Social Security disability claims are difficult to get approved. They require strict and hard hitting medical proof of a long lasting disability that prevents the claimant from doing any full-time work. The failure to provide this evidence is why claims often get denied.
Two specific reasons for denial are discussed here.
(1) "Your condition results in some limitations in your ability to perform work related activities. We have determined that your condition is not severe enough to keep you from performing your work as (type of job)."
This is called a Step 4 decision because it occurs at the fourth step of the evaluation process. It simply means that Social Security has found the claimant capable of returning to one of his/her past jobs.
(2) " Your condition results in limitations that prevent you from performing your past work as (name of job). However, your condition does not prevent you from adjusting to other work available in the national economy."
This is a Step 5 denial because it occurs at the final step (Step 5) in the decision making process. Social Security admits that you are not able to perform any of the jobs you performed during the past 5 years. However, they find you are able to adjust to some other type (easier) work which exists in the national economy. This decision often occurs with claimants who are under 55 years of age because the rules for disability change at age 55.
Some particulars to point out about a Step 5 decision:
- Other work can be anywhere in the national economy; it doesn't matter where. Jobs do not have to be in your community or even in your state.
- It doesn't matter what the "other work" pays. It may be, and often is, a low paying minimum wage job that's far below what you are used to earning. It still counts as "other available work."
- Whether you can live and pay your bills on the salary from the "other work" is not considered.
- It doesn't matter whether you want to do any of the "other work." It may be simple unskilled work involving manual labor or menial tasks. But as long as Social Security finds you able to do the work, it counts.
The Key Fact in a Social Security Denial
The initial Social Security denial is NOT final. It is to appeal and higher review. You have a legal timeline of 60 days to file an appeal and ask for review. Most approved claims happen in appeals, not in the early application process. A majority of claims that stick with the appeal process eventually get approved, often with a lot of "back pay" or past due benefits. It costs you nothing to appeal.
There are 2 common steps in the appeal process:
The first appeal is called "Reconsideration." I put the word in quotation marks for a reason. Often, the so-called "Reconsideration" is just another rubber stamp denial. In fact, this first appeal has a denial rate of almost 85 percent. Not a really good chance.
The second appeal carries you before an Administrative Law Judge for a hearing. Unlike the previous faceless bureaucratic processes, here you sit down with a real judge and explain why you qualify for benefits. Your lawyer sits next to you and can explain the law, rules, medical evidence and various legal aspects of the case. Your lawyer will have already prepared the appeal by gathering and evaluating medical evidence and working through problems with the case.
The hearing is not like a trial you see on TV. There is no jury and no opposing lawyer trying to get you denied. It's just you, your representative, the judge and a court reporter. Social Security usually invites an employment expert to testify. Your lawyer can question the expert and often can mitigate damage done to your case.
The hearing is not in a large courtroom and there is no audience. It takes place in a conference room. Recently, more hearings are held by telephone or video connection, so you may not even be in the same room as the other participants. Your lawyer can still be with you.
Your lawyer will thoroughly prepare you in advance of the hearing. What kind of questions will you be asked? How do you address the judge? How do you explain your medical issues? What do you focus on? By the time you walk into the hearing, you know what to expect and you won't feel "hung out to dry.
The hearing will last 30 to 60 minutes. It will be non-confrontational. The judge will send you a copy of the decision within about 45 days. If the decision is still unfavorable, there are other appeals.
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