Social Security Disability Insurance, more commonly referred to as SSDI, offers a financial lifeline when a physical, emotional or mental condition makes it impossible for you to be gainfully employed. The Social Security Administration adheres to strict criteria to determine if you meet the definition of a disability qualifying for SSDI benefits. In fact, almost two-thirds of initial applications for benefits are denied.
There is too much at stake to give up and not continue to fight for SSDI benefits even in the face of a denial. Given the high rate at which the Social Security Administration rejects initial applications, it may make sense to request an appeal of the decision. The legal advice and skilled representation of a lawyer experienced in handling SSDI cases from application through an appeal to the federal court ensures that your rights are protected by an advocate dedicated to achieving a favorable result.
Denial of an initial application should not stop you
There are a number of reasons why an initial application for benefits may be denied by the SSA, including:
· Absence of a qualifying disability: A claim for SSDI will be denied if the applicant does not have a disability preventing them from engaging in any type of gainful employment for at least one year or which is expected to cause the person to die.
· Lack of medical documentation: An application for SSDI must include medical records, including doctor’s notes, supporting the existence of a disability that prevents the applicant from engaging any form of gainful employment. Short-term or partial disability does not satisfy the eligibility guidelines, so the medical documentation submitted in support of an application must clearly establish the existence of full and long-term disability.
· Failure to follow medical advice: The course of treatment recommended by an applicant’s physician, including participation in physical or occupational therapy, must be followed. Failure to follow the orders of the treating physician may be taken as being the true cause of an applicant being unable to work as opposed to the cause being the underlying medical condition itself.
Engaging the services of a knowledgeable and experienced federal court lawyer to review a denial of SSDI benefits may reveal grounds for an appeal. For example, it may be true that an applicant failed to follow a recommended course of treatment, but the SSA recognizes justifiable reasons that would not prevent you from receiving benefits, including:
· The recommended treatment is contrary to your religious beliefs.
· Failure to have surgery as recommended by your physician may not disqualify you from receiving benefits if there is evidence supporting an intense fear of surgery as the reason.
· Being unable to afford the recommended treatment may be justified if you do not have medical insurance or community resources that would pay for it.
· Refusing additional major surgery for a medical condition that failed to respond to a previously performed surgical procedure.
· Refusing high-risk treatments, such as surgery to replace a heart valve or to replace an organ.
Instead of giving up and allowing the denial to prevent you from receiving the benefits you may actually be entitled to receive, a New Mexico federal court attorney may recommend pursuing an appeal.
The SSDI appeals process
You have 60 days from when you receive an adverse decision on your application for benefits to appeal it. There are four separate levels of appeals:
· Reconsideration request.
· Hearing with an administrative law judge.
· Appeals council review.
· Lawsuit in federal court.
The appeals process in New Mexico begins with a request for reconsideration of your application.
Reconsideration puts a new set of eyes on your file by assigning it to someone who was not involved in the original decision. An attorney handling the appeal for you may submit new evidence to support the reason for challenging the original decision. Your attorney may request a meeting at a local Social Security office to go over your file with the person handling the review, but most appeals at this level proceed on the documents in the file along with new documents submitted by your attorney.
A formal hearing conducted by an administrative law judge is the next level of the appeals process in the event that reconsideration results in an adverse decision. The hearing offers your attorney an opportunity to present evidence, including the testimony of medical experts and other witnesses, in support of your claim for SSDI benefits.
In addition to presenting evidence and witnesses in support of your claim for benefits, your attorney has the opportunity to question witnesses testifying in support of the decision by SSA. At the conclusion of the hearing, the administrative law judge takes all the evidence into consideration before making a decision on the appeal.
An adverse decision from an administrative law judge should be reviewed with your lawyer to determine if there is a basis to request an appeal to the Social Security Appeals Council. A review by the Appeals Council relies upon the record of the hearing conducted by the administrative law judge to determine if the decision was supported by the evidence. The Appeals council may allow the decision to stand or make its own decision based upon the evidence. It may also send the case back for further action by the administrative law judge.
Taking your SSDI case to federal court
If the decision from the Appeals Council does not offer a favorable result, your federal court lawyer may recommend filing a lawsuit. Filing a civil lawsuit in federal court is the final level of the SSDI appeals process.
You have only 60 days from receipt of the letter from the Appeals Council to start a civil action in federal court challenging an unfavorable decision, so it is important to review the matter with your attorney as soon as possible after receiving the decision to decide whether to take the matter to court. Judges have the authority to reverse the findings reached at other levels of the appeals process, or they can send the matter back for further review and consideration by the Social Security Administration.
Applicants for SSDI living in New Mexico can find sound legal advice and superior representation at the Decker Law Office. Whether you have questions about filing an initial application for SSDI benefits or need representation to appeal an unfavorable decision, the firm’s founder, Benjamin Decker, holds the highest attainable peer review rating through Matindale-Hubbell and is ready to help.