At Seelig Law Offices in New York City, we understand the complexities and challenges of filing for disability benefits. Our dedicated team of disability appeal attorneys is here to help you navigate the often overwhelming process of appealing a denied claim. Whether your claim has been denied due to insufficient evidence, procedural errors, or other reasons, our Social Security disability appeal attorneys are equipped to guide you through the appeals process to seek the benefits you deserve.

What Is Social Security Disability Insurance?

Social Security Disability Insurance (SSDI) is a federal insurance program managed by the Social Security Administration (SSA) designed to provide income supplements to people who are physically restricted in their ability to be employed because of a notable disability, usually a physical disability. SSDI can be supplied temporarily or permanently, depending on whether the disability is temporary or permanent.

Here are key points about SSDI:

• Eligibility: To qualify for SSDI, individuals must have accumulated sufficient work credits based on their age and the years they have worked. Additionally, they must have a medical condition that meets the SSA’s definition of disability, which is typically a condition that has lasted or is expected to last at least one year or result in death.
• Benefits: The monthly benefit amount depends on the recipient’s earnings record, similar to the Social Security retirement benefit. The benefits continue until the individual can work again regularly. There are also provisions for recipients to receive vocational training and other support to help them return to work.
• Medicare Coverage: Generally, after receiving SSDI benefits for two years, individuals are eligible for Medicare, regardless of age.
• Application Process: Applying for SSDI benefits can be a complex process. It involves submitting various forms, medical records, and other documentation. The SSA reviews the application to determine eligibility based on disability and work credits.
• Appeals Process: If an application is denied, applicants have several levels of appeal available. They can request reconsideration, a hearing by an administrative law judge, a review by the Appeals Council, and, if necessary, a Federal Court review.
• Difference from SSI: SSDI differs from Supplemental Security Income (SSI), another program administered by the SSA. SSI provides payments to individuals who are elderly, blind, or disabled and have little or no income, and it’s funded by general tax revenues, not Social Security taxes.

SSDI is critical in assisting those who cannot work due to a serious medical condition but have previously contributed to the Social Security trust fund through their payroll taxes.

Claim Denial And The Appeals Process

When a claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) is denied, the decision can be disheartening. However, the Social Security Administration (SSA) provides a structured appeals process that allows claimants to contest the decision. Understanding the stages of this process can help applicants navigate it more effectively.

Reconsideration

This is the first stage of the appeal. After a claim is denied, the applicant can request reconsideration, where a different examiner from the SSA reviews the claim. This review includes all the previously submitted evidence and any new evidence. Most reconsiderations involve a review of files and documents only, without the need for the applicant to be present.

Hearing by an Administrative Law Judge (ALJ)

If the claim is denied at the reconsideration stage, the applicant can request a hearing before an ALJ. This is the applicant’s opportunity to present their case in person or via video conferencing. The ALJ, who has had no prior involvement with the initial decision, will consider all evidence, hear testimony from the claimant and witnesses, and may also include expert testimony from vocational and medical experts.

Appeals Council Review

If the ALJ denies the claim, the applicant can request a review by the Social Security Appeals Council. The Council does not review every request; it may deny a review if it believes the hearing decision was correct. If it decides to review the case, it will either decide it itself or return it to an ALJ for further review.

Federal Court Review

The final stage of the appeals process is to file a lawsuit in a federal district court. This step is taken if the Appeals Council denies the request for review or if the applicant disagrees with its decision. This process involves a legal proceeding where the court reviews the administrative record to determine if the SSA’s decision was supported by substantial evidence and made in accordance with the law.

Tips for Navigating the Appeals Process

• Timeliness: It’s important to meet all appeals filing deadlines, usually within 60 days from the date of the decision notice. Late appeals can be granted only with a valid reason for the delay.
• Documentation: Continuously gather and submit relevant medical evidence that supports your disability claim. Updated medical records, doctors’ opinions, and other documents can be crucial.
• Preparation: For the ALJ hearing, prepare to explain how your disability affects your daily life and your ability to work. Practice describing your condition clearly and succinctly.
• Representation: Consider hiring a disability appeal attorney. We can help navigate the process, gather evidence, and represent you during hearings.

The appeals process for SSDI and SSI ensures that every claimant receives a fair application review. While it can be lengthy and sometimes complex, understanding and actively engaging in each step can significantly enhance your chances of a successful appeal.

How a Social Security Disability Appeal Lawyer Can Help

At Seelig Law Offices, we have experience assisting clients through the complexities of the appeals process for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). We understand that being denied disability benefits can be frustrating and stressful, but you don’t have to face this challenge alone. Here’s how our experienced Social Security disability appeal lawyers can help you:

Guidance Through the Appeals Process

• Understanding the SSA’s Requirements: The rules and regulations governing SSDI and SSI can be intricate and confusing. Our attorneys are well-versed in these laws and can help you understand the criteria and procedures, ensuring that your appeal complies with all necessary guidelines.
• Strategic Case Preparation: We meticulously prepare for each stage of the appeal, beginning with the reconsideration phase, progressing through the administrative law judge hearing, and if necessary, moving on to the Appeals Council and federal court. Our preparation includes gathering critical medical evidence, obtaining expert opinions, and ensuring your case is presented as strongly as possible.

