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What Are The Types of Decisions That Can Be Made on Disability Applications?

On the surface, this may seem like a fairly simple question to answer.  But in reality, decisions on disability applications can go a little bit deeper than just an approval or a denial on an application.  Let’s take a closer look at what that means. You’re approved.  This is what everyone wants to hear when […]

On the surface, this may seem like a fairly simple question to answer.  But in reality, decisions on disability applications can go a little bit deeper than just an approval or a denial on an application.  Let’s take a closer look at what that means.

You’re approved.  This is what everyone wants to hear when they first submit a disability application.  But the sad truth is that a vast majority of people will not.  Statistics show that around 70% of all applications are denial upon an initial submission.  There are a couple of different types of reasons why you may be denied at this level.

Denial for a technical reason.  Social Security uses a five step evaluation process to determine if a person is eligible for benefits or not.  The first step in this process is to see if they make too much money from a Substantial Gainful Activity (SGA).  In other words, if you work, do you earn more than the SGA threshold as defined by Social Security.  In 2018, this amount is $1,180 for an individual.  If you make more than the allowable amount, you will be denied benefits based on a technical reason.  This will happen even before your medical issues are reviewed.  The thinking is that if you can earn at least this amount, then you are not considered disabled by definition.

Denial for medical reasons.  The vast majority of initial applicants are denied benefits due to a variety of medical related reasons.  After your SGA amount is reviewed, Social Security will take a close look at all your medical records to determine if you are disabled according to standards they are required to follow.  You could be denied for medical reasons if you do not submit adequate records, if your medical records show that you do not meet the test for disability, or that your condition is expected to last less than 12 months or that it is not expected to result in your death.  These are but a few of the reasons why you could be denied for medical reasons.  

Denial for work-related issues.  If you meet SGA guidelines and you have submitted sufficient medical evidence, Social Security next reviews your ability to perform other suitable work based on your age, nature of your disability, work history and your ability to perform a variety of basic work-related tasks, including things such as standing, lifting, bending, or other physical activities.  If your job skills and your physical well being stand up to these tests, then you will be denied benefits as well. 

If you are denied at any of these steps, you have the right to request an appeal of your decision.  The first level of appeal is a Reconsideration.  At this level, a second claims representative and medical examiner will review your files, plus any additional files you submit in support of your claim, to determine if you should be granted benefits.  At this level, your claim will either be approved or denied.  If you are denied, you will have the right to appeal your claim to an Administrative Law Judge.  Administrative Law Judges have more leeway in how they decide an application.

Unfavorable Notice of Decision.  If a judge decides to deny a claim, the applicant will receive an Unfavorable Notice of Decision.  This will interpret the evidence presented at the hearing and will explain the basis for the judge’s decision.  If this happens, an applicant has the right to file an appeal for their case to be heard by an Appeals Council. 

Partially Favorable Decision.  If your decision is deemed partially favorable, that means the judge has granted you benefits, but he or she does not agree with you in terms of when your disability began, which is known as the Alleged Onset Date (AOD).  When this happens, the judge will determine when an applicant’s Established Onset Date (EOD) took place, and that is the date that will be used to determine when a person became eligible for benefits.  In some cases, partially favorable means that a claimant will not receive ongoing monthly disability benefits, and will only receive benefits for a past specific and limited period.  This is called a closed period and takes place when a judge believes a person was disabled at one time, but that is not longer the case

Fully Favorable Decision.  When a judge grants a fully favorable decision, it means they not only agree that someone is disabled, but that they also agree with the claimed AOD. 

Case Dismissal.  A judge may dismiss your claim if you did not show up for your hearing or if your request for a hearing in front of a judge was not filed on time, or if your case has already been decided on the same issues with the same facts.

Appeals Council Denial.  If you appeal a judge’s decision and your case is heard by an Appeals Council, you could continue to be denied benefits.  The Appeals Council generally only looks at what the judge’s criteria were for making his decision, and if he applied the evidence and procedures in the right way.

Appeals Council Remand.  Rather than completely deny a claimant’s case, the Appeals Council may send it back to the judge for another look, or remand.  The Council will ask the judge to take another look at the evidence presented, and whether it was given appropriate consideration or not, as well as if the judge incorrectly applied some aspect of the law or Social Security processes in reaching their decision. 

Appeals Council Approval.  Approvals at this level are rare, but they do happen.  The best way to give yourself an optimal chance of gaining approval at this level is to retain the services of an attorney to assist you with your case.

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