Help Appealing a Disability Benefits (SSDI) Denial in New Jersey

Applying for Social Security Disability (SSDI) benefits in Pennsylvania challenging and intimidating. Any small mistake in completing a form could result in your claim being denied. If you failed to provide enough medical documentation, you will probably see a notice of denial in the mail. While this sounds discouraging, it is important to remember that more claims are denied than approved. Our New Jersey disability attorney from Young, Marr, Mallis & Associates is available to help guide you through the initial claims process or appealing a denied claim.

Initial Disability Claims Are Denied Regularly in New Jersey

Every year, millions of Americans will apply for disability benefits. While the SSA (Social Security Administration) will approve some of those claims, the vast majority will, unfortunately, be denied. The average denial rate throughout the United States is around 70%, while the denial and approval rates by state are reported as:

• Pennsylvania: average 32% approved vs. 68% denied
• New Jersey: average 43.2% approved vs. 56.8% denied

As these discouraging numbers make all too clear, applicants realistically face a much higher chance of being denied than approved even in the best-case scenario.

Fortunately for rejected disability claimants, a denial does not have to be the end of the matter. If your claim was denied, you can contest the SSA’s decision by requesting a Reconsideration and going through the appeals process. So how does this process work, and what should you do to increase your chances of being approved for monthly benefits?

Why Did Was Your Disability Claim Denied?

Before discussing the appeal process in more detail, it is crucial to understand why your claim was denied. As stated earlier, initial claims are denied more often than not. Claims are not approved for a variety of reasons. Technical errors, mistakes, or omissions could result in a rejected claim. This includes failing to complete forms in their entirety or missing deadlines. Having an experienced New Jersey disability attorney at your side could help you avoid some of the typical errors that occur. Four of the most common other reasons disability claims are denied are discussed below.

Exceed Income Thresholds

To qualify for SSDI, your medical condition must prohibit you from engaging in substantial gainful activity (SGA). This means that your disability or disorder makes it impossible to earn a living. The SSA will deny your application if your monthly income exceeds the current SGA threshold. As of 2021, for an individual, the SGA threshold is $1,310 a month. If you are statutorily blind, the threshold increases to $2,190.

Insufficient Medical Evidence

The key element in qualifying for Social Security Disability benefits is having a medical condition or impairment that restricts your ability to work. Therefore, it is crucial to provide medical documentation to support your claim.
Your medical evidence should include your medical records, history of hospital stays or emergency room visits, diagnostic test results, and medical statements from your treating physicians. The evidence you provide should not only detail your condition but must also demonstrate that you are incapable of performing the ordinary duties and tasks your job requires.
The SSA is looking for documentation that details your disability and its impact, medical treatments, medication and therapy, and your efforts to improve your medical condition.

Not Following Medical Treatment

In addition to providing evidence of your medical condition, you must follow your doctor’s prescribed treatment. If medication is prescribed, you need to take it. If your doctor recommends physical therapy, you need to do it. If the SSA believes you are not trying to mitigate the impact of your disability or attempting to improve your condition, your claim could be denied. Furthermore, if you are receiving disability benefits already, failing to follow your medical treatment could result in the termination of your benefits.

Filing Another Claim After a Denial

Because more initial claims are denied than are approved, people are often left wondering what to do next after receiving a notice of denial. Appealing a decision might appear to be a considerable amount of work, so they decided to apply again. Unfortunately, when a claim is resubmitted, it is almost always denied for the exact same or similar reasons as the initial claim. The best thing you could do if your claim is denied is to contact an experienced New Jersey disability attorney to guide you through the appeals process.

How Does the Appeals Process Work?

Step 1: Request for Reconsideration

If your initial claim for disability benefits was denied, the next step is to request a formal Reconsideration. The appropriate forms are available for download on the SSA website.

If you live in Pennsylvania, you must request a hearing within 60 days of your denial.

If you live in New Jersey, you must request Reconsideration first.

When the SSA reconsiders a claim, it will be reviewed by a medical professional and an examiner who was not involved in the original determination. You are entitled to provide additional medical evidence or documentation to help support your claim. If you have not retained the services of an attorney for filing your initial claim, you should have representation when requesting Reconsideration. A knowledgeable PA disability attorney will be able to review your original application to address any issues, problems, or lack of medical evidence.

