What Recourse Do You Have if You’ve Been Denied Social Security Disability or Supplemental Security Income Benefits?

If you have a physical or emotional medical condition that prevents you from working at any job on the open labor market for at least 12 months or is expected to result in death, you should file for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) benefits. These benefits are designed to ensure that disabled persons have long-term income if they cannot work at any job on the open market.

If you are over the age of 50, and you are unable to perform the job that you have performed in the last 15 years, you may qualify for SSDI/SSI without showing that you cannot work in any job in the open labor market. Your education and skill level will be a factor in this determination.

According to the Disability Benefits Center, of the more than four million residents living in Massachusetts, approximately 4.5 percent receive disability payments from the Social Security Administration. Unfortunately, more than half of the Massachusetts SSDI applicants who apply for disability benefits are denied at the initial stage of the application process

But a denial for disability benefits is not the end of the road. There is a process for appeal, giving you more chances to prove you are entitled to receive benefits. This process involves four steps:

• Request for reconsideration
• Disability benefits hearing
• Review by the Appeals Council
• Appeal to the Federal Court

Request for Reconsideration

A request for reconsideration is simply asking the Social Security Administration (SSA) to take another look at your application. It will be reviewed by someone different and he or she may come to a different conclusion.

The rate of acceptance during the Massachusetts reconsideration step is only one out of four, so if you are denied at reconsideration, you will want to request a hearing.

Disability benefits hearing

If your request for reconsideration is denied, you have the right to request a hearing. This hearing will be made by an Administrative Law Judge (ALJ). The process can take up to a year or more to be scheduled and will be held at a location near you.

During the hearing, your presence is required. The rules are strict and the burden of proof is very high. It is crucial that you understand the law and its requirements. Having an attorney with you at the hearing is very important.

Having supportive medical evidence is the key to proving that you meet the disability standard. An experienced attorney would know how to gather and present this medical evidence. The judge is required to review and comment on the medical evidence provided. If there is strong evidence of disability, that is helpful in getting a favorable decision. If the evidence is weak or insufficient, the judge will most likely deny the claim.

Review by the Appeals Council

The process involving the Appeals Council is a paper review. The role of the Appeals Council is to determine if the judge’s decision was NOT supported by substantial evidence. This is a difficult task but one which an experienced attorney will do if warranted by the evidence.

Appeal to Federal Court

If your claim is denied at every level, it is possible that you may be able to appeal to a federal court judge to review the previous decisions in your case. While previous decisions may be overturned, it is a rare occurrence.

Why you need an attorney for SSDI/SSI

For many reasons, your best chance for a positive outcome at any stage of the appeal process is to be represented by a qualified SSDI/SSI attorney. The attorney will gather medical evidence, ask the right questions of doctors and other medical personnel, prepare you for the hearing, and guide you through the entire court process.

Should the judge call in vocational or medical experts, a qualified attorney will be prepared to respond to such witnesses and their testimonies.

In addition, the attorney will focus, not just on the testimony of witnesses, but on the definition of disability according to the SSA. The attorney will attempt to prove that you have functional disabilities that prevent you from working, and therefore qualify for disability benefits.

A qualified attorney will be proactive in representing you, bringing their expertise to work for you.