The Social Security Administration (SSA) administers the disability benefits program along with federal retirement benefits. The SSA has a very specific criteria for approving SSDI, often known as disability benefits. People who apply for Social Security Disability benefits can often face a seemingly uphill battle. Two-thirds of all disability benefits claims are rejected on the initial application for SSDI.
In some cases the applicant might not meet the criteria for disability benefits. This could be because the SSA doesn't consider the applicant's condition severe enough. In some cases, the applicant may not have worked enough to accumulate the necessary work credits, or the applicant may have continued to work in excess of the allowable income following the onset of the disability. Applicants who have been denied for this reason may be eligible for Supplemental Security Income (SSI) which is available to disabled people with a limited work history, income, and assets. The SSA also might deny SSDI claims if the applicant didn't follow instructions from the SSA or follow a doctor's treatment advice.
In many cases however, the applicant meets the qualifications for SSDI but can be denied for reasons such as missing or incomplete information. Sometimes an applicant does have a condition that would qualify for disability benefits but didn't provide the supporting medical evidence. The applicant also may have missed providing significant employment or even identifying information that would be required for receiving benefits.
The first step of the SSDI appeals process is the the Request for Reconsideration. At this stage, your can resubmit your Social Security Disability claim and add new documentation or evidence that you may have missed in your initial claim. All of the information submitted for Reconsideration is reviewed by medical experts who haven't examined you or your records previously. Most appeals at the reconsideration level are denied, upwards of about 90%.
If your reconsideration request is denied, the next step is the Administrative Law Judge (ALJ). This is an opportunity to make an in person argument for your claim. You will want to demonstrate that you have a disability under SSA guidelines and also show the ways in which this disability keeps you from being able to work at your previous job, or any other. At this stage, your chances of approval are about 50%.
Your next option is to go before the Appeals Council. At this level you would need to prove to the Appeals Council that there was an abuse of discretion or that there was considerable factual or procedural error in the ALJ's decision. These tend to be difficult arguments to make on appeal, the Appeals Council will presume that the ALJ's decision was correct unless you convincingly prove to them otherwise.
The last stage of a Social Security Disability appeal is to take the case to a Federal District Court if the Appeals Council decision again denies your claim. At this stage you cannot bring in any new evidence to prove that you are disabled or reargue your claim on whether or not you are disabled or eligible for benefits, just that the ALJ was incorrect in making it's determination. In some cases, the Court may reverse the SSA or ALJ's decision but very often the case will be sent back to the SSA for a new determination that should have taken into account certain information but didn't.
An appeal before the Federal Court can have better chances of success than before the Appeals Council, but the cost to file will be high and the process can take a long time.
In reality, the best way of having your claim approved or winning on appeal is to hire a Social Security Disability Lawyer. Whether you are at the application stage or looking to appeal a denied decision, a Social Security disability attorney can often make the difference when it comes to being awarded disability benefits. Disability lawyers are familiar with the SSA's standards and criteria and know the information that the SSA is looking for when it comes to awarding disability benefits. An experienced disability lawyer will know why the SSA often denies claims for people who actually are eligible and knows how to make your case on appeal. Having an attorney handle your claim can increase your chances of a successful first claim for SSDI benefits or a win at the appellate level