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Government benefits paid to someone with a disability are not welfare. Social Security Disability Insurance (SSDI) is a program set up by the U.S. Congress to allow Americans to pay into an annuity that pays out if they become disabled and can no longer work. Workers with a recognized, diagnosed disability will only qualify for monthly SSDI payments if they contributed to the SSDI program through payroll deduction or direct payment (if self-employed).
Although most American workers qualify for SSDI after suffering a permanent disability, the federal government has made the approval process difficult. In fact, as high as 60% of all initial applicants are denied, usually because of minor administrative details.
There are eight main reasons a social security disability claim may be denied. Knowing them can help applicants take necessary steps to ensure that their claim is not denied.
- The applicant makes too much money. While people can work and earn an income while on social security disability benefits, they can only earn a certain amount. When they make more than that amount, they will likely be denied benefits.
- The disability is not severe enough. Except for blindness, the disability must be severe enough to last for 12 months or result in a death.
- The Social Security Administration (SSA) cannot communicate with the applicant. This agency needs to communicate with applicants about paperwork, examinations, or other aspects of the application. If they cannot reach the applicant, and no representative has been named, social security disability benefits may be denied.
- The applicant refuses to cooperate. The SSA may make many requests of applicants. They may want applicants to see their own doctors, perhaps several times. They may also ask for additional information about the impairment, and expect the applicant to provide that information. If the applicant does not visit the doctor to be examined, benefits may be denied.
- The applicant fails to follow treatment plans. While the SSA will make some exceptions for refusing to follow treatment plans, most must be followed by the applicant. If they are not, benefits can be denied.
- Drugs and/or alcohol are part of the disability. If the SSA would not find an applicant disabled if he or she stopped using drugs or alcohol, they may deny benefits.
- The applicant was convicted of a crime. If the applicant was committing a crime while injured, or is currently in prison, he or she cannot receive benefits.
- The applicant includes fraudulent information on the claim. When applicants are not honest on their applications and the SSA find out, benefits can be denied.
In North Carolina, the appeals process begins with a Request for Reconsideration. The method to submit this request will be in the letter outlining the denial of benefits and the reasons for it. Reconsideration can be a lengthy process, but in short, it is a complete review of the claim by medical consultants and examiners that were not part of the original decision.
When a request for reconsideration is denied, applicants can still appeal the denial. The next step is to request a hearing with an administrative law judge (ALJ) within 60 days of the denial of reconsideration. Generally speaking, ALJs grant benefits to approximately half of the applicants who make it this far in the appeals process. When they do not, applicants can request that the Appeals Council review their case. The Appeals Council randomly selects cases for review and has the authority to grant, deny, or dismiss a request for review. The Appeals Council is not likely to grant benefits to those that have been denied, particularly if they cannot find error with the ALJ’s decision. The chances of winning at this stage are only 2% to 3%.
When all other methods have been exhausted and benefits have still been denied, applicants can file a lawsuit in a U.S. district court. While there will not be a jury present in the courtroom, applicants are strongly advised to hire a lawyer if they have not already done so. A social security attorney in Wilmington can ensure all paperwork is filed properly, explain the process to the applicant, and give them the best chance of success.
There are many medical conditions that can qualify an individual for social security disability benefits as outlined in Social Security’s Blue Book. In addition to meeting the medical requirements outlined in this book, an applicant must also provide medical evidence from acceptable sources that prove that they are impaired. To learn more about applying for disability benefits and to get a social security attorney from Wilmington on your side, call our firm today.
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