Q

Why Was I Denied Disability Benefits?

A

There are many reasons why an application for disability benefits will be denied. Some of the most common reasons for denial include:

1. Insufficient medical evidence.

   The Social Security Administration (SSA) requires that specific and significant documentation be provided in order to prove the seriousness of a person’s symptoms.

2. Previous application denials.

   Some people make the mistake of re-applying when they should appeal their application. A previous denial without appeal is likely to result in a second denial.

3. Applicant income.

   SSI benefits are need-based. If the applicant’s income is above a certain threshold designated by the SSA, the applicant will not qualify for benefits.

4. Opposition to treatment.

   The SSA looks to confirm that each applicant is doing what they can to treat their condition, including following the treatment provided by their doctor. Applicants who refuse to comply with their doctor’s recommendations will be denied.

5. Opposition to SSA processes.

   The application process has many steps. An applicant who fails to submit paperwork on time or misses scheduled appointments related to their claim will be denied.

Q

What Can I Do About Being Denied Disability Benefits?

A

You have the right to appeal the denial within 60 days. Acting quickly to determine why your application was denied can help you respond effectively. Hiring qualified legal representation to review your case and help you make your appeal can improve your odds of approval.

Q

How Many Times Can I Appeal a Denial?

A

Following an initial application denial, you will have three opportunities to appeal decisions made on your claim before filing a lawsuit. The different levels of the appeals process are:

1. Request for reconsideration.

   During a reconsideration, your application will be reviewed by a new person within the SSA, taking into account all prior and new evidence submitted.

2. Hearing with an Administrative Law Judge (ALJ).

   If you disagree with the decision made during reconsideration, the next step is to request a hearing with an ALJ. These hearings may include questions for the applicant, witnesses, and reviewal of any prior or new evidence.

3. Review by the Appeals Council.

   If you disagree with the hearing decision, you can request a review from the Appeals Council.

4. Federal Court review.

   Those who disagree with the Appeals Council’s decision (or are denied review) can file a lawsuit in the federal district court.

Q

How Can I Appeal My Denial?

A

You must make a request for reconsideration in writing within 60 days of the date you receive the letter with your decision. You can also call the SSA and request the appeal form or visit www.socialsecurity.org/disability/appeal. Hiring our Denver disability attorney at this stage can help ensure that all necessary documentation is submitted and important dates are not missed.

Q

How Do I Apply for Disability Benefits?

A In order to accommodate claimants, the Social Security Administration offers many different ways to apply for disability benefits. You can apply online, in-person, or over the phone. You will be asked to provide substantial documentation regarding your condition, educational background, and work experience. Social Security may be able to process your application faster if you help them by getting any other information they need.

• Apply online by filling out an
  electronic application on SSA.gov.
• Apply in-person at the Social Security office
  nearest to you.
• Apply over the phone by calling this toll-free number: 1-800-772-1213. The TTY number for the deaf and hard of hearing is 1-800-325-0778. The lines are open from 7.a.m. to 7 p.m. on weekdays.

Q

What Do I Need to Apply for Disability Benefits?

A

To complete your application, you will need to provide detailed medical, educational, and work records. All documents presented as evidence must be either originals or copies certified by the issuing agency. The SSA cannot accept non-certified or notarized photocopies as evidence as their authenticity is unverifiable.

Gathering your documentation before beginning your application can help make the process as smooth as possible. If you need help determining which documents are needed for your application, reach out to the SSA for more information.

1. Your Social Security number (SSN)
2. Your birth certificate or other evidence of your date of birth
3. Your military discharge papers, if you were in the military service
4. Your spouse’s birth certificate and SSN if they are applying for benefits
5. Your children’s birth certificates and SSN if they are applying for benefits
6. Your checking or savings account information for direct deposit
7. Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated you and dates of treatment
8. Names of all medications you are taking
9. Medical records from your doctors, therapists, hospitals, clinics, and caseworkers
10. Laboratory and test results
11. A summary of where you worked in the past 15 years and the kind of work you did
12. A copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your federal tax return for the past year
13. Dates of prior marriages if your spouse is applying

If you are applying for Supplemental Security Income benefits, you also need the following:

1. Information about the home where you live, such as your mortgage or your lease and landlord’s name
2. Payroll slips
3. Bank books
4. Insurance policies
5. Car registration
6. Burial fund records
7. Any other pertinent details about your income and the things you own

Q

How Does the SSA Define Disability?

