Appeals & Reconsiderations

Disability Appeals & Reconsiderations

After months of waiting for the Social Security Administration to process an initial disability benefits claim, you finally receive notice of a disability denial. Along with frustration comes uncertainty about what to do next to get the financial assistance you need. One option is to file an appeal.

The SSA rejects the claims of 62% of the people with disabilities who apply for Social Security disability benefits each year. If you are one of them, don’t give up. Instead, fight a denial of your claim with James Mitchell Brown, a disability attorney for appeals with more than 50 years of experience practicing disability law, including the disability appeals & reconsiderations process.

Why Claims Are Denied

Although each applicant for Social Security disability benefits presents their own unique set of facts, the following seem to be the most common reasons for claims being denied:

• Lack of or inadequate medical records to document the existence of a disability. A diagnosis must be supported by the notes and findings from physical examinations, laboratory results, diagnostic testing, and other evidence of a disabling medical condition.
• Applicants who do not meet the non-medical requirements for the disability program: Work history for the Social Security Disability Insurance program and resource and income limitations for Supplemental Security Income.
• Filing an application after denial of a prior claim. Submitting a new application without addressing the reason a prior claim was denied may result in another unfavorable outcome. Consult a disability attorney about appealing a decision instead of reapplying.
• Failing to take prescribed medications and follow the treatment plan recommended by a treating healthcare professional.

The advice and guidance of an experienced disability lawyer, such as James Mitchell Brown, can help avoid common reasons for claim denials. Should a claim be denied, a seasoned disability attorney for appeals will promptly submit an appeal request to fight it.

What Is Reconsideration?

The appeals process has four levels: Reconsideration, disability hearing, Appeals Council review, and a civil lawsuit in a federal district court. Challenging the denial of an initial disability claim starts with a request for reconsideration.

The disability appeals & reconsiderations process begins with reconsideration. Claimants cannot skip a level, so you cannot immediately request a hearing until you receive a reconsideration determination.

You have 60 days from the date you receive the denial notice to request reconsideration. The SSA assumes you receive the notice five days after the date printed on it. Do not delay submitting a reconsideration request, or you may lose your right to appeal.

The disability appeals & reconsiderations process begins with reconsideration. Claimants cannot skip a level, so you cannot immediately request a hearing until you receive a reconsideration determination.

When you request reconsideration, an examiner who was not involved in the initial determination is assigned to review your application. The medical consultant assisting the examiner would have no connection to the original review of the claim.

As the claimant, you or your disability lawyer for appeals has an opportunity to review the evidence that the SSA and Disability Determination Services used during the initial review process. You or your lawyer may submit additional evidence, such as updated medical records, to support and strengthen the claim for Social Security disability benefits.

How To Strengthen Evidence for Appeal

Evidence proving the existence of a medical condition and the limitations that affect your ability to work is essential to the success of an appeal. Disability attorney for appeals, James Mitchell Brown, uses the following methods to strengthen your chance of a successful outcome from an appeal:

• Keep a diary or journal: Recording the symptoms, pain levels, limitations, and other ways that a medical condition affects you on a day-to-day basis offers a personal narrative of daily struggles caused by a disability.
• Medical records: Current records of hospitalizations, diagnostic imaging, lab work, and examinations or specialist consultations provide proof of the ongoing effect a condition has on your life.
• Treatment history: Documentation of prescribed medications, surgeries, and other treatment options.
• Statements from treating medical providers: What your doctors, including specialists, have to say about your medical condition, particularly how treatment options have affected it, can be powerful evidence for an appeal.
• Statements from friends, family, and co-workers: Third-party statements can be persuasive in proving the limitations caused by your medical condition and how they affect your ability to work.

Experienced disability lawyers understand the importance of evidence to the success of disability appeals & reconsiderations. As your attorney, James Mitchell Brown works closely with your medical providers to ensure the availability of current medical records and other documentation at all levels of the appeals process.

Appeal Deadlines

Appeals must be submitted within 60 days of the date you receive a decision on your claim. The SSA assumes you receive the notice five days from the date printed on it. If you receive the notice more than five days from its date and miss the deadline to appeal, it is your responsibility to prove when you received the notice.

If you miss an appeal deadline, submit your appeal immediately. Include a request for an extension of time along with the appeal.

The SSA may grant an extension of the time to appeal on a showing of “good cause.” Good cause generally requires proof of a physical, mental, linguistic, or educational limitation that prevented you from meeting the deadline. Examples of good cause reasons could include:

• A death or serious illness of a family member.
• You were too seriously ill to contact the SSA or have someone else contact it.
• Important records that you need were destroyed by an accidental incident, such as a fire.
• You did not receive notice of the initial determination in time to meet the 60-day deadline.

Proof of the good cause reason must be submitted along with your request. For instance, a doctor’s statement to prove that you were seriously ill.

How a Lawyer Improves Your Chances

You are not required to have a lawyer represent you in the disability appeals process. However, the experience, knowledge, and skills provided by a disability appeals attorney relieve you of the burden of navigating a complicated and confusing appeals & reconsiderations process.

The U.S. Government Accountability Office reported that people with representation had a success rate three times higher than those without an attorney. Advantages offered by a disability lawyer include:

• Avoiding missed deadlines with a keen awareness of the deadline to appeal.
• Knowledge of the procedures, laws, and regulations that must be followed throughout the appeals process.
• Ability to identify and gather evidence to support and strengthen an appeal.
• Preparation assistance to get you ready to answer questions during a disability hearing.

A disability attorney for appeals gives you someone you trust and can rely upon to look out for your interests. If you need help to appeal an adverse decision from the SSA, contact James Mitchell Brown for a free consultation and case evaluation.