What Are the Most Common Causes of Claim Denial in California?

To be eligible for disability benefits, your medical condition must have lasted at least 12 months or be expected to result in death. For SSDI, you must have earned a sufficient number of work credits (wages or earnings where Social Security taxes were withheld) — a minimum of 40, half of which must have been earned within the last ten years. However, younger workers may qualify with fewer credits. For SSI, you must have limited income and resources. Please contact our law offices for more information.

One of the most common reasons for receiving a claim denial letter is that the applicant did not provide sufficient information.

Claims are frequently denied due to common errors made by applicants. These are some examples:

Filing for Disability While Working — While you are allowed to work while filing a disability claim, doing so may reduce the likelihood of your claim being approved. To qualify for benefits, you must demonstrate that you are unable to perform a substantial gainful activity (SGA). For determining SGA, the Social Security Administration (SSA) sets a monthly income threshold that changes each year. In 2022 SGA is $1350 for non-blind disability and $2260 for disability based on blindness. If you work and your earnings exceed this limit, you may face claim denials.

Failure to Provide Sufficient Medical Evidence — An application for disability benefits must be accompanied by medical evidence, which includes an exam history, a diagnosis/prognosis of your condition, and the results of any surgeries, prescribed medications, rehabilitation, and therapy that are listed in your medical records. The SSA may require you to attend one or more consultative exams if they determintion the information in your medical record is insufficient to support your disability claim. The exam results will play a significant role in the outcome of your claims.

Failure to Follow Doctor’s Orders — When reviewing your Social Security disability benefits claim, the examiner will confirm that you have been receiving treatment by reviewing medical records and then assess how well you have responded. As a result, following your doctor’s instructions for any treatment, including taking prescribed medications and participating in rehabilitation, is critical. If you do not adhere to the recommended treatments, your disability application will most likely be denied, and you will not be eligible for disability benefits.

Lack of Legal Representation for Social Security Disability Appeals — Having a disability lawyer represent you during your initial application or appeal greatly increases your chances of being approved for Social Security disability payments. You should be aware that The Law Offices of CAWISE LAWYERS handles all disability benefits claims on a contingency basis if you’re concerned about the cost of hiring a lawyer. This means that until and unless your Social Security disability insurance claim is granted, you will not be required to pay any legal fees to our firm.

What Are the Four Levels of Appeals After the Social Security Administration Denies Your Claim?

Even if you received a denial letter from the Social Security Administration for your initial application, it does not rule out the possibility of receiving monthly benefits in the future. The application process for SSDI benefits is complicated, and many applications are denied on the first try. However, with the assistance of an experienced disability lawyer, you may be able to file a successful appeal.

The appeals process has four levels:

• Reconsideration
• Administrative Hearing
• Appeals Council Review
• Federal Court Review

The act of re-submitting your claim to the Social Security Administration so that it can be read and reviewed by a different government employee is referred to as reconsideration. The hope is that, after reviewing and reconsidering your claim, the second SSA employee will determine that you have a qualifying claim and will begin receiving benefits. If the second employee arrives at the same conclusion as the first then the next step is filing a request for an Administrative hearing.

You have the right to request an Administrative hearing. A Judge will review your Social Security disability claim and conduct a hearing where you will have the opportunity to present your case, and the Judge will ask you questions about your claim. The assistance of a good lawyer at this hearing greatly increases the chances you will be able to obtain disability benefits. If the Judge still denies the claim, there is one last step in the administrative appeal process.

You may request review of the Judge’s decision by the Appeals Council. The Appeals Council will review the claim and determine if the Judge made an error that requires their action. Having a lawyer who understands the laws and regulations the Appeals Council applies will increase the chance of success at this level of appeal. If the Appeals Council declines to take action, the final option is to file a lawsuit in federal court. The federal court will make another review of the claim to determine if there were significant enough errors in the decision that require their intervention.

How Much Time Do You Have to File SSDI and SSI Appeals?

If the Social Security Administration denies you disability benefits, you have the right to appeal the decision. However, that right has an expiration date, so you must act quickly if you want to receive benefits.

You must file an official written request to appeal within 60 days of receiving your denial letter. If you wait more than 60 days, it will be too late to navigate the appeals process unless you can prove good cause for the failure to meet the deadline.

It is advisable to consider retaining the legal counsel of a law firm skilled in handling these types of Social Security disability claims, such as The Law Offices of CAWISE LAWYERS], for higher odds of receiving benefits upon appeal. By getting in touch with our lawyers as soon as possible, you will give them more time to develop a strong case for you by assembling the necessary evidence and medical opinions that support your claim.

Time is running out the moment you receive your denial notice. But even after successfully filing your appeal, you will still need the guidance of an experienced advocate to navigate this process. Make sure you have everything you need to win your case, contact a lawyer from The Law Offices of CAWISE LAWYERS today by calling 866-300-8751.

Speak with a California SSI and SSDI Denial Expert Today

When you choose The Law Offices of CAWISE LAWYERS, we will make every effort to complete your claim for disability benefits accurately and quickly. To support your claim, we will work with you to gather the required medical proof, opinions and documentation needed to win your case. When you deal with our knowledgeable Social Security disability lawyers, you will be confident that we will fight to uphold your rights and assist you in obtaining the benefits you deserve.