What Are My Options If a Disability Claim Is Denied Due to RFC?

Your application for Social Security Disability Insurance (SSDI) benefits may be denied at both the initial and subsequent filing stages. The national average for initial disability claim denials is about 65 percent, and those who file a reconsideration appeal are denied about 85 percent of the time.

In general, you have two choices:

  • Appeal – asking the Social Security Administration to reconsider your case
  • Re-file – start the application process all over again

You should file a reconsideration of your initial disability denial as soon as possible, but do not be disheartened if this is also denied. Reconsideration appeals should be viewed primarily as a stepping stone to requesting an administrative law judge (ALJ) hearing. The approval rate for the ALJ hearing is higher than any other decision point in the adjudication process.

Suppose your application is rejected at the Initial Application or Reconsideration stages. In that case, it almost always makes more sense to appeal those decisions and request a hearing before an ALJ rather than submitting a new application. 

Submitting a new application (re-filing) at this point may be a waste of time because a new application will most likely be denied for the same reasons as your previous application, unless your condition has worsened and you have new medical evidence to prove it.

If you file an appeal and request a hearing, your representative will continue to collect evidence to support your case. Your representative will also have the opportunity to make a legal argument that addresses any issues that were overlooked  or erroneously decided during your previous decisions. Finally, at the hearing, you will have an opportunity to meet with an ALJ in person and explain why you should be awarded Disability benefits.

Why do so many applicants experience disappointment in the early stages of a disability application?

Following are key factors that influence the denial of disability claims:

  • A lack of convincing medical evidence supporting an applicant’s claim that he or she cannot work due to a disabling condition
  • Previous denials
  • Failure to adhere to prescribed medical treatment 
  • Failure to be prompt, thorough, and cooperative with claims processors on issues ranging from documentation requests to scheduled hearings and exams.

A key point to remember about SSDI claims is that staying the course throughout the entire process dramatically increases the chances of success for most applicants who experience early setbacks. In an SSDI claim, an experienced disability attorney can provide additional information and results-oriented representation. If you are applying for disability at age 50, there are special criteria that may make it easier to qualify for the benefits.

What should you do if your claim is denied?

If your disability claim is denied, you only have a few options. You can give up and return to work, which may be difficult if your disabling condition causes significant functional limitations. 

You could also start the appeals process, which can be a financial and emotional struggle in itself. If your application for disability is denied because the Social Security Administration believes you are capable of working, you should do the following:

  • Contact the Social Security Administration office where your claim is being processed. Do this right away and notify them that you intend to file an appeal. The Social Security Administration should send you the necessary appeal forms and other information about the appeal process.
  • If you have legal representation, contact your disability lawyer as soon as possible. Copies of everything you receive from SSA, including denial notices, should be sent to your lawyer. In many cases, however, the attorney of record does not receive what the claimant received in the mail, and vice versa. Contact your lawyer to ensure that you and your lawyer are both aware of the status of the claim.

Should I work?

Every person with a disability is unique, as is every case involving Social Security Disability Insurance. In such cases, this flat reality leads to a variety of conclusions. 

Some people’s core identities are inextricably linked to long-term work histories, and they will fight tooth and nail to keep working full-time even if they have a physical or mental disability. Others may look for a flexible work schedule. Some may try to engage in effective on-the-job activities and discover that the effort simply cannot be sustained.

In other words, when it comes to the work-or-no question for SSDI applicants, there are a plethora of options and outcomes. Unsurprisingly, the SSDI realm is fairly complex, with a comparatively dense and technical legal sphere. 

Many people are dealing with physical and mental issues that have prevented them from working for a year or more and are likely to keep them from working for the foreseeable future. They may have a number of reasonable questions and concerns about the government’s disability process.

Finally, consider your “Date Last Insured,” which refers to the last date you are eligible to receive Social Security disability insurance. If your Date Last Insured has already passed, you should consider appealing your SSDI decision because you will be unable to reapply for SSDI benefits.

A skilled and compassionate Chicago disability attorney can advocate passionately and effectively on your behalf, pursuing the best possible outcome that always serves their clients’ best interests.

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