What to Do When Your Social Security Claim Is Denied

Overview of Social Security Claims

A. Definition of a Social Security Claim

A Social Security claim refers to the process of applying for and receiving benefits from the Social Security Administration (SSA). These benefits are primarily designed to provide financial assistance to retired individuals, disabled persons, and survivors of deceased workers. The claim can be made online, over the phone, or in person at a local SSA office.

B. Eligibility Requirements for Social Security Benefits

To be eligible for Social Security benefits, individuals must meet certain criteria set by the SSA. The eligibility requirements vary depending on the type of benefit being claimed:

1. Retirement Benefits:
– Age Requirement: Generally, individuals need to be at least 62 years old to qualify for retirement benefits. However, full retirement age (FRA) is gradually increasing from 66 to 67 based on birth year.
– Work Credits: Individuals must have earned enough work credits by paying Social Security taxes during their working years. The number of credits required depends on the year of birth.

2. Disability Benefits:
– Medical Condition: Claimants must have a severe medical condition that prevents them from engaging in substantial gainful activity (SGA). The condition should be expected to last at least one year or result in death.
– Work Credits: The number of work credits required depends on the age when the disability occurred. Generally, younger individuals need fewer work credits.

3. Survivor Benefits:
– Relationship to Deceased Worker: Surviving spouses, children, and dependent parents may be eligible for survivor benefits.
– Age Requirement: In most cases, surviving spouses can receive benefits at age 60, or as early as age 50 if they are disabled.

C. Typical Reasons Why Claims Are Denied

While many Social Security claims are approved, some are denied due to various reasons. Common reasons for claim denials include:

1. Insufficient Medical Evidence: In disability claims, the SSA requires substantial medical evidence to prove the severity of the condition and its impact on the claimant’s ability to work. Inadequate medical documentation or incomplete medical history may lead to denial.

2. Failure to Meet Non-Medical Requirements: Apart from medical eligibility, claimants must also meet non-medical requirements specific to each benefit program. For example, individuals claiming retirement benefits must have earned enough work credits.

3. Earning Above SGA Limit: Individuals receiving disability benefits are subject to a substantial gainful activity (SGA) limit. If their earnings exceed this limit, their claim may be denied or benefits may be suspended.

4. Improper Documentation: Inaccurate or incomplete information provided during the application process can lead to claim denial. It is important to provide correct and complete details about employment history, medical conditions, and other relevant information.

5. Appeals Process: If a claim is denied, applicants have the right to appeal the decision within a specified timeframe. It is crucial to understand the appeals process and provide additional evidence or clarification to support the claim.

For more detailed information on Social Security claims and eligibility requirements, you can visit the official Social Security Administration website at www.ssa.gov.

What to Do When Your Social Security Claim Is Denied

Dealing with a denied Social Security claim can be overwhelming and frustrating. However, it’s important to know that you have options to appeal the decision. In this article, we will explore the steps you can take when your Social Security claim is denied.

Request a Reconsideration of Your Claim

If your initial Social Security claim is denied, the first step is to request a reconsideration. This involves asking the Social Security Administration (SSA) to review your case again, with fresh eyes. Here are some key points to keep in mind:

  • You must make your request within 60 days of receiving the denial notice.
  • Gather any additional medical evidence or documentation that supports your claim.
  • Submit the necessary forms and paperwork along with your request for reconsideration.

It’s important to note that the majority of reconsideration requests are also denied. However, this step is necessary before moving on to the next level of appeal.

Request a Hearing before an Administrative Law Judge (ALJ)

If your request for reconsideration is denied, the next step is to request a hearing before an Administrative Law Judge (ALJ). Here’s what you need to know:

  • You must file your request within 60 days of receiving the denial of your reconsideration.
  • The ALJ will review your case and hold a hearing where you can present evidence and arguments supporting your claim.
  • It is highly recommended to have legal representation during this stage, as an experienced attorney can guide you through the process and present your case effectively.

During the hearing, you will have the opportunity to provide testimony and present witnesses if necessary. The ALJ will consider all the evidence before making a decision on your claim.

Appeal the ALJ’s Decision to the Appeals Council

If the ALJ denies your claim, you can further appeal the decision to the Appeals Council. Here are some important points to consider:

  • Your request for review by the Appeals Council must be made within 60 days of receiving the ALJ’s decision.
  • The Appeals Council will review your case, but they have the discretion to deny your request for review without holding a hearing.
  • If the Appeals Council decides to review your case, they may either uphold the ALJ’s decision, issue a new decision, or send your case back to an ALJ for further review.

