SSI & SSDI Denials and Appeals in California

Helping You Receive the Benefits You Deserve

If you have a disability and cannot work, you may have applied for disability benefits as supplemental income. Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) are made to assist those with chronic or long-term disabilities. Unfortunately, the Social Security Administration has strict regulations for these benefits, and many people find that the first time they apply, their application is denied. This can be very frustrating, as many individuals with disabilities are unable to work full-time to support themselves.

The SSDI benefits program gives individuals with disabilities support if they have worked long enough and recently enough to pay Social Security taxes on their earnings. The SSI benefits program supports those who meet the SSA requirements for a disability and have limited income and resources. During the application process, you are required to submit medical records, work history, and other documents proving that you have a disability and are unable to work. The Social Security Administration will review your application and evaluate any current work activities, plus any doctor’s notes in support of your disability diagnosis. Then, the SSA sends your case to the Disability Determination Services office in your state for deliberation.

Once you have applied for SSI or SSDI benefits, the processing time varies from a few weeks to multiple months. The nature of your disability, the medical evidence and examinations, and the quality reviews required all affect how long your application process takes. Once the state agency decides on your application, you will be notified via a certified letter in the mail. Most individuals get an answer to their disability claim within three to six months of submission. If you are denied, your denial letter will include instructions on submitting an appeal.

At Roeschke Law, we understand just how frustrating it is to go through the entire application process only to get a denial letter months later. The SSA has strict disability criteria, and our experienced attorneys can help you submit evidence of your disability and your needs to get your application approved. In most cases, individuals see success with a qualified legal team on their side. Please don’t feel like you must go through the Social Security disability benefits process on your own. Call our office today at 480-999-4740 for more information.

Why Would an SSI or SSDI Claim be Denied?

Millions of people apply for benefits every year, but only a small percentage of them get approved. SSDI and SSI denials happen for many reasons, and understanding why your initial claim was unsuccessful can help you in the appeals process. Our team can meet with you to discuss the specifics of your case and find out exactly why your claim was denied.

Below are the main reasons why an SSDI or SSI claim might be denied:

Insufficient Medical Evidence

When submitting a disability benefits application, you are required to include medical evidence supporting your disability diagnosis. SSI and SSDI claims are often rejected because the Social Security Administration does not believe that there are sufficient medical records or other evidence to support an individual’s claim.

Medical records must prove not only that the disability exists but that it interferes with your ability to work on a continual basis. Records that are short or sparse do not contain a diagnosis, or do not have doctor’s notes about your specific limited ability to work will not meet the SSA’s criteria.

For instance, if you have not sought medical care for your medical condition or have insufficient medical records, you will likely face a denial. It’s important to seek medical care as soon as possible to ensure your documents are fully fleshed out and specific.

High Earnings

There is a threshold for how much you can earn per month to qualify for disability benefits. If you are able to work and make more than what qualifies as “substantial gainful activity,” the SSA will immediately deny your application. Although this threshold changes annually, the SSA will not award you benefits if you make over $1,740 per month.

Multiple Applications

If your application is denied, you must follow the correct appeals process. Some individuals submit a new application without following the correct appeals procedure, which leads to the SSA denying new requests. In most cases, it is better to appeal any prior denials before submitting a new application for benefits.

Not a Qualifying Medical Condition

The SSA has a list of medical conditions that qualify for disability benefits. Even if your disability limits your ability to work, it may not be a qualifying medical condition under SSA rules. The SSA will then decide whether the medical condition is comparable to the ones on their list. If they decide it is not, your claim will likely be denied.

Lack of Employment History

When applying for SSDI benefits, you must have worked recently enough to qualify. The SSA will ask you to note your “work credits,” which are achieved from yearly wages or self-employed income. These credits are earned quarterly for every year a person works above a certain income level. This income level changes annually.

The amount of work credits you need to qualify depends on the age at which you became disabled. In general, individuals need 40 work credits, and 20 of those must have been earned in the last ten years. Younger applicants may need fewer work credits. If you do not have enough work credits, your application may be denied, even if you qualify as disabled.

