Life is full of surprises – and not always the best kind. An accident or condition that leaves thousands of Coloradans unable to work each year is one of them. If you become disabled, it is important to focus on your health and get the treatment you need. At the same time, it’s natural to be concerned about lost income. So you complete your disability claim and wait for a decision, which can take several weeks, a few months or even up to a year because of backlogs. When the decision comes, it might bring another unexpected surprise: a technical denial of your claim.
Is a technical denial the final word? Here is what the decision means and what you can do about it.
Disability Insurance Basics
First, it is helpful to understand what the Social Security Disability Insurance (SSDI) program is and who makes decisions on disability applications in Colorado.
The Social Security Disability Insurance (SSDI) program is federally funded but administered by each state. A portion of every working Coloradan’s paycheck goes toward the disability program as a Social Security tax. Generally speaking (because Social Security gives consideration to several special situations), the SSDI program pays monthly benefits to qualified individuals who cannot work for a year or more because of a disability. A separate federal program, Supplemental Security Income, or SSI, assists disabled people who do not have the work history to qualify for SSDI.
The Colorado Disability Determination Services (CDDS) agency, which makes decisions on disability applications, is based in Aurora and staffed by disability examiners, physicians and administrators. They process about 40,000 claims each year.
Claim Process and Three Possible Outcomes
A Social Security office reviews your application for SSDI benefits against basic criteria, such as whether you’ve worked long enough to collect benefits, before it reaches the decision-making CDDS.
The CDDS reviews the information you supplied, gathers its own additional information, and if needed, can require you to have a medical exam (for which it pays). The CCDS analyzes all the information, makes a decision and notifies your Social Security office, which in turn, contacts you. There are three possible outcomes:
- Your application is approved.
- Your application is denied for medical reasons.
- Your application is denied for non-medical, or technical, reasons.
It is more common in Colorado, as well as many other states, to receive an SSDI denial on the first submission rather than an approval. Many people do not appeal the decision because the process has already been lengthy, complex and even emotionally exhausting. They might also worry about handling a case against the government on their own. However, with the help of an experienced attorney to advocate for you, the appeals process does not have to be as overwhelming.
For this discussion, we’ll focus on appeals of technical denials of SSDI applications. Two common reasons for a technical denial are:
- Insufficient work credits: Social Security calculates work credits based on your income. This year, for example, for each $1,410 of income, one work credit is earned, with a maximum of four work credits a year. Generally, the more years you’ve worked, the more work credits you need to collect disability benefits.
- The government believes you can work – or you work too much:If you can engage in “productive work,” or if you work, even part time, that pays more than Social Security’s monthly income limit (what the agency calls substantial gainful activity), your application can be denied.
Appealing a Technical Denial
- If you decide to appeal an SSDI technical denial and would like an attorney’s help, it’s important to hire a lawyer with experience in disability law. Typically, this is not your real estate attorney or the counsel who drew up your will. You will want to retain an attorney soon after receiving the denial letter because disability benefit appeals, like other legal matters, have deadlines.
- This first appeal stage, called reconsideration, was reinstated in Colorado in 2019 after about a 20-year absence. Some disability advocates say it adds time to an already slow process. Your attorney can help you file a reconsideration appeal with your Social Security office; this must be done within 60 days of your denial notification. It is strongly recommended that you submit new or updated information to your original application, such as additional medical evidence, testimonials from family or friends about how your disability has affected you, and missing information. During reconsideration, your application will be reviewed by a claims examiner who was not involved in making the original decision.
- Let’s say the second claims examiner agreed with the first examiner and your SSDI application is denied again. Next, your case will be heard before an administrative law judge. Your attorney will help you prepare for this hearing and be at your side, as the judge could ask you questions about your disability and how it is affecting your daily activities. He or she could also hear testimony from expert witnesses, such as doctors or physical therapists. You can expect to receive the administrative law judge’s decision by mail within 30 days, although occasionally it is announced at the hearing.
- If the judge’s decision is not in your favor, you have two additional opportunities to present your case: an Appeals Councill review, and finally, you could file a lawsuit in federal court.
An Experienced Advocate for You
As you can see, the disability appeals process can be slow-moving (months and years because of the number of appeals cases), as well as complicated, which is why the choice of a SSDI attorney is so important.
John A. Anderson understands how frightening it is when the disability claim you’re depending on to support you and your family is initially denied. He has many years of experience with disability claim cases in Colorado, and equally important, is committed to work tirelessly on your behalf. If you need help with an SSDI application or someone to represent you if your disability claim is denied, contact his office at (303) 880-7994 or online to learn more.