If your disability was denied after a review, don’t panic. Many of our readers were able to get their benefits back.
Most appeals are successful. Some appeals are quick and others involve more rounds of appeals and hearings and can take time, but statistically most are successful in the end. Keep appealing.
How to Appeal
🌷 The denial letter will tell you how to appeal. There is a deadline of 60 days.
🌷 If you want your disability check and insurance to continue while you are appealing, then you have just ten days! Act quick! Learn more about: Benefit Continuation During Social Security CDR Appeals
Appeal or Start a New Application?
🌷 That’s easy. Appeal. Always appeal!
🌷 The rules for new applications are different than the rules for reviews. New applications are much harder.
🌷 Keep appealing, as long as you are appealing, you can be considered under the rules for reviews. Also, you have the option for benefit continuation.
🌷 If you’ve missed a deadline, for appealing or benefit continuation, take a look here: What To Do If You Miss a Social Security Deadline
Request Your Case File
🌷 You should be able to contact your local office and request a copy of your file for the Continuing Disability Review. They will mail it to you on CD. Or sometimes they will give it to you immediately if you visit local office. Request copies of medical records plus any documents used in preparing the decision.
🌷 This will give you a better idea what happened with your case. You will also be able to see if any important medical records were missing from your file when the decision was made.
Reasons For Denial
Below are some of the most common reasons why your case might have gotten denied:
- Working over the limit (you earned above the limit for too many months)
- Failure to Cooperate (this is a scary-sounding term that usually just means “lost mail”)
- Missing Records (some of your records were lost or never collected by Social Security)
- Medical Improvement (something in your records indicates that your condition has gotten better)
- Lack of Treatment (not seeing doctor)
- Non compliance (medical records state that you refused to take medication or follow doctor’s recommendations)
Reason for Denial: Working
🌷 One reason reviews are denied is if you have gone back to work and earned over the limit.
🌷 However, if your work reduces at any point, you can restart your benefits. In some cases, they will restart easily, other situations you may need to apply again.
🌷 Tip: When determining if you were earning over the limit, you are allowed to deduct “Impairment Related Work Expenses”. If you were self-employed, you are allowed to deduct business expenses when reporting your earnings. Learn more about these work incentives and other working rules:
🌷 Learn more about Working While On Disability
🌷 Learn more about: How to Handle Disability Reviews While Working
Reason for Denial:”Failure to Cooperate”
🌷 If your case was denied because of “failure to cooperate,” this usually means a letter got lost in the mail, or they could not reach you for some reason. This is a fairly easy problem to solve.
🌷 Appeal the decision and stay in regular touch with the person assigned to your case to check your file and confirm that they get all your medical records.
Reason for Denial: Missing Records
🌷 If your review was denied because of “medical improvement” the first thing to do is confirm that they actually got and read all your medical records! Missing and lost records are common at Social Security.
🌷 If any records are missing, you can stay in touch with the person handling your case, or you can try collecting and sending your records yourself. (Hint: Do not collect online records. Collect full medical records).
🌷 Read your records yourself to make they are accurate and have no problems.
🌷 After you send in the appeal, stay in regular touch with the person assigned to your case to check your file and confirm that all your records are still there.
Reason for Denial: Medical Improvement
🌷 Some denials happen because something in the medical records indicates that your condition has improved.
🌷 If your condition has not improved, you can collect letters or forms from your doctor to show this.
🌷 If your condition has improved, your appeal may be more difficult, but can still be successful. You can show that your condition is still severe, and you can also collect documentation if you have developed any new conditions.
🌷 It may help if you can supply your recent medical records. It can also be a great help to request a letter from your doctor.