Filing While Working

While it is technically allowed to file for disability while working a job, filing while currently employed can lower your chances of success. To qualify for disability benefits, you need to prove to the Social Security Administration that you cannot perform a substantial gainful activity. Unfortunately, if an applicant is currently holding a job of any kind, the SSA tends to deny their claim. Similarly, if you are making too much money to qualify for benefits, the SSA will deny your claim automatically. If you are concerned about your job and would like to learn more about how it could impact your disability claim, contact our team today for more information.

How Do I Submit an Appeal?

If you believe you were denied unfairly, you can submit an appeal to the Social Security Administration. Typically, your denial letter will explain exactly how to submit an appeal. To request disability reconsideration, you can submit an online request within 60 days of your denial. Simply go to the SSA website and follow the instructions on the screen to complete your form.

You can also send the SSA a form by mail or by fax. Fill the appeal form out by hand, then send the form to your local Social Security office. You can find your local office’s address by using the Social Security Office Locator on their website. Once you submit your request for appeal, your information will be sent to a Disability Determination Services examiner for review.

What is the Appeals Process?

There are four steps to the appeals process that you may go through. Not everyone completes the entire process; it’s possible that your claim could be accepted before you complete every step. However, it’s important to understand what the appeals process is to ensure you are prepared for what’s to come. Note that you can seek legal counsel before or during any of these steps for assistance.

Below are the steps in the disability appeals process:

Reconsideration

Reconsideration is the first step and starts the appeals process. If you disagree with the SSA’s initial determination, you can file a request for reconsideration. Either submit a form online or print it out and mail the form to your local office. You must do this within 60 days of receiving your denial letter.

If you are already receiving Social Security benefits and submit an appeal within ten days of your initial notice, then you will continue to receive payments until the SSA makes its reconsideration determination. If you submit an appeal ten or more days after receiving the notice, your payments may decrease temporarily until the SSA makes its reconsideration determination.

Hearing

If the SSA denies you again, you can request a hearing before a judge. You must fill out a form and submit it online or by mail to request this hearing. You or your legal representation must request a hearing within 60 days of getting a denial notice. Before the hearing, you can submit additional evidence, including medical records and doctor’s notes. If you are receiving benefits and wish to continue receiving them, you must ask in writing for your benefits to continue within ten days of your cessation notice.

The SSA will give you notice of when and where the hearing is. If you do not attend this hearing, you could lose your right to appeal. The SSA will pay for your travel costs if the distance from your home is more than 75 miles. You or a lawyer on our team can request travel costs from the judge before the hearing is scheduled.

During the hearing, you will provide evidence of your disability to the judge. The judge will examine any new evidence as well as what is already included in your case file. The judge may also call witnesses, like medical or vocational experts, to testify. If you are appealing due to a non-medical reason, like an overpayment, the judge will focus on evidence specifically related to that issue.

The judge may also allow you or a lawyer on our team to subpoena documents or witnesses. To do so, you must file a written request ten days before your hearing. You must describe all documents and witnesses as well as how they would be helpful to your case. The judge will then make a determination on whether you can include these documents or witnesses in your hearing.

The hearing will be informal, but in most cases, an audio recording is taken and put into your case file. You can also ask for a copy of this hearing afterward. The judge will give you a digital or paper copy of the hearing decision once it has been made.

Appeals Council

If you disagree with the judge’s decision, you can request an appeal for the hearing online or through the mail. You must request an appeal within 60 days of receiving the hearing decision. The Appeals Council may also decide independently to review your case.

You can submit new evidence to the SSA before the Appeals Council reviews your case. This evidence must be new, related to the period on or before the hearing, and have a reasonable probability of changing the decision outcome.

The Appeals Council will then review your case and either grant, deny, or dismiss your request. If the Appeals Council grants your request, it will either decide your case for you or return the case to a judge, which will likely result in a new hearing or a new decision. The Appeals Council may also issue a decision about your case that is less than fully favorable to you, in which case you will receive a notice of this proposed action. You can then respond to the Appeals Council before they issue their decision. In some cases, part of your case will be decided upon, while the other part will be relegated to further proceedings.

