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The Appeals Process

Are you reeling from a Social Security claim denial and wondering what to do next? Don’t lose hope. You could still get your benefits by filing an appeal. The appeals process can be complex and confusing, but you don’t have to go through it by yourself. A lawyer from Crowe & Shanahan can help you understand your options, prepare strong evidence, and fight for the benefits you need. Contact us today to arrange a free initial consultation. We’re here to talk with you and help you take your next steps.

Common Reasons for Claim Denials

If you received a denial on your Social Security Disability claim, you’re not alone. Many people get denied the first time they apply. That doesn’t mean you did anything wrong or that you don’t qualify. It just means the Social Security Administration (SSA) didn’t find enough proof in your application to approve it. Below are some of the most common reasons the SSA denies claims:

Insufficient Medical Evidence: The SSA needs clear proof that your health problems prevent you from working. If your records don’t include details about your diagnosis, treatment, and how your condition limits your daily life, they might deny your claim. Even if you are too sick to work, the SSA has to see that in writing from your doctors and medical reports.
Failure to Follow Treatment Plans: If your doctor gave you a treatment plan and you didn’t follow it, the SSA might use that as a reason to deny your claim. They want to see that you’ve tried to get better. If you miss appointments or refuse treatments without a good reason, the SSA might say they can’t tell how serious your condition really is.
Too Much Income From Work: Disability benefits are for people who can’t work enough to support themselves. If you still work and make more than the SSA’s substantial gainful activity (SGA) limits, they will turn down your claim, even if you have health problems. If your earnings exceed the limit, the SSA assumes you’re able to support yourself.
A Condition That Won’t Last Long Enough: To get disability benefits, your health issue has to last at least one year or be expected to result in death. If Social Security thinks your condition will improve in a few months, they won’t approve your claim. The SSA doesn’t provide benefits for short-term health problems, even if they stop you from working for a little while.
Failure to Give the SSA What They Asked For: The SSA sometimes sends letters asking for more documents, answers to questions, or medical exams. If you ignore these requests or miss deadlines, the SSA might deny your claim for lack of cooperation. If Social Security asks for more information and doesn’t get it, they’ll move forward without it, which often means a denial.
A Condition That Doesn’t Match the SSA’s Rules: The SSA maintains a list of qualifying health problems and the symptoms they expect for each one. If your symptoms don’t line up with their criteria, the SSA might deny your claim. This might mean you need to provide more evidence or go through more steps to show how your condition affects your ability to work.

The Social Security Appeals Process

If the SSA denied your disability claim, you still have options. Many people win benefits during the appeals process. The key is to act quickly and meet all the requirements. An experienced disability attorney can help you. Each stage of the appeals process gives you another chance to prove that you can’t work because of a medical condition. Here’s what the process looks like.

Stage 1: Request for Reconsideration

The first stage is called a Request for Reconsideration. You must file this request within 60 days of the date on your denial letter. If you miss the deadline, you’ll likely need to start over with a new claim, which could delay your benefits even more.

At this stage, a new SSA reviewer who didn’t take part in the initial decision takes a second look at your claim. They check your original paperwork, plus anything new you want to add, like more medical records, updated test results, or a doctor’s note that explains your limitations. You must complete this step before moving on to the next stage of the appeals process.

Stage 2: Hearing Before an Administrative Law Judge (ALJ)

If the SSA still denies your claim after reconsideration, you can ask for a hearing with an Administrative Law Judge (ALJ). You must file your request within 60 days of the second denial.

At the hearing, the ALJ will listen to your story and review your medical records. You can also present witnesses, like doctors or people who know how your condition affects you. The judge might also ask a job expert to explain what kind of work you can still do, if any. Many people get approved at this stage, especially if they come prepared and have a lawyer on their side.

Stage 3: Appeals Council Review

If the ALJ denies your claim, you can ask the Appeals Council to review the decision. Again, you must act within 60 days, or you will lose your right to appeal.

If the Appeals Council agrees to hear your case, it will review the judge’s decision and decide whether the judge followed the law. The Council won’t hold a hearing or look at your case from the beginning. It will either agree with the judge, send your case back for a new hearing, or reverse the decision and approve your claim. Most of the time, the Appeals Council agrees with the judge, but it’s still a step you can take if you think the judge made a mistake.

Stage 4: Federal Court Review

If the Appeals Council turns you down or refuses to review your case, you can file a lawsuit in federal court. This is the last step in the appeals process. If you don’t already have one, you’ll need a lawyer to help with this stage because it involves legal filings and court rules.

In federal court, a judge will look at your case and decide if the SSA made legal or factual mistakes. The judge can approve your claim, send it back to the SSA for more review, or uphold the earlier decisions. This stage takes time and is difficult to win, but it’s still an option if you believe you qualify for benefits.

How a Disability Lawyer Can Help During the Appeals Process

Filing a Social Security appeal takes more than just filling out a few forms. You have to meet deadlines, present strong evidence, and explain your case in a way that makes sense to the SSA. A seasoned disability attorney knows how the system works and can guide you through each step of your appeal by:

Reviewing your denial letter to determine what went wrong
Gathering medical records that support your case
Talking with your doctors to get detailed written statements
Filling out and filing appeal forms on time
Working with witnesses who can support your claim
Cross-examining vocational or medical experts at hearings
Writing legal briefs to explain why you meet the rules for disability
Keeping track of deadlines so you don’t miss any steps
Pointing out errors the SSA made in your case
Filing your case in federal court if you choose to appeal further

Contact a Missouri Disability Appeals Lawyer

If you feel stuck after a claim denial, now is the time to act. You still have a chance to win benefits, but you need to take the right steps. The team at Crowe & Shanahan can guide you through the appeals process and help you build a strong case. Contact us today to learn more in a free initial consultation.

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Why Crowe & Shanahan?

A Trusted Guide Throughout the Confusing Disability Benefit Process

We take pride in the strong professional and personal relationships we build with each client. You will meet with the attorney early on and that same attorney will be with you throughout the process. You can rely on us to give you honest advice about your options because this is the right thing to do.

As your advocates, we will remain by your side throughout the process, developing a strategy that fits your specific circumstances. Your legal and financial issues are unique, so we tailor our advice according to your situation. Many individuals and families have benefited from this legal approach.