What if you Receive a Disability Denial from Social Security?

What does it mean when you receive a denial notice from Social Security? It simply means that the Social Security Administration has determined that, according to their rules and regulations, you are not disabled at this time and that Social Security feels that you can either do work that you have done in the past, or that there is other work that you are able to do.

What are the "rules and regulations" as they pertain to eligibility determinations?

Disability claims are approved by SSA (Social Security Administration) in one of two separate ways. The first is by meeting or equaling the requirements of a disability listing. Listings are the specific approval criteria for certain physical and mental conditions in the blue book, also titled "Disability Evaluation under Social Security".

The blue book, or Social Security Disability List of Impairments functions as a guidebook for decision-makers on claims, i.e. disability examiners and administrative law judges. However, not all conditions are listed in the blue book. There are no listings, for example, for fibromyalgia or carpal tunnel syndrome. Additionally, some listings have been removed or deprecated (e.g. the endocrine listings for obesity and diabetes).

Because most disability approvals will not occur by satisfying the requirements of a listing, SSA provides a secondary means of approval. This method uses a five step sequential disability evaluation process which, if passed, results in a medical vocational allowance.

Qualifying for disability benefits under this process means that A) a claimant must be found to have a severe condition, B) the condition must last for at least one year, C) the condition must be severe enough to prevent the claimant's ability to return to their past work, and D) the claimant's condition must be severe enough to prevent them from engaging in other types of work that their combination of education and work skills might ordinarily qualify them for.

If you receive a denial on your claim

You should not be discouraged if you receive a disability denial. The disability examiners at DDS, a.k.a. disability determination services--the state disability agency that handles disability claim decisions for the social security administration--typically deny the great majority of the cases they evaluate.

Historically, the average rate of denial at the initial claim level is approximately 70 percent. Requests for reconsideration (this is the first appeal) which are also handled by DDS examiners are denied at an even higher rate--more than 80 percent. This is why so many disabled individuals do not receive a Social Security Disability or SSI approval until the administrative law judge hearing.

You may ask, of course, what changes when you reach this level of appeal? Well, an administrative law judge may use a different interpretation of Social Security regulations when making their medical decision. And in many cases a judge will give more weight and consideration to the opinion of claimant's physician if one has been submitted in writing. Finally, a disability judge may find that prior decision-makers were incorrect in denying your claim.

However, for most claimants who win their cases at the ALJ (administrative law judge) hearing level, the most significant differences between this level of appeal and the prior levels of the system are the following:

1. You may present your case directly to the individual who is making the decision on your disability claim. This is not something that occurs at the initial or reconsideration levels where the decision is made by a disability examiner and where the claimant is basically just a file in a caseload.

2. You and your attorney or non-attorney representative may present your interpretation of the facts; in other words, you will have the opportunity to state exactly why it is that the physical or mental limitations resulting from your disabling impairments prevent you from being able to engage in substantial and gainful work activity, either in the performance of work that you've done in the past, or in the performance of some type of other work for which you might be suited based on your work skills, age, education, and your mental and/or physical residual functional capacity.

Note: Residual functional capacity is simply a measure of what you are still capable of doing despite your condition.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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