Being approved for Social Security Disability Insurance can be a long and frustrating experience for many individuals who do not have an obvious debilitating medical condition. These applicants must prove to the Social Security Administration that the condition exists, to begin with, and then they must also prove that they cannot earn a substantive living through employment because of the problem, or multiple problems for many. These claimants are typically denied approval on the first application and even on an initial reconsideration for most. So, are denials for SSDI more common than approvals? The answer is easily yes, at least in the beginning. Almost all SSDI cases are won through the appeals process, and this happens for some very basic reasons. 

The Initial ApplicationKellum Law Firm New Bern NC

Most applications for Social Security Disability Insurance begin with a scheduled phone call from the Social Security Administration. It is vital to be ready for this call. Those who miss it will need to reschedule, which can also cause further delays that many claimants do not want. An intake specialist will ask pertinent questions regarding the inability to work and file the initial request with the agency. The SSA has 60 days to provide a response, which is almost always a denial unless the applicant is immobile or in a hospital undergoing serious medical treatment. In this event, a duly assigned personal representative may make the initial contact for benefits. Remember also the distinction between different types of claims/benefits. From the Social Security Administration website:

“The SSDI program pays benefits to you and certain family members if you are “insured.” This means that you worked long enough – and recently enough – and paid Social Security taxes on your earnings. The Supplemental Security Income (SSI) program pays benefits to adults and children with disabilities who have limited income and resources.

While these two programs are different, the medical requirements are the same. If you meet the non-medical requirements, monthly benefits are paid if you have a medical condition expected to last at least one year or result in death.”

Why the SSA is So Diligent

Social Security Disability Insurance is different from any other program that is offered by the Social Security Administration. While requests for Supplemental Security Income benefits are subject to annual or at least biannual reevaluation, approvals for SSDI are permanent total disability decisions unless the applicant recovers to the point that they can return to work. This actually does occur from time to time for those who can perform sedentary work or are approved based on a mental condition that is improved. These cases are very rare. When SSA issues a ruling on a claimant, they will almost always receive government benefits from that point. The agency is very cautious with paying out benefits for this primary reason, as it is in fact a legal ruling of disability that prohibits the claimant from maintaining substantive gainful employment. Additionally, the amount of time it takes to approve a case indicates to the agency that funding for benefit payments will be allocated beginning in the next accounting cycle. 

How Denials Become Approvals

The truth about claims for SSDI is that almost all cases are won through the appeals process by a disability lawyer who focuses their practice on these individuals and understands what the agency needs to approve an application. Applications are not as much a claim of disability as they are a claim of inability to retain continual employment due to problems experienced by the medical condition or combination of conditions. Some medical conditions are pre-approved through other cases processed for a single medical issue. Most claimants actually win their approval based on multiple issues that mimic a particular pre-approved Blue Book medical problem, many of which are eventually terminal. The primary rule is that the condition must last for at least one year or end in death. Claimants also must have been unable to work for the immediate six months prior to being approved.

What a Disability Lawyer Can Do

Proving a claim through the SSA without an attorney is practically impossible for the novice claimant. It can be done, but it is rare. SSDI attorneys can assemble all necessary medical documentation needed by the SSA to support a claim approval, including meeting with an administrative law judge if necessary as the final step in the appeals process. And, sometimes it takes more than one hearing for approval. SSA ALJ officials are very diligent and reluctant to issue a final approval because benefits are permanent. SSDI attorneys know what to provide in the early stages in hopes of approval, and they also know how to address reasons given by the agency for a denial. The SSA always provides a reason for denial because the claimant would otherwise be eligible. Each claim is unique on some level, and it commonly requires an attorney to clarify the evidence through medical proof presentation from doctors who are considered experts in their practice area.

Contact Our Disability Law Firm

While it is not necessary to have legal counsel when first filing for SSDI benefits, the sooner an attorney is acquainted with a case and claimant, the more information they have to obtain benefits as soon as possible. This is almost always an issue for claimants because the inability to work leaves them in financial straits. It is easy to make mistakes in the early stage of filing that can impact the time it takes to gain approval. Anyone in North Carolina who has filed for Social Security Disability Insurance should contact our office as soon as possible so we can begin the evaluation of your case immediately.

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