🌷 Here’s where you can learn what Social Security looks for during reviews and how to prove your condition: Everything You Need to Know About Social Security Disability Reviews
🌷 Some of our readers reported that by submitting a letter from their doctor early, they were able to overturn the denial without having to go to a hearing. If you need to continue appealing, then there are more things you can do to improve your case. Long List of Ways to Improve Disability Cases
Reason For Denial: Lack of Treatment
🌷 If you haven’t been going to the doctor, be clear and honest with Social Security about the reason. If at all possible, try to start going to the doctor now. More about: How to Explain Why You Haven’t Been to The Doctor
🌷 If you are not seeing a doctor who is an Acceptable Medical Source – Start seeing one now. Acceptable Medical Source Rules
🌷 Some denials happen because the person has not been in regular treatment, or has not been following their doctor’s treatment recommendations. See below for more ideas if this is your situation.
Reason For Denial: Not Following Treatment
🌷If your doctor has written “non-compliant” or you have refused treatment that your doctor thinks can help your condition, this can cause a problem with reviews.
🌷 There are some reasons that Social Security will accept for not following treatment. What is Good Cause? What is Not Good Cause?
How to Submit
🌷 Ideally submit your records or letters at the same time as your appeal form. If this is not possible, then you can submit records and letters later.
🌷 Once your case is assigned to someone, request the name and contact information for that person, communicate directly with that person and be 100% certain that person has received your documents. If the appeal is very recent it may not have been assigned to anyone yet.
🌷 If you bring anything to your local office, please double check that it actually makes it to the person handling your case.
🌷 These pages are about new applications, however, all the same information can apply to your review. How to Submit Documents and How to Stay In Touch with Your Disability Examiner
You Can’t Change the Past. You Can Change the Future
🌷 If you haven’t been going to doctor, or haven’t been having good doctor visits, or don’t have a supportive doctor who understands your disability, it is not too late to change this. Appeals can go on for several years, so starting to improve your records right now can make a big difference.
🌷 Some of our readers report that they had major problems with their reviews because they were hiding from their doctor how sick they were.
🌷 They felt shy or embarrassed about admitting how bad things were. Or they tried to have a “positive attitude” or “put on a good face” or practice “positive thinking.” Or they tried to make friends with their doctor instead of focusing on their medical problems. Or they felt discouraged about always showing up at the doctor’s office with bad news and they didn’t want their doctor to feel bad so they downplayed symptoms.
🌷 If you are doing any of these things, look here: How to Have Doctor Visits That Create Accurate Records
🌷 It’s really helpful to try to keep health insurance during a disability review appeal, so you to get the medical documentation you need to win your appeal.
🌷 If you did a benefits continuation, your health insurance will continue the whole time you are appealing.
🌷 If you did not do a benefits continuation, you may be able to apply for Medicaid, depending on your state. Also check out: How to Go to The Doctor When You Can’t Afford to Go to the Doctor
🌷 Wisteria & Buttercup both got their benefits back in a few months without needing a hearing: Wisteria Appeals Her Continuing Disability Review
🌷 Several more success stories appear on this page: How to Explain Why You Haven’t Been to The Doctor
🌷 In most cases, a disability lawyer will not help with this situation.
🌷 Some lawyers will take cases like this, but may charge $2,000 upfront.
🌷 You may be able to get free assistance from your local poverty law center or nonprofit legal aide program.
🌷 If you did not choose benefit continuation, you may be able to find a lawyer, because they will be paid a part of your backpay… but you may have to go a year or more with $0 income, before they would find it financially worth it to put any effort into your case. It may be better to just take the benefit continuation, and pay them yourself.
🌷 If you cannot get a lawyer, do not worry. Most people appeal on their own and do not use a lawyer.
🌷 If you do use a lawyer, you should still do as much as you can yourself to improve your case, if at all possible. There is more you can do to help yourself then a lawyer can do to help you.
🌷 This page is for new applications, but you may find some of it helpful: How to Apply or Appeal Without a Lawyer
🌷 Whatever happens, do not start a new application. Appeal and keep appealing, at least until you get a hearing. Keep appealing til you get a hearing with a judge (not an informal hearing at your local Social Security office).
🌷 After a hearing with a judge, you can decide whether to continue appealing or reapply (but hopefully you’ll just get approved, so no decision needed!)
🌷 Most appeals are approved at some point.
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