How to Appeal a Long-Term Disability Denial
Legally Reviewed and Edited by: Terry Cochran
We do not choose to be ill or injured, or to be off work for extended periods of time as a result. But when it does happen, we expect that the government schemes put in place for such eventualities will be there to support us and to prevent financial hardship.
But when we submit an application for disability benefits only to receive a denial letter, it can be intensely frustrating. The worry over any condition now has the worry about coping financially added to it.
Bills can begin to mount up and the stress can at times be overpowering. So, if we have been denied social security disability, what are our options? How do we proceed in challenging that decision and ensuring we receive what we are entitled to?
What Are Disability Benefits?
If you have been unable to work for a year or more, there are two different federal programs designed to offer support. Both are managed by the Social Security Administration.
The first is social security disability (SSD) which is designed to support any worker currently unable to work and who has amassed enough work credits. The second is SSI (supplemental security income) which is for people who have either never worked or who do not have enough work credits to qualify for SSD.
Initial applications to these programs rarely succeed. In fact, Michigan only has a 29.7% success rate at this stage. This is lower than the national average which sits at 32.3%.
What Happens Next?
If, as is very likely, your initial application for a long-term disability claim is turned down, what are your options and how do you submit an appeal? You should always ensure that you meet all the criteria that are set out for eligibility of these benefits. If you are sure that you meet these criteria, yet have still been refused, then it is time to consider engaging Cochran, Kroll & Associates, P.C., who have extensive experience of working within the social security appeals system.
Hiring a lawyer prior to your initial application almost doubles your chances of success. Experienced lawyers know how the system works, how to obtain a copy of your medical records, and what quality evidence the Social Security Administration requires to approve an application.
If your application for long-term disability insurance and benefits has been turned down, then it is time to move into the appeals process. Please note that the first of these stages – reconsideration – will not be running again in Michigan until April, 2020.
- Reconsideration. This level of appeal is an overall and complete review of your original claim. It is carried out by DDS (Disability Determination Services) and the review is performed by an examiner and a medical consultant. No-one involved in the denial of your original application is allowed to be part of the reconsideration process so this examiner and medical consultant are in effect “fresh eyes.” The normal success rate at this stage of the appeals process is only 5 to 10%.
- When you received the refusal for your original claim by certified mail, the notice will have contained various information including some regarding your stated medical condition. If you have not previously had a lawyer working on your case, this notice can help them identify areas where insufficient information was provided or where a dispute was raided over your condition. You or your lawyer will need to find which local office to contact to begin the appeals process. Success rates at any stage of the process can differ – though not greatly – according to which office deals with your claim.
- Hearing (or Administrative Hearing). This is currently the first appeal stage in Michigan but will move to the second stage when reconsideration is reintroduced in April, 2020. These hearings are presided over by an ALJ (administrative law judge). You must submit a request for a hearing within 60 days of receiving your denial notice and this timeframe will also apply when the reconsideration level restarts.
- An ALJ is an attorney who works for the Social Security Administration’s Office of Hearings Operations (OHO). They specialize in reviewing a wide range of social security cases but long-term disability appeals make up a large part of their work. Having a disability insurance lawyer presenting your case at this stage is very important. If your claim was denied, they can examine the reasons and work toward getting the required supporting documentation or getting testimony from medical or vocational experts if needed.
- The success rate at this stage is about 50%, and your chances of success are again greatly improved if you have one of the experienced team from Cochran, Kroll & Associates, P.C. representing you. Your lawyer can also draft and submit an appeal letter to the ALJ in advance, setting out the reasons why they feel your claim is valid and including any pertinent facts within it.
What Happens if Those Appeal Stages Fail?
If previous appeals have failed, there are two legal avenues of further appeals left open to you and your lawyer.
Appeals Council. This is a discretionary stage of appeal. That means that any application for your appeal to be heard is not automatically granted, They will only review a case if they consider one of the following points to be valid.
i. That some legal or procedural error occurred during the hearing. This could be something like your hearing being cut short timewise, or where your lawyer was not allowed to cross-examine a witness called by the SSA.
ii. Any decision made against you at previous stages does not appear to be supported by any substantive evidence.
iii. Another procedural error occurred such as paperwork not arriving in time or you and your lawyer not being notified that the SSA were calling an expert witness (thus giving your legal counsel no time to prepare cross-examination questions).
The chances of success at this level are a staggeringly low 2-3%. Many clients ask why they should even attempt an appeal at this stage. The answer is that by submitting to the Appeals Council, we have attempted appeals at all levels of the Social Security Administration appeals process and only by doing that can we move to the final appeal option left open to us.
Federal Court. Once we have exhausted all SSA appeal options, the final appeal level is filing a lawsuit with a U.S. District Court. No juries are involved in these hearings and the judge’s primary role is to look for legal errors, though he may also consider other errors if identified and presented.
While judges tend to only reverse decisions in very few cases, they can send cases back to the SSA for further review (and this happens in about 50% of cases they preside over). In cases where they do this, they will add reasons to their ruling such as pointing out where the SSA did not give sufficient consideration to evidence from medical records or to testimony from an expert witness,.
While that sounds promising, it has to be noted that this is both expensive and can take many years to reach this level. Only around 1% of failed claimants choose to pursue this level of appeal.
What Are the Costs?
Federal law sets the fees for these cases. The fee is the lesser amount of 25% of any back payments you receive or $6,000. If your lawyer does not win your case, you do not pay any legal fees to our firm.
Claiming benefits you’re entitled to can be a long and exhausting process. On average, it can take 324 days in Michigan from requesting a hearing to it actually taking place. While many claimants think the initial application process is merely filling out forms, the low success rates without the assistance of a lawyer shows that it can save you a lot of time and worry if you engage with an attorney from the beginning.
Here at Cochran, Kroll & Associates,P.C., we have been specializing in social security disability claims for many years. And with our experienced nurse attorney working on your case, we can cut through the medical jargon and identify the correct medical experts to call as witnesses. We offer a free first appointment to discuss and evaluate your case, so please call our law firm at 866-MICH-LAW for more information.
Disclaimer : The information provided is general and not for legal advice. The blogs are not intended to provide legal counsel and no attorney-client relationship is created nor intended.