Disability Appeals & Reconsiderations

A denial of an initial disability claim can be discouraging, but it’s not uncommon. About two-thirds of people who apply for disability benefits do not get approved during the initial review process.

Challenging an unfavorable decision through the disability appeals & reconsiderations process could change the outcome of a claim. Knowing how the process works and how to navigate through it are critical to success.

This guide provides the information you need to understand how the appeals process works. Your next step should be contacting a disability attorney for appeals in NY at The Law Firm of Nikki L. Prasad, P.C., for representation.

Why Claims Are Denied

Common reasons for disability denials include:

• Failure to meet the non-medical requirements: Applicants for Social Security Disability Insurance benefits must have a long enough work history with Social Security taxes paid on their income. Supplemental Security Income claimants cannot exceed income and resource limits, but SSI does not have a work requirement like the SSDI program.
• Insufficient medical documentation: Disability claims must be supported by medical records, including physicians’ notes of physical examinations, lab and diagnostic testing results, and other evidence proving the existence of a disabling medical condition.
• Application errors: Applications with mistakes, omissions, or inconsistencies may cause processing delays or a denial of the claim.

Working with a disability attorney skilled in assisting people during the initial disability claim process gives you a seasoned advocate to rely on throughout the appeals process. The attorney understands the requirements for approval of a claim and can identify and correct common causes of denials. When a claim is denied, the attorney can identify the reason and file an appeal to challenge it.

What Is Reconsideration?

Reconsideration represents the first level or step in the disability appeals & reconsiderations process. This process gives you a chance to have a denied claim for disability benefits reviewed by a disability examiner and a medical consultant or psychological consultant who were not previously involved in reviewing the claim. Think of it as a fresh set of eyes taking a look at the case.

Claimants have the right to review the evidence used to make the initial determination. They also have the right to submit additional evidence in support of their claim.

Although only 16% of claimants are allowed benefits through reconsideration, you cannot skip it or any other level of the appeal process unless you receive a favorable outcome. The appeals process consists of the following levels:

• Reconsideration
• Hearing with an administrative law judge
• Appeals Council review
• Federal court review

Upon receipt of an unfavorable decision from the Social Security Administration, whether from the initial disability claim review or an appeal, an applicant has just 60 days to file an appeal.

How to Strengthen Evidence for Disability Appeals & Reconsiderations

Just as initial disability claims must be well-documented and supported by evidence, so must disability appeals and reconsiderations. Some of the methods relied upon by an experienced disability attorney for appeals may include:

• Requesting updated medical records from healthcare providers: Recent examination reports with the physician’s notes, diagnostic test results, and imaging reports can be useful in proving a claimant’s current condition and the limitations it causes.
• Current treatment history: Medical evidence of medications prescribed, along with treatment recommendations, should be updated to include proof of compliance by the claimant. Lack of evidence of compliance may be grounds for an initial claim denial and could weaken an appeal.
• Obtain statements from treating physicians: Statements from the physicians, and particularly any specialists, who are currently providing care to the claimant, add significant value as evidence in support of an appeal.
• Statements from third parties: Evidence of how a medical condition affects a person’s life can be shown through statements from friends, relatives, co-workers, and employers.
• Claimant’s journal or diary: A daily journal or diary of symptoms, levels of pain, and other issues related to a medical condition can be used as evidence and as a way to refresh a person’s memory when asked to testify at a hearing.

A disability attorney for appeals at the Law Firm of Nikki L. Prasad, P.C., knows through experience and training the type of evidence needed to present a strong, persuasive case at all levels of the appeal process.

Appeal Deadlines

Meeting deadlines for filing an appeal is critical to preserving your right to challenge and appeal adverse decisions. The deadline to appeal at each level of the appeals process is 60 days from receipt of the notice from the SSA. The Social Security Administration assumes that you receive the notice five days after the date printed on it.

Missing a deadline could mean the loss of your right to appeal, but you can request an extension provided you show “good cause” for having missed it. File the appeal immediately and include a request for an extension if you believe you missed the filing deadline.

The SSA considers “good cause” for missing an appeal deadline any physical, mental, educational, or linguistic limitations, such as the following:

• You had aserious illness that prevented you from contacting the SSA or having someone contact them for you.
• There was a death or serious illness of a member of your immediate family.
• There was destruction of important records in a fire or other accidental incident.
• You did not receive notice of the decision to be appealed.

Submit proof of the good cause for the request, such as medical records or a death certificate, when you ask for the extension.

How a Lawyer Improves Your Chances

Representation by a disability attorney for appeals in NY provides the following advantages:

• Disability attorneys know the deadlines and how to ensure they are met.
• Knowledge of the law, procedures, and regulations makes it easier for attorneys to navigate the appeals process.
• Attorneys understand what constitutes the best, most compelling evidence, and they how to gather it to support the appeal.
• An attorney helps a claimant prepare for the disability hearing to be able to provide testimony in support of the claim.
• Disability attorneys know how to present evidence and question witnesses to build a strong and persuasive case.

Having a representative you can trust and rely on to advocate for you offers peace of mind throughout the appeals process.

Contact an Outstanding Disability Attorney For Appeals in NY

A denial of an initial disability claim may be disappointing and frustrating, but it’s not the time to give up. Continue to fight for disability benefits through the appeals process.

Give a disability attorney for appeals at the Law Firm of Nikki L. Prasad, P.C., the opportunity to show you how to challenge a disability denial through the appeals process. Learn more during a free consultation and case review.