What Does a Social Security Notice of Denial Really Mean?
Author Attorney Greg Reed:
If you have applied for Social Security Disability but then receive a denial letter SSA-L443 it’s important that you don’t give up. Most are denied initially. Believe in your claim and if you so choose appeal the denial within 60 days.
If your initial claim for Social Security Disability Income is approved, you will receive a notice in writing from the Social Security Administration detailing the amount of your monthly benefit and past-due benefits, as well as when you will receive payment.
Sometimes applicants receive a letter stating they have met the medical requirements for disability, but their claim is still being reviewed to confirm they have met the non-medical requirements for eligibility.
During this process the SSA will want to find out:
- if the applicant has recently been employed in a job which required them to pay FICA taxes into the Social Security system
- if the applicant is still working; and
- if the applicant’s income is above SGA, or Substantial Gainful Activity ($1220 in 2019).
If the applicant meets both the medical and non-medical requirements after review of their case, the applicant will receive a Notice of Award.
Social Security denies approximately 67% of initial disability claims in Texas.
Though an applicant’s name, address, and medical condition are contained in the letter, these Notices of Denial (SSA-L443) are not unique. The letters begin by acknowledging the claim that was filed, and based on a review of the applicant’s health problems, the applicant does not qualify for benefits on the claim. Notices of Denial are basically form letters stating that you, the applicant, claim you are unable to work because you suffer from XYZ condition, but upon review of your medical records, doctors and other trained medical providers have determined that XYZ condition does not prevent you from working.
If you have been denied disability don’t give up! Contact a Disability lawyer at 512-454-4000 for a free consultation and get the benefits you deserve.
The letter is divided into several sections explaining the Social Security Administration’s determination process.
Social Security will list the medical sources that were relied upon in reaching its decision; for example, the Department of Veterans Affairs reports received 5/12/2017 and 6/9/2017. This list will usually look like the list of records you provided, but may also include medical providers you did not include in your application, or the list may omit medical providers you did include. If you believe some medical records were not reviewed, you should contact a Social Security case worker.
The Notice lists the conditions for which the claim was evaluated; for example, degenerative joint disease, arthritis, and generalized anxiety disorder.
The letter will state how the limitations of your medical condition(s) have affected your ability to work. It may say something like, “Although you may experience pain, you are able to move about and have satisfactory use of arms, hands and legs. We conclude you are able to return to your previous job.” Or, “While you are unable to perform previous work, you are capable of performing some type of work.” Social Security will justify their conclusion by stating that doctors and other trained staff reviewed the applicant’s case and reached this decision. But in most cases, a disability examiner with no medical training reviews the claim and passes it on to a doctor working in the same case unit who approves the examiner’s assessment.
A Notice of Denial emphasizes that the applicant is not disabled under Social Security Administration rules and points out that there are other government and private programs which provide benefits, but use different rules.
An applicant may receive benefits from another program which follows different rules and not qualify for Social Security Disability benefits. The applicant may be entitled to benefits in the future, but will need to file again.
If you disagree with Social Security’s decision, you may appeal.
The first step in this process is filing a Request for Reconsideration within 60 days, beginning the day after you receive the Notice of Denial. A complete review of your claim will be performed by a different medical consultant and examiner who reviewed your initial claim. About 5% to 10% of claims are granted at this stage. You may file a Request for Reconsideration (Form SSA 561-U2) online or request a form by calling 1-800-772-1213. You must also complete a Disability Report Appeal to provide Social Security with information about your medical condition since filing your original claim.
If your claim is denied again, you will receive another Notice of Denial similar to the first letter you received.
The next level of appeal is to request a hearing before an administrative law judge and again, this must be done within 60 days. Though legal representation is not required, appearing at a court hearing before an administrative law judge without an attorney can hurt an applicant’s chance of success. If you represent yourself and lose, you may have to reapply all over again. Disability attorneys are experts in the reconsideration and appeals process; a disability attorney can craft your case to reverse a denial and present your case to the ALJ. Administrative law judges uphold or overturn decisions on disability benefits. Generally, administrative law judges grant 50% of claims that reach the hearing stage.
If an administrative law judge upholds the SSA’s decision you may request a review of your claim before the Appeals Council.
The Appeals Council looks for a flaw in the administrative law judge’s decision before deciding to review a case. The only reason to request a hearing before the Appeals Council is to exhaust all the avenues of the SSA’s administrative appeal process as the chance for winning at this stage is only 2% to 3%. When a claim is denied at this stage, an applicant’s only option is to file suit in federal court.
The Notice of Denial also informs you that you have the right to file a new application at any time, but this is not the same as filing an appeal and you may lose some benefits or not qualify for any benefits.
The protected filing date of a claim is based on the date you informed the SSA that you intended to file for disability. This date is used to calculate any back pay you are due. If your initial claim is eventually approved, you will be paid all the money that would have been paid to you if you started receiving benefits from the protected filing date. Filing a new application begins the whole process over again. The protected filing date is moved forward and you could lose thousands of dollars in benefits. Some people think they need to file a new claim because they have new medical evidence supporting their disability claim, but this is not necessary. The point of the appeals process is to allow you to gather and present more information supporting your disability claim to the SSA.
You have 60 days to request an appeal, beginning the day after you receive the Notice of Denial.
If you need help with your appeal, you should consider asking an attorney to help you. Social Security is more likely to approve an applicant who is represented by an attorney than an individual who does not have legal counsel. A Notice of Denial is not the end of your claim. If your application for disability benefits is denied, you can still take steps to have your claim approved.
Disability benefits are an important source of income for those who are unable to work. If you not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court – all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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