give up after the initial denial. Approval rates improve significantly at later stages of the process for a variety of reasons, including:
- Medical documentation continues to grow over time;
- The applicant’s condition may worsen over time;
- Applicants are more likely to be assisted by an attorney at later stages;
- A live hearing may provide a greater opportunity to make an effective case.
Complete Medical Records are Important
One thing to note specifically about the Ohio social security process. Compiling complete medical records can be a key to getting your claim approved, and under Ohio law you have access to your records free of charge. We’ve all been to the department of motor vehicles, and we all know government can work at a snails pace sometimes. Getting all your records together yourself, rather than relying on Social Security to request them for you, can be a game changer.
If you can document that a disability claim has been filed, you are entitled to your records free of charge under Ohio Law.
What to Do When Social Security Disability Benefits are Denied
If you’ve received a denial of Social Security Disability benefits, the very first thing you’ll want to do is read your paperwork carefully to ensure that you understand your rights and the deadlines for contesting the decision.
Request for Reconsideration
For most people, the next step will be a Request for Reconsideration. You have only 60 days to request reconsideration. If you miss that window, you will likely be required to start the application process over. The reconsideration process is virtually identical to the initial application review—the reviewer at this stage isn’t assessing the previous decision, but taking a fresh look at the case and making an independent determination. Reconsideration is a paper review, but you will have the opportunity to supplement the record, if you have new medical reports or other relevant information.
The success rate at the reconsideration level is low—in Ohio, only about 11% of those who request reconsideration are granted disability benefits. That figure may sound discouraging, but it’s important not to be daunted by the low approval rate on reconsideration. Remember that the process is very similar to the initial review, so it’s unsurprising that the outcome is often the same. But there is a chance that you’ll be approved on reconsideration. And if reconsideration results in another denial, that moves you one step closer to a more thorough review, where success rates are higher.
Why Not Just Start Over?
Many people are unconcerned about the reconsideration deadline, thinking that they can always just start over if they want to fight for benefits. Some even believe that starting fresh is a better approach, since they won’t be working against a previous denial. But starting over can work against you in two ways.
First, if and when your claim is ultimately approved, you may receive benefits dating back to your initial application. Depending on how much time has passed, this can mean thousands of dollars in a lump-sum payment after your benefits are approved. However, if you abandon your application and start a new one, that clock re-starts, shortening the time during which you would be eligible for back pay.
Second, the initial application stage and the reconsideration stage have the highest denial rates. Thus, starting the process over again means another pass through the initial application stage, with its roughly 70% denial rate. Unless something significant has changed since your first application and denial, odds are that you will simply receive another denial. If something significant has changed, you can provide supplemental information at the reconsideration stage.
Hearing before an Administrative Law Judge
If your application is denied again on reconsideration, the next step in the appeal process is to request a hearing before an administrative law judge (ALJ). The hearing must be requested in writing, within 60 days of the denial on reconsideration. This is where an experienced Social Security Disability attorney like Plevin & Gallucci can come in handy; having the right counsel at the time can help to increase the chances of seeing an approved appeal.
The claimant may request that the ALJ make a decision based on the written record, but that is not the norm and is generally not the most effective approach. An ALJ hearing allows the applicant and witnesses to testify, and the applicant and/or their attorney will have the opportunity to question witnesses and to make arguments to the ALJ.
This provides a much greater opportunity for the applicant to address concerns of the ALJ, provide additional information as it becomes clear that it will be useful, and generally ensure that the decision-maker has a clear and accurate picture of the applicant’s condition and limitations. In part because of these expanded opportunities and in part because claimants are much more likely to be represented by an attorney at this stage, the approval rate at the ALJ hearing stage is significantly higher than either initial consideration or reconsideration.
Request for Appeals Council Review
If the ALJ finds against the applicant, he or she can request that the Appeals Council review the ALJ’s decision. The Appeals Council must first decide whether or not to review the case: The request may be granted, denied, or dismissed. If the Council grants the request and reviews the case, it will consider any evidence that is part of the record, the findings and conclusions entered by the ALJ, and any supplemental information the applicant has submitted. Unlike decision-makers at earlier stages in the process who simply grant or deny benefits, the Appeals Council has several options. The Council may:
- Uphold the ALJ’s decision;
- Reverse the ALJ’s decision;
- Modify the ALJ’s decision;
- Or send the case back to the ALJ for further action.
The Appeals Council is the end of the administrative road for Social Security Disability applicants, but even their decision isn’t necessarily final. After a negative decision from the Appeals Council, the applicant has 60 days to file an action in federal court and, if necessary, may appeal the District Court’s decision.
Don’t Give Up Social Security Disability Benefits Lightly
The process can be daunting and many people abandon their efforts to secure Social Security Disability benefits. But those who persevere to later stages in the process and who receive knowledgeable guidance and representation from experienced Social Security Disability attorneys like Plevin & Gallucci have a significantly better chance of approval than initial applicants. Don’t assume that a denial in the early stages is the final answer. Contact Plevin & Gallucci for a free consultation today.