What should I Do if My Disability Benefits Claim is Denied?

On This Page

1. What Do You Need to Qualify for Disability Benefits?
2. Why Was Your Disability Benefits Claim Denied?
3. How Do You Appeal If Your Disability Benefits Claim Is Denied?
4. Benefits You Can Receive With a Successful Disability Claim
5. How Can a Disability Attorney Help With Your Denied Benefits Claim?
6. Contact Berger and Green About Your Denied Disability Claim

REVIEWED BY

C. William Kenny

May 05, 2022

Board certified by National Board of Trial Advocacy

Social Security Disability can provide much-needed monthly payments to disabled individuals who cannot work due to a medical condition.  However, securing benefits can be difficult because many applicants receive an unfavorable determination.

If your disability benefits claim is denied, you should appeal the decision. However, appeals can be complex.  If you believe your denial is in error, a Pittsburgh Social Security Disability lawyer with our firm can guide you through the appeal process. Read on to learn more about how to fight back against a disability denial. 

What Do You Need to Qualify for Disability Benefits?

There are two different Social Security disability programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both programs require that you have a condition that is disabling.

However, to be eligible for SSDI, you must have earned enough work credits by paying into the Social Security system through taxes on your wages. You generally need 20 credits (five years of work of the last ten years) to become eligible. There are exceptions to this which is why it is important to speak with an experienced Social Security disability lawyer. To qualify for SSI, you do not need work credits. This needs-based program provides benefits to individuals with very low income and limited resources.

Why Was Your Disability Benefits Claim Denied?

According to the Social Security Office of Retirement and Disability Policy, the SSA denies nearly 70 percent of disability claims, and denials have increased by nearly 10 percent since 2010. There are many reasons you may receive an initial denial, including:

• Lack of medical evidence
• The SSA does not believe your disability will last at least 12 months
• You make too much money from working
• You do not have enough earned work credits
• You made a technical error on your application
• You did not provide correct or up-to-date contact information
• You did not provide proof of citizenship or lawful alien status
• You did not correctly complete or submit an Adult Disability Report 

Qualifying Medical Conditions

To receive disability benefits, you must have a qualifying medical condition. Eligible conditions include:

• Respiratory disorders
• Skin disorders
• Mental disorders
• Cancer
• Chronic heart problems
• Immune disorders
• Musculoskeletal disorders
• Hearing, vision, or speech impairments
• Congenital conditions affecting multiple body systems
• Blood disorders
• Chronic kidney disease
• Neurological disorders
• Digestive system disorders

You can find a complete list of eligible injuries and illnesses in the SAA Blue Book. However, just because your specific condition is not listed does not mean you do not qualify. The SAA adds new conditions to the Blue Book every year, and if you can prove your medical problem prevents you from earning substantial income for at least one year, you may still receive benefits.

SSD Income Requirements

While work credits only affect SSDI claims, SSDI and SSI both require that your disability prevent you from performing substantial gainful activity (SGA). According to the SSA, the SGA limit for 2023 is $1,470 per month ($2,460 for blind individuals). Therefore, if the SSA believes you earn more than this amount, it will deny your claim for benefits.

How Do You Appeal If Your Disability Benefits Claim Is Denied?

If the SSA denies your benefits application, you can file an appeal. There are four stages to the appeals process, and you can potentially resolve your claim at any stage:

Reconsideration

The first step of an appeal is to file a request for reconsideration for medical or non-medical reasons. You must file for reconsideration within 60 days of receiving an application denial. A Disability Determination Services representative not involved in determining your initial claim will review your application and make a decision. While some claims get resolved through reconsideration, it is rare. 

Administrative Law Judge (ALJ) Hearing

If you are unsatisfied with reconsideration, you can ask for an ALJ hearing. A hearing can occur in person, over the phone, or by video conference. During this official court proceeding, the Judge will review the evidence and may question witnesses, such as medical professionals or vocational experts. You have 60 days from receiving the reconsideration decision to file for a hearing. Having an attorney at your hearing benefits your claim for Social Security Disability. 

Appeals Council Review

You can request that the Appeals Council review the ALJ’s decision. However, the council will only permit the review if they find a Social Security law or regulation issue. The Appeals Council will either make a decision or refer your case back to the ALJ. Again, you have 60 days from receiving notice of the ALJ hearing decision to file for review.

Federal Court

If all other attempts have been unsuccessful, you can file a civil action in the United States District Court. You must file your case within 60 days of notice of the Appeals Council’s decision.

Benefits You Can Receive With a Successful Disability Claim

Your monthly disability payments will depend on the disability program you qualify for.

SSDI insurance payments depend on your work credits, with more credits usually leading to higher benefits. According to the Social Security Administration, the highest possible benefit in 2023 is around $3,600 monthly. We can help with an appeal related to claims denials or if you disagree with your payment amount.

The annual SSI rate is the same for all recipients and changes annually based on economic indicators. The 2023 benefit amount is $914 per individual/$1,371 per couple. Some applicants qualify for both SSDI and SSI. 

How Can a Disability Attorney Help With Your Denied Benefits Claim?

A Social Security disability attorney with our firm can represent you through every step of your claim, starting with answering your SSD questions and filing your initial application.

If you are among the many applicants who receive a denial, we will file your appeal and assist in gathering any information needed by the Social Security Administration. Finally, we will file your reconsideration paperwork or hearing requests and represent you during your ALJ hearing.

Contact Berger and Green About Your Denied Disability Claim

Berger and Green has over 40 years of experience helping injured and disabled individuals secure the monetary resources they need and deserve. We can file your initial application, and if your disability benefits claim is denied, we can help you navigate your appeal.

We serve SSD clients in Pennsylvania, Ohio, and West Virginia. We can assist with your appeal for no upfront fees. We only get paid if we win your case. To learn more, contact us for a free consultation.