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Appealing Denial of Social Security Disability Benefits

Published July 19, 2009

Unexpected illness or injury can intrude upon an individual’s life at any time, preventing work and cutting off valuable sources of income. Social Security disability benefits are available to those unable to work due to illness or injury, but many who apply for benefits have their initial claim denied. There is a process for appeal of a denial of claim that can be taken advantage of, improving the chances of receiving important benefits.

Unfortunately, the majority of Social Security disability claims are initially denied. According to the Social Security Administration’s own annual report, in 2006 only 32 percent of disabled workers applying for Social Security disability benefits were determined to be entitled to an award. Those in the position of applying for Social Security should be aware of this issue and prepared to take the next step if an application is denied.

If the Social Security Administration (SSA) determines that an applicant is ineligible for benefits, he or she will receive a letter in the mail with a notification of the denial and a brief list of the medical information that was used to make the determination. This letter is referred to as the initial denial, and the applicant then has 60 days from receipt of the letter to file an appeal in writing. In New York, the SSA assumes that you have received your letter five days after the date on the letter unless other evidence is presented. If no appeal is made within this 60-day window, the SSA closes the case and will take no further action.

After the initial denial, there are three levels of appeal available to applicants in New York: a hearing by an administrative law judge, a review by the Appeals Council, and a Federal court review.

The hearing before an administrative law judge is critical, because in this step, the applicant, witnesses, and a representative may appear before the judge to present evidence. The judge is independent of the SSA and is not bound by the fact that the applicant has been previously denied. The judge’s decision will be based upon the evidence presented at the hearing and a prior review of the case. According to the SSA, it is in the applicant’s advantage to attend this hearing.

If the claim is denied after the administrative hearing, the applicant may still ask for a review by the Social Security Appeals Council. If the Appeals Council decides to review a case, it may decide the case itself or order it returned to an administrative law judge for further review.

In the event that the Appeals Council decides not to review the applicant’s case or reviews the case and still denies the claim, the applicant may file suit before a Federal Court.

The process for appealing a denial of Social Security disability benefits is complicated and can be lengthy. According to the SSA’s own statistics, however, those willing to undergo the process are often successful in having the initial denial reversed. A New York Estate Planning attorney can offer advice and representation throughout the process to help ensure a positive outcome.

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