Comprehensive Evidence Gathering

• Medical Documentation: Insufficient medical evidence is one of the most common reasons for disability claims being denied. Our NYC disability appeal attorneys work closely with your healthcare providers to obtain comprehensive medical records that accurately reflect your condition and limitations.
• Expert Testimonies: We have access to a network of medical and vocational experts whose professional insights can support your appeal. These experts can provide valuable testimony about your disability and its impact on your ability to work.

Representation at Hearings

• Personal Representation: Our NYC disability appeal attorneys personally represent you at all hearings, advocating on your behalf. We ensure that your voice is heard, present a compelling case to the judge, and challenge any adverse evidence.
• Preparation for Testimony: We prepare you for what to expect at the hearing, including the types of questions the judge or opposing counsel might ask you. We aim to make you feel confident and well-prepared to testify about your disability and how it affects your daily activities and work capabilities.

Continuous Support and Communication

• Keeping You Informed: We believe in keeping our clients informed throughout the process. Our NYC disability appeal attorneys ensure that you understand each step, what decisions are being made, and what those decisions mean for your case.
• Emotional and Professional Support: We recognize that pursuing a disability appeal can be emotionally draining. Our team offers not just legal support but also understanding and encouragement, acknowledging the challenges you face and striving to make the legal process as stress-free as possible.

Injuries And Disabilities Covered By SSDI

Social Security Disability Insurance (SSDI) provides benefits to individuals who are unable to work due to a severe medical condition that is expected to last at least one year or result in death. The range of injuries and disabilities SSDI covers is broad, encompassing various physical and mental health conditions. Here’s an overview of some of the key categories of disabilities and injuries that SSDI covers:

Musculoskeletal System Disorders

These include conditions that affect the bones, joints, and muscles, which can significantly impair mobility and dexterity. Common examples include:

• Chronic back injuries involving herniated discs, spinal stenosis, or degenerative disc disease.
• Arthritis, particularly rheumatoid arthritis and osteoarthritis that severely limit joint function.
• Fractures that don’t heal properly and lead to functional limitations.

Neurological Disorders

Neurological conditions that affect the brain, spinal cord, and nervous system are also covered, including:

• Multiple sclerosis (MS), which can cause problems with muscle control and strength, vision, balance, feeling, and thinking.
• Parkinson’s disease, affecting movement and typically characterized by tremors, stiffness, and slowness of movement.
• Epilepsy, where frequent seizures impact an individual’s ability to work safely and consistently.

Mental Disorders

SSDI covers a range of mental health disorders that impair cognitive function and behavior, such as:

• Depression and bipolar disorder, when these conditions severely limit one’s ability to function daily.
• Schizophrenia, which can cause disorganized thinking and difficulties in managing emotions and maintaining relationships.
• Anxiety disorders, including panic disorder and generalized anxiety disorder, when they severely impair daily functioning.

Cardiovascular System Conditions

Heart and circulatory system disorders can also qualify for SSDI, including:

• Chronic heart failure where the heart is unable to pump sufficiently to meet the body’s needs.
• Coronary artery disease leading to severe limitations.
• Peripheral arterial disease that limits circulation and mobility.

Respiratory Illnesses

Disabilities due to lung and respiratory issues include:

• Chronic obstructive pulmonary disease (COPD), which makes it hard to breathe and significantly limits physical exertion.
• Asthma, when severe and chronic, requiring hospitalization and frequent emergency treatments.
• Cystic fibrosis, which can lead to frequent lung infections and decreased lung function.

Other Conditions

SSDI covers many other conditions, including but not limited to:

• Cancer, depending on the type, severity, and impact on a person’s ability to work.
• Kidney disease, especially in advanced stages, requires dialysis.
• Autoimmune diseases like lupus involve the immune system attacking its own tissues, affecting various organs and causing widespread inflammation and pain.

Why SSDI Applications Get Denied

Social Security Disability Insurance (SSDI) applications often face denial for various reasons. Understanding these reasons can help applicants better prepare their applications or take appropriate actions if they need to appeal a denial. Here are some of the most common reasons why SSDI applications get denied:

1. Insufficient Work Credits

SSDI benefits are contingent upon having enough work credits earned by working and paying Social Security taxes. Typically, you need 40 credits, 20 of which must have been earned in the last 10 years ending with the year you become disabled. Younger workers may qualify with fewer credits. If applicants have not worked enough or recently enough, they may not meet the eligibility criteria for SSDI.

