Not all disabled workers will qualify for disability benefits. To qualify users must meet the following requirements:
Claimants who do not meet the requirements above will automatically be denied SSDI benefits, regardless of the severity of their health condition.
Certain claimants may have severe health conditions and symptoms which are considered automatically disabling. Specific conditions and their corresponding symptoms which are considered automatically disabling by the SSA are listed on the SSA Listing of Impairments and the Compassionate Allowance list.
Workers whose condition meets or exceeds a listing on the SSA Listing of impairments or the Compassionate Allowance list will be considered disabled, assuming they have sufficient work credits to be insured, they are not currently working too many hours or making too much money, and they have medical evidence proving the severity of their condition.
Many disability applicants will have their Social Security Disability application denied by the Social Security Administration (SSA). In fact, it is estimated that 60 to 70% of first-time disability applications are denied.
Disability applications are denied for a variety of reasons:
Although some denials are unlikely to be overturned, there are some Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) denials which can be successfully challenged by filing a reconsideration or requesting a hearing before an administrative law judge.
Not all denials can be challenged, but assuming you have a right to appeal, you must submit your request for the appeal within 60 days from the date of your denial letter. Information about the appeal process should be included with the denial letter.
The first appeal in most states is a reconsideration. The reconsideration allows a second disability examiner to review your SSDI or SSI case file and make a disability determination. Unfortunately, because the disability determination process remains unchanged from the application decision-making process, the denial rate at the reconsideration is approximately 80%.
If your application is denied a second time, you have 60 days to file a request for a hearing. The hearing allows your disability case to be heard and decided by an administrative law judge. Fortunately, the administrative hearing generally gives you the best opportunity to win benefits. Due to the high number of hearings requested, however, it is not unusual for claimants to wait up to a year or more to have their hearing scheduled.
Claimants who are denied a third time at the hearing may appeal their denial within 60 days to the Appeals Council. The Appeals Council may decide not to hear the case, remand it back to the lower court, or hear the case and issue a new decision.
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