A

The Social Security Administration defines disability as the inability to work due to provable medical impairments. Applicable impairments will last for at least 12 months or for the duration of a person’s life. In determining disability, the SSA has five essential questions that must be answered before an application is approved. To improve your chances of a speedy decision, you will want to supply information that makes the answers to these questions clear.

1. Are you working?

   If you are working and your earnings average more than a certain amount each month, you generally will not be considered disabled. If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.

2. Is your medical condition “severe”?

   For the state agency to decide that you are disabled, your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting and remembering—for at least one year. If your medical condition is not that severe, the state agency will not consider you disabled.

3. Is your medical condition on the List of Impairments?

   The state agency has a list of Impairments that describes medical conditions that are considered so severe that they automatically mean that you are disabled as defined by law. If your condition (or combination of medical conditions) is not on this list, the state agency looks to see if your condition is as severe as a condition that is on the list. If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled.

4. Can you do the work you did before?

   With this question, the state agency will determine if your medical condition prevents you from being able to do the work you did before. If you are still able to do the work you once did, the state agency will decide that you are not disabled.

5. Can you do any other type of work?

   If you cannot do the work you did in the past, the state agency looks to see if you are able and qualified to do another type of work. Your medical condition, age, education, past work experience, and skills will be evaluated. If it is found that you cannot do other work, the state agency will decide that you are disabled.

Q

How does the Social Security Administration define disability?

ASocial Security defines disability as the “…Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for continuous period of not less than 12 months.” While this is the hard line of the law, there are many variables. We would be happy to discuss these details with you.

Q

What kinds of Social Security benefits are there?

A

There are several kinds of disability benefits for which a person can be eligible, including:

• Disability Insurance Benefits (DIB)
• Supplemental Security Income (SSI)
• Disability Widow(er) Benefits (DWB)
• Disabled Adult Child (DAC) benefits

Some individuals qualify for multiple types of benefits, paid concurrently. The medical rules are the same for all categories; you must be just as disabled to qualify for one as for another. The non-medical requirements—such as your age, how much you have paid into Social Security, and your resources—are different for each category.

Q

Is it hard to apply for Social Security disability benefits?

A

No. There are several ways to apply for a Social Security disability claim. The first is to go to the Social Security District Office and file the claim in person. Now applications can also be made online at www.ssa.gov. Another way is to call Social Security at 1-800-772-1213. They will make an appointment for a telephone interview for you. Once the interview is finished they will send necessary forms for you to fill out. All the basic
information will have been collected during the phone interview.

Q

When can I file for Social Security disability benefits?

A You can file for Social Security disability benefits on the day that you become disabled if you believe that you will be out of work for one year or more. Sometimes hospital social workers can help you and your family make the initial contact with Social Security.

Q

Do I need a lawyer to represent me for my Social Security disability claim?

A No. Any claimant can represent themself in all phases of the Social Security disability process. Though it is not required, the assistance of a trained attorney can make a big difference in terms of the speed of your case and its outcome. Many people who are unfamiliar with the process find it intimidating and may not know exactly what their application is missing, leading to stress and delays. Claimants with representation win their cases more often than those who are not represented.

Q

How do representatives who help Social Security disability claimants get paid?

A

Cases are generally handled on a contingency basis. That means the representative receives a fee only if you win your case. Normally the fee is 25% of your back benefits and must be approved by Social Security. This fee is set by federal law.

If you do not win your case there is no fee. There are also costs in each case for which you may be responsible. These costs are charges paid to doctors for medical records.

Q

Can I get Social Security disability benefits if I expect to get better and return to work?

A You have to have been disabled for at least one year or be expected to be disabled for at least one year. So, if you expect to be out of work for one year or more on account of illness or injury, you should file for Social Security disability benefits.

Q

Can I file a claim for Social Security benefits while receiving workers’ comp?

A Yes; these are separate programs, and both can be applied for and collected at the same time. However, the qualifications for each program are different, and you should not expect to be approved for one if you are approved for the other. Worker’s compensation programs vary by state, while Social Security benefits are offered as a federally supported program.

