What does it mean when an initial claim is denied?
EACH CLAIM MAY HAVE FOUR STAGES
- The Initial Application Stage
- An Appeal Stage where we ask “them” to Reconsider what they did if the Initial Application was denied.
- A Request for a Hearing before a Social Security Administrative Law Judge where we ask to speak informally to a real live lawyer appointed to hear claims.
- A Request the Appeals Council review an Unfavorable decision by the Judge.
(If the Appeals Council Agrees with the Judge there are other appeals. I don’t do those but I know someone who does. Mr. Jared Walker. Esq. https://www.socialsecurityappeals.net/)
At the initial stage, the person who is evaluating a claim (Called a DDS Analyst) probably will not talk to you. The Analyst only looks at the documents they receive and the requirements of the law. If the claim isn’t approved, the claimant will get a computer-generated form letter that says one of a few different reasons for the denial: Based on the evidence we have, you are not disabled according to our rules because:
- We think you will get better within the next 12 months;
- We think your problems are not severe enough to cause any work-related limitations;
- We think you have limitations, but you are able to perform your past work; and
- We think you have limitations; we agree you are not capable of performing your past work; but, we think there is other work that you could do.
They will say things like, “although you have problems with your legs but you have the ability to move about independently.” I recall a client with MS who required a walker and who fell and hit their head, cracked it open and was taken to the ER by ambulance who got that reason for the denial. Where Normal People live, this is, in a word stupid. But as a guide in Social Security land, I understood (and strongly disagreed) with their reasoning.
Because it was, in fact stupid, even in Social Security land, we asked SSA to assign it to a different analyst and reconsider what the first Analyst did. That is why the first appeal is called a Request for Reconsideration. The client was approved when we appealed. Refer to the Quick Start PDF HERE to understand what happens while Reconsideration is pending.
Appeal to a Judge: When the second analyst agrees with the first analyst that based on the evidence, the claimant is not disabled under the rules. The letter starts, You asked us to take another look at your claim. We did and we find no reason to change our opinion. Unsurprisingly, this is called a Request for Hearing before a Judge. This is the time that we actually get to talk to a live person about the case.