If your request for Reconsideration is also denied, you must then request a hearing. This is the most likely course of events because only about 10% to 14% of applications are approved at the Reconsideration stage.

Step 2: The Disability Appeal Hearing

If your Reconsideration was denied, you are entitled to request a hearing. Initially rejected applications are most likely to be approved during the hearing stage, meaning this stage of the appeals process is especially critical to success.

An Administrative Law Judge (ALJ) will preside over your hearing. During the hearing, the judge will likely ask you questions regarding your medical condition, work experience, activity level before the disability, and how you accomplish ordinary tasks. It is important to answer each question thoroughly and honestly. You do not want to exaggerate your condition, but you also do not want to omit critical information.

Most, if not all of the judge’s questions will be directed to you. While you should have legal representation, much of the work a Trenton, NJ disability attorney will do will be before the hearing – especially providing additional medical documentation and evidence. However, in some cases, an attorney will ask you direct questions to elicit information that might not have come through the judge’s inquiries. Furthermore, if an expert witness appears at your hearing, your attorney will direct a line of questions towards them to support your claim.

You will receive written notification of his or her ruling, usually about two to three months after the hearing. When a claim comes before an ALJ, the claimant is successful in about forty percent of the cases where they are not represented by a competent attorney. When an experienced disability attorney is involved, the rate of success climbs to over sixty percent.

If your claim was approved at the hearing stage, you can generally expect benefits to begin within two to three months. But if your claim was denied at the hearing stage, it’s time to move on to the next step.

Step 3: Appeals Council Review

If the ALJ denies your application, it’s time for the Appeals Council Review. You only have 60 days following your hearing to request a review from the Appeals Council. If you miss the 60-day deadline, you will have to start the entire process over from the beginning.

The Appeals Council will evaluate the decision rendered at your hearing.

If the Council disagrees with the ALJ’s verdict based on the evidence presented at the hearing, you will be approved for benefits. Unfortunately, only a few appeals are approved by the Appeals Council. The most a claimant could reasonably hope for is to have their case remanded, or sent back, to the ALJ with instructions to review the medical documentation closer or give more weight to a doctor’s testimony. However, if the Council supports the outcome of your hearing, there is still one step left: federal court. While the Appeals Council might appear to be a waste of time, before filing a lawsuit in federal court, a claimant must exhaust all administrative remedies provided by the SSA.’

Step 4: Federal Court

Once again, time is of the essence. You have only 60 days to file a complaint in Federal District Court following the Appeals Council Review. If you miss the cut-off, you will have to start from scratch.

At this stage, a Federal Judge will review your case. Three outcomes are possible:

1. The judge denies your claim.
2. The judge approves your claim, and you may now receive benefits.
3. The judge sends your case back for a second hearing.

If the Judge decides your case needs another hearing, the appeals process continues through the cycle again.

Because your claim will be evaluated by judges based on evidence and the overall strength of your case, it is extremely important that you are supported by an aggressive attorney with experience navigating the appeals process.

Do Not File An Appeal With an Experienced New Jersey Disability Attorney

If you are considering requesting a Reconsideration from the SSA, an experienced disability benefits lawyer can help guide you through this complex and often time-consuming legal process. At the law offices of Young, Marr, Mallis & Associates, our attorneys are equipped with more than 25 years of experience handling thousands of cases throughout New Jersey and Pennsylvania.

No matter how complicated or hopeless you may feel about your claim, your case will be supported by decades of practical experience handling these matters. You will be treated with dignity, compassion, and respect, and our committed attorneys will work closely with you throughout each and every step of the appeals process. With Young, Marr, Mallis & Associates, you’re in capable hands.

Our New Jersey Disability Attorneys Can Help With Your Benefits Appeal

To schedule a completely free and confidential legal consultation with a disability benefits lawyer, call the law offices of Young, Marr, Mallis & Associates at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania, or contact us online. Missing a single deadline can force you to start the appeals process over from the beginning, so don’t delay: call today. We don’t charge a fee unless we win benefits for you.