Federal Court

If the Appeals Council issues a decision or denies your request for review and you disagree with its action, you can file a civil action with the U.S. District Court. A lawyer on our team can help you file this action within 60 days of your Appeals Council notice. The District Court will review your case and the final Agency decision. The U.S. District Court can either send the case back to the Agency, request that a judge hold a new hearing, or direct the Agency to award benefits or dismiss the case.

If your case is denied in Federal Court, it means that your initial application has been officially denied, and you can no longer appeal. Fortunately, this does not mean that your disability claim will never be approved. You can submit a new application from scratch if you believe your circumstances have changed enough to warrant a different decision. Our team can review your case and make a suggestion on whether it’s in your best interest to submit a new application now or wait until your medical conditions have changed.

How Do I Fill Out an Application for a Better Chance of Success?

When filling out your disability application, it’s important to understand all the information you should include to up your chances of getting your benefits approved. Leaving out information, including misleading information, or neglecting to fill out the application completely can lead to an automatic denial, delaying you from getting the benefits you deserve. It can take between one to two hours to complete the application completely, so be sure to set aside plenty of time.

Below are some helpful tips to keep in mind when filling out your disability application:

Gather Your Information Ahead of Time

There are multiple documents and a lot of background information you must include in your disability application. Many applicants find it easier to gather this information ahead of time before starting the process. You will need information about the following:

• Date and place of birth
• Marriage and divorce, if applicable
• Name and dates of birth of any underage children
• U.S. Military service period dates, if applicable
• Employer for the current year and past two years
• Self-employment details, if applicable
• Bank account and routing number
• Contact information of an individual who knows about your medical conditions

Collect Detailed Information About Your Disability

In many cases, disability benefits are denied due to incomplete medical information. Be sure to gather and submit all the information about your doctors, healthcare professionals, and hospitals you have visited. Include the names and phone numbers of any healthcare professionals so SSA agents can follow up on your medical history.

If you have had any medical tests related to your disabling condition, include the names of those tests and the test results. If you are on medication, include the names of those medications and who prescribed them. For more success, also include information about why you were put on the medication and what symptoms the medication treats.

Include Detailed Information About Your Work History

For certain disability benefits, you must include information about your work history for the past two years. Always include your most recent job history and the type of duties you did on the job the longest. Also, include any information about your education and special training you have received in addition to on-the-job training.

Check the Status of Your Application Often

Once you submit your initial application, the website will give you a confirmation number. You can use this number to check the status of your application to see when it is under review. Most applications take between three and six months to reach a conclusion, but it’s important to keep an eye on them in case you need to submit an appeal.

Submit an Appeal as Soon as Possible

If you receive a denial, you likely have around 60 days to submit a request for reconsideration. Always submit a request for an appeal as soon as possible to avoid losing any benefits you currently have. The sooner you submit your request for an appeal, the sooner your case will be reviewed and potentially accepted.

Can a Lawyer Help Me Get Approved?

The world of disability benefits can be complex and confusing. Unfortunately, the Social Security Administration has a limited amount of money they can give to people, leading to many deserving individuals getting their applications denied. Receiving a denial letter can be disheartening, especially if you are disabled and unable to work to support yourself or your family.

Fortunately, by hiring a lawyer, you have a much higher success of getting your disability application approved to start receiving benefits. As your lawyers, our team can analyze your current Social Security file and help you submit an appeal no matter where you are in the process. We will then prepare your case and map out a unique legal strategy for your circumstances and medical history. Once we file your appeal, we will then gather additional evidence from doctors and medical providers to bolster your claim.

Our team will also prepare your testimony and represent you in court before a judge. If you go to a hearing during the appeals process, our attorneys can subpoena documents and witnesses to testify in your case, including healthcare professionals and other medical experts. We will use all the evidence we have gathered to make the necessary legal arguments to prove that you deserve disability benefits.

Our team at Roeschke Law is dedicated to assisting our clients through the entire appeals process, from submitting a request for reconsideration online all the way to filing a civil suit in federal court. If you are in the California area, including anywhere near San Diego or Los Angeles, our team is prepared to help you with your disability claim. We know just how difficult it can be to receive multiple denial letters, and we will use our experience and our legal knowledge to get you the outcome you deserve. To learn more about our services, contact our office today by calling 480-999-4740.