It’s worth noting that the Appeals Council may take a significant amount of time to make a decision, and their review does not guarantee a favorable outcome. However, pursuing this level of appeal is important if you believe there were errors in the ALJ’s decision.

File a Lawsuit in Federal Court

If the Appeals Council denies your request for review or issues an unfavorable decision, you have the option to file a lawsuit in federal court. Here are some key considerations:

  • You must file your lawsuit within 60 days of receiving the Appeals Council’s decision.
  • Filing a lawsuit involves complex legal procedures, and it is highly recommended to have an experienced attorney represent you.
  • The federal court will review your case independently and make a final decision.

While filing a lawsuit in federal court is an option, it should be noted that the success rate at this stage is relatively low. However, for some individuals, pursuing this level of appeal may be the best course of action.

Hire an Attorney to Help with Your Claim

Throughout the appeals process, it is crucial to have professional legal representation. An attorney experienced in Social Security claims can provide valuable guidance and support. Here are some reasons why hiring an attorney is beneficial:

  • An attorney understands the complex Social Security rules and regulations, increasing your chances of success.
  • They can gather and present relevant evidence, medical records, and documentation on your behalf.
  • An attorney can prepare you for hearings and represent you effectively before an ALJ or in federal court.

Remember, hiring an attorney does not guarantee a favorable outcome, but it significantly enhances your chances of success at each stage of the appeals process.

Dealing with a denied Social Security claim is undoubtedly challenging, but it’s important to explore all available options for appeal. By following the appropriate steps and seeking legal assistance, you can maximize your chances of obtaining the benefits you deserve.

Resources for Filing a Social Security Claim

A. Online Resources from the Social Security Administration

The Social Security Administration (SSA) provides a range of online resources to assist individuals in filing a Social Security claim. These resources are designed to simplify the process and provide easy access to important information. Here are some of the key online resources offered by the SSA:

  • my Social Security Account: By creating an online account, you can access your Social Security statement, estimate future benefits, and manage your personal information.
  • Benefits Planner: This tool helps you understand the benefits you may be eligible for, including retirement, disability, survivor, and Medicare benefits.
  • Application for Benefits: You can apply for retirement, disability, Medicare, and other benefits through the SSA’s online application portal.
  • Online Appeals: If your claim is denied, you can submit an appeal online using the SSA’s secure portal.
  • Frequently Asked Questions (FAQs): The SSA’s website provides a comprehensive list of FAQs to address common inquiries related to Social Security benefits and the claims process.

These online resources offer a convenient way to access important information and complete various tasks related to your Social Security claim. It is recommended to explore these resources before visiting a local SSA office or seeking assistance elsewhere.

B. Local Offices and Other Services Available from the SSA

In addition to the online resources provided by the SSA, there are local offices and other services available to help individuals with their Social Security claims. These services can provide personalized assistance and guidance throughout the application process. Here are some of the services offered:

  • Local Social Security Offices: The SSA has field offices across the country where you can schedule an appointment to discuss your claim in person. These offices have knowledgeable staff who can answer your questions and provide guidance.
  • Telephone Assistance: If you prefer to speak with someone over the phone, you can contact the SSA’s toll-free number at 1-800-772-1213. Representatives are available to assist you with your Social Security claim-related inquiries.
  • Interpreter Services: The SSA provides interpreter services for individuals who do not speak English as their primary language. This ensures that language barriers do not hinder the claims process.
  • Specialized Assistance: The SSA offers specialized assistance for individuals with disabilities or impairments. This includes accessible formats for documents and assistance with navigating the claims process.
  • Publications and Forms: The SSA’s website has a comprehensive collection of publications and forms that can be downloaded or ordered to provide further information and support during the claims process.

It is important to note that due to the ongoing COVID-19 pandemic, some SSA offices may have limited in-person services or modified operating hours. It is advisable to check the SSA’s website or contact your local office for the most up-to-date information before visiting in person.

While these local offices and services offer valuable assistance, it is recommended to utilize online resources first whenever possible, as they provide a convenient and efficient way to access information and complete necessary tasks.

Remember, filing a Social Security claim can be a complex process, and it is crucial to gather all necessary documentation and seek appropriate guidance to ensure your claim is accurate and complete. Utilizing the online resources and local services available from the SSA can help simplify the process and provide you with the support you need.