Appealing Your SSDI or SSI Disability Denial

Social Security does not award disability benefits easily – you need to do what it takes to win – and never give up

It is important to understand that getting a Social Security Disability Insurance (SSDI or SSI) claim approved is not an easy matter. It is a process that needs to be managed effectively to ensure a favorable outcome. A reality of this process is that most claims are denied before they are approved! In fact, about 70% of claims are denied at the Initial Application level and about 80% are denied at the Reconsideration level. While the disability Hearing represents the best chance to win, the award rates at Hearings are still only about 50%.

What should you do if you are denied disability benefits? The answer is simple: Appeal

To quote legendary football coach Vince Lombardi, “It does not matter how many times you get knocked down, but how many times you get up.” The same can be said about an SSDI or SSI disability claim. You are likely to get knocked down. But you need to get up and fight. Because never has a disability claim been won by someone who was denied and who did not appeal. And it will never happen.

If you want to speak to a disability expert now regarding your recent denial, contact us. We will get to work immediately and ensure your appeal is filed and ensure your claim is on a path to approval. If you want to learn more about what we do at Quikaid, we invite you to do so. We are experts at appealing disability denials and we would like to help you. There is zero cost to our service unless we get your claim approved.

Disability claims are denied for a variety of reasons. But, fundamentally, claims are denied because Social Security (specifically, the adjudicator) determines you do not meet Social Security’s definition of being disabled under their complex rules. They employ the same 5-step sequential evaluation process at each phase of a disability claim. So, a denial indicates that they utilized this evaluation process and were not convinced you are disabled. Oftentimes, this hinges on credibility (or lack thereof), as well as insufficient medical evidence in your claim. To address these issues, you need to present compelling medical evidence and create credibility in your claim.

What types of disability denials and appeals are there?

There are primarily two types of disability denials: non-medical denials (which we also refer to as ‘technical denials’) and medical denials. These denials can be received at any phase in the process, notably the Initial Application, the Reconsideration, and the Hearing.

What is a non-medical or technical denial?

To be found disabled under Social Security Disability Insurance (SSDI or SSI) rules, you must meet the non-medical as well as the medical eligibility requirements. Only when both sets of eligibility requirements are met are you awarded benefits. But, if one or the other is not met, you are denied. Under SSDI, there are many non-medical eligibility requirements, but the primary requirement is sufficient work credits.

Generally, if you have not worked 5 of the previous 10 years (and paid FICA taxes), you will not meet the non-medical eligibility requirements of the SSDI program and, therefore, will receive a technical denial. Under the SSI program, there are strict resource and income limitations because it is a need-based program. If you exceed either the resource or the income limits, you will receive a non-medical or technical denial under SSI. Generally, technical denials are difficult to appeal, unless your circumstances change.

For example, if you have only worked 4 of the prior 10 years, you would not be eligible for SSDI. But if you did return to work, your earnings record will be updated such that you may now have sufficient quarters of coverage to be non-medically eligible for SSDI. On the SSI side, if you have $5,000 in your 401(k), you would be non-medically ineligible for SSI. But if you exhausted those resources, you would likely meet the non-medical eligibility requirements of the SSI program.

What is a medical denial?

Once you meet the non-medical eligibility requirements, your claim is then reviewed for medical eligibility. If the adjudicator (the DDS Examiner or the Administrative Law Judge, depending on what level your claim is at) evaluates your claim using the 5-step sequential evaluation process and determines you do not meet the medical definition of being disabled, your claim will be denied. This often comes down to the (lack of) credibility of your claim – or the insufficiency of your medical evidence.

If you receive a disability denial, you generally have 60 days to appeal this decision. If you properly appeal an Initial Application denial, your claim will advance to the Reconsideration level. If you properly appeal a Reconsideration denial, your claim will advance to the Hearing level. If you properly appeal an Unfavorable decision at the Hearing level, your claim will advance to the Appeals Council. The final appeal option is to federal court, although fewer than 1% of claims make it to this level.

If you need assistance with a recent disability denial, contact us now. We are experts in disability appeals and we win the majority of our claims on appeal. We will get started immediately and won’t stop until your claim is approved. We are standing by now.

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