Social Security Disability Insurance (SSDI) is a program used by Oregonians to help them make ends meet while living with a disability. It can often be the difference between poverty and getting by. That’s why being denied SSDI can feel so devastating. In Oregon, about 63% of disability benefits applications are denied at least once. This article will help you understand why you were denied and what actions you can take after you are denied.
Reasons An Application Might Be Denied
The Social Security Administration (SSA) has very specific criteria that it looks for when approving benefits applications. Here are some of the most common reasons an application may be denied:
- You Earn Too Much: The SSA may deny your application if you are able to earn a livable wage despite your disability. If this is the case, your application will be rejected on the grounds that insurance benefits are not necessary. The SSA calls this minimum income amount Substantial Gainful Activity, or “SGA.” In 2022, the SGA is set at $1350 per month. So if you gross more than $1350 per month, you are ineligible for disability benefits.
- There’s a Lack of Medical Evidence: You will be required to prove your disability with documentation from medical professionals. The evidence must show that not only are you physically or mentally impaired but also that your ability to work has been substantially affected. Insufficient evidence will be cause for denial of your application.
- You Were Denied Previously: A substantial number of cases are denied because of a previous denial. If your application is denied initially, and instead of following the appeals process, you submit another application, that application will also be denied. You must follow the designated channels of appeal.
The Appeals Process
If your application is denied for the reasons above (or any other reason), you should appeal your case. Each step in the appeals process becomes a bit more complicated, but an experienced Social Security attorney can help you navigate them. Here are the steps for appeal:
Request A Reconsideration
If you are initially denied, the first step is to ask for reconsideration of your application. You must do this by calling or writing the Social Security Office within 60 days of your denial. The SSA will assign a specialist to review your case and look for any mistakes that may have caused your denial. If they find that the previous SSA employee made mistakes in their findings, your application will be approved. If they do not see any such errors, you will be denied a second time. The SSA will contact you by mail to let you know their findings.
Request A Hearing
You can appeal your reconsideration decision by asking for a hearing. This is a chance for you to explain your situation to an Administrative Law Judge (ALJ) who can grant you benefits. Hiring a lawyer at this stage is highly encouraged since most people are unfamiliar with a court setting. Your attorney will also use this time to provide more evidence of your disability. You will have 60 days to request the hearing following your denial of reconsideration.
Appeals Council Review
If you are denied benefits a third time by the Administrative Law Judge, the next step is to request an appeal with the Appeals Council. The Appeals Council will not weigh whether you are disabled, but rather if the Administrative Law Judge made any legal mistakes. They will decide on one of three possible outcomes:
- Denial of Request: Most of the time, the ALJ’s decision will be accepted by the Appeals Council, and your application will be denied again.
- Remand: Occasionally, the Appeals Council will find that the ALJ did not take into consideration all of your medical documentation or the ALJ made another error. If this is the case, you will have another hearing with the same judge.
- New Decision: Rarely will the Appeals Council will decide to overturn the ALJ’s decision and approve your application for disability benefits. However, this occurs only about 2-3% of the time.
If you are denied again, you can appeal your case to the federal district court in your state. Your attorney can advise you on whether this is recommended for your particular case.
If you have been denied Social Security Disability Insurance at any point, call Drew L. Johnson, P.C. Attorneys At Law, at (541) 434-6466. Let us help guide you through the appeals process.