Q

Can I qualify for Social Security benefits with multiple conditions?

A Yes. Many individuals collecting Social Security disability benefits suffer from multiple conditions. Those struggling to manage several more minor conditions may still be found to be disabled when the overall effect is considered. When applying with multiple conditions, you will need to provide the same level of medical evidence to prove your symptoms.

Q

My doctor says I am disabled. Why is Social Security denying my claim?

A Social Security will only approve you for disability benefits if your condition meets their definition of disability. All rulings are based on the requirements outlined in the Listing of Impairments (“The Blue Book”). If you received a decision you believe to be incorrect, you are entitled to appeal that decision with additional medical evidence and testimony.

Q

If I am approved for Social Security disability benefits, how much will I get?

A For disability insurance benefits, it all depends upon how much you have worked and earned in the past. For disabled widow’s or widower’s benefits, it depends upon how much the late husband or wife worked and earned. For disabled adult child benefits, it all depends upon how much the parent worked and earned. For all types of SSI benefits, there is a base amount that an individual with no other income receives. Other income that an individual has reduces the amount of SSI which an individual can receive. Each year we all receive a report from Social Security about our retirement benefits. This report also has the dollar figure you’d receive if you were disabled. A spouse and children are also eligible in most cases.

Q

VA says I am disabled, so why is Social Security denying my Social Security disability claim?

A It is Social Security’s position that VA decisions are not binding upon them. Social Security and VA have similar standards for approving disability claims, but the VA has many partial disability programs. For Social Security disability, one must be totally disabled from any kind of work.

Q

If I am found disabled how far back will Social Security pay benefits?

A For disability insurance benefits, it all depends upon how much you have worked and earned in the past. For disabled widow’s or widower’s benefits, it depends upon how much the late husband or wife worked and earned. For disabled adult child benefits, it all depends upon how much the parent worked and earned. For all types of SSI benefits, there is a base amount that an individual with no other income receives. Other income that an individual has reduces the amount of SSI which an individual can receive. Each year we all receive a report from Social Security about our retirement benefits. This report also has the dollar figure you’d receive if you were disabled. A spouse and children are also eligible in most cases.

Q

What is the difference between Medicare and Medicaid?

A The short answer is that Medicaid is a program for people with limited resources, and Medicare isn’t. Many disabled people who get Medicaid get it because they are on Supplemental Security Income (SSI). To get SSI and thereby get Medicaid you have to be poor and disabled. Medicaid does pay for prescription medications. Medicaid can go back up to three months prior to the date of a Medicaid claim. For Medicare it does not matter whether you are rich or poor. If you have been on Disability Insurance Benefits, Disabled Widows or Widowers Benefit or Disabled Adult child Benefits for 24 months you qualify for Medicare. The good thing about Medicare is that it pays doctors at a higher rate than Medicaid. Almost all doctors are happy to take Medicare patients. Medicare does not begin until after a person has been on disability benefits for two years, and it only pays for prescriptions through Medicare Part D.

Q

If Social Security tries to cut off my disability benefits, what can I do?

A You should appeal immediately. If you appeal within 10 days after being notified that your disability benefits are being ceased, you can ask that your disability benefits continue while you appeal the decision cutting off your benefits. You may also want to talk with an attorney about representation on your case, but you should file the appeal immediately.

Q

What is the difference between Medicare and Medicaid?

A The short answer is that Medicaid is a program for people with limited resources, and Medicare isn’t. Many disabled people who get Medicaid get it because they are on Supplemental Security Income (SSI). To get SSI and thereby get Medicaid you have to be poor and disabled. Medicaid does pay for prescription medications. Medicaid can go back up to three months prior to the date of a Medicaid claim. For Medicare it does not matter whether you are rich or poor. If you have been on Disability Insurance Benefits, Disabled Widows or Widowers Benefit or Disabled Adult child Benefits for 24 months you qualify for Medicare. The good thing about Medicare is that it pays doctors at a higher rate than Medicaid. Almost all doctors are happy to take Medicare patients. Medicare does not begin until after a person has been on disability benefits for two years, and it only pays for prescriptions through Medicare Part D.