2. Disability Not Severe or Long-Term Enough

To qualify for SSDI, the disability must be severe enough to limit one’s ability to perform basic work activities significantly—and it must be expected to last at least 12 months or result in death. If the Social Security Administration (SSA) deems the disability too mild or not long-term, the application will likely be denied.

3. Lack of Medical Evidence

A common reason for SSDI denial is insufficient medical evidence to support the claim of disability. Applicants must provide comprehensive medical records, doctor’s reports, and sometimes testimonies from medical professionals to substantiate the severity of their condition. Failure to provide adequate documentation can result in a denial.

4. Non-Cooperation

If applicants do not cooperate with the SSA during the application process—such as failing to provide requested documents or not showing up for required medical exams—their applications may be denied.

5. Failure to Follow Prescribed Therapy

If an applicant does not follow the treatment their healthcare provider prescribes without a good reason, the SSA may deny the application. The rationale is that if the applicant is not following the treatment, it may be unclear whether the disability is as limiting as claimed.

6. Previous Denial

Sometimes, applicants denied benefits simply reapply in hopes of a different outcome without appealing the initial decision or presenting new evidence. This often leads to another denial because the SSA already determined their eligibility based on the evidence previously submitted.

7. Ability to Work

If the SSA determines that you can adjust to other work or continue doing your current job despite your medical condition, your application for SSDI may be denied. This includes evaluating whether your skills can be transferred to another field or if there are any jobs available that you could perform despite your disability.

8. Income Exceeds Substantial Gainful Activity (SGA)

If you earn more than a certain monthly amount (set by the SSA and adjusted annually), the SSA may conclude that you can engage in substantial gainful activity. For 2023, the SGA amount for non-blind individuals is $1,470 monthly. Earning more than this can lead to a denial of benefits.

Steps After Denial

If your SSDI application is denied, you can appeal the decision. The appeal process includes several stages: reconsideration, a hearing before an administrative law judge, a review by the Appeals Council, and possibly a federal court review. It is often beneficial to consult with or hire a disability attorney to help navigate this process and improve your chances of a successful appeal.

Ready to Challenge Your SSDI Denial? Let Us Help!

If your application for Social Security Disability Insurance has been denied, don’t face the appeals process alone. Our experienced NYC disability appeal attorneys can provide the guidance and representation you need to challenge the decision effectively. Contact us today to schedule a consultation and take the first step toward securing the benefits you deserve.

---

Disability Appeal Attorney FAQs

When facing a disability appeal, having the right information at your fingertips is crucial. Here are some frequently asked questions (FAQs) about hiring a disability appeal attorney and navigating the appeals process:

What does a disability appeal attorney do?

A disability appeal attorney has experience in Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) law. They assist clients whose disability claims have been denied by helping them gather sufficient medical evidence, properly complete necessary paperwork, and represent them during appeals. This includes preparation for and representation at hearings before an Administrative Law Judge (ALJ).

Why should I hire a disability appeal attorney?

Hiring a disability appeal attorney can significantly increase your chances of overturning a denial. Attorneys experienced in disability law are familiar with the SSA’s procedures and can navigate the complex appeals process effectively. They know what evidence is most persuasive and how to argue for your eligibility based on legal standards.

When should I contact a disability appeal attorney?

It’s advisable to contact an attorney as soon as your initial disability claim is denied. The appeals process has strict deadlines, typically requiring you to file for reconsideration or an appeal within 60 days after receiving your denial notice. Early consultation with an attorney ensures you meet all deadlines and have adequate time to prepare your case.

What can I expect during the appeals process?

The appeals process generally starts with a request for reconsideration, followed by a hearing if the reconsideration is unsuccessful. During the hearing, a less formal procedure than court trials, your attorney will present evidence, call witnesses if necessary, and argue your case before the judge. Your disability lawyer will prepare you for what to expect and coach you on answering questions during the hearing.

How much does it cost to hire a disability appeal attorney?

Most Social Security disability attorneys work on a contingency basis, meaning they only get paid if you win your appeal. The Social Security Administration typically caps attorney fees at 25% of the past-due benefits you are awarded, up to a maximum amount set by the SSA (currently $6,000). This fee structure ensures that attorney services are accessible to those who need them most.

What is the likelihood of winning an SSDI appeal?

The likelihood of winning an SSDI appeal varies based on the specifics of each case. Statistically, claimants represented by an attorney have higher success rates than those who choose to represent themselves. An experienced attorney can help strengthen your case by effectively compiling and presenting evidence and navigating the legal complexities of the SSA’s appeal process.

How long does the appeals process take?

The duration of the appeals process can vary greatly depending on the complexity of the case and the backlog of cases at the SSA and the hearing office. It can take anywhere from a few months to over a year. A Social Security disability appeal lawyer can sometimes expedite the process by ensuring timely and complete filings.