My Social Security Disability Claim Was Denied in North Carolina. What Are My Next Steps?

The Social Security Administration (SSA) denies most initial claims for Social Security Disability benefits. If it rejects your claim, you’ll need the services and advice of a North Carolina Social Security Disability lawyer.

North Carolina’s denial rate for initial disability applications is higher than the national average. Understanding the reasons for a denial, the steps for appeal, and the value of legal assistance is essential for those seeking the benefits they need and deserve.

What Are the Non-Medical Reasons for Denials?

The Social Security Administration reviews each case based on strict criteria. A denial can be for medical or non-medical reasons. The SSA may issue a denial for one of these non-medical reasons even before it reviews your medical evidence:

1. Inadequate work credits: To qualify for Social Security Disability Insurance, you must earn work credits by paying FICA taxes. Qualifying requires forty work credits for most workers, with at least half earned in the decade preceding the disability.
2. Excessive income: The SSA limits the income (“Substantial Gainful Activity” or SGA) you may earn while disabled. The SSA may reject your claim if your monthly earnings exceed the SGA limit.
3. Failure to cooperate: The SSA requires applicants to cooperate, attend scheduled medical examinations, and provide all requested paperwork and medical records. If the SSA can’t contact you or if you fail to comply, it may deny your claim.

What Are the Medical Reasons for Rejecting Claims?

A medical denial may be issued for one of these reasons after the SSA’s evaluation of your medical condition and its effect on your ability to work:

1. Inadequate medical documentation: Lack of documentation is a common cause of denials. The SSA needs proof of your condition and how it keeps you from doing work-related tasks.
2. Condition is not severe or long-lasting: Your medical condition must be so severe that it prevents you from doing “substantial work” and will likely last for at least a year or result in death.
3. Failure to follow a doctor’s recommendations: If you are not following your doctor’s treatment plan, the SSA may deny your claim. The SSA may presume your condition will improve if you comply with medical advice.
4. Disability linked to substance abuse: The SSA does not grant disability benefits when drug or alcohol use contributes to the disability.

How Does the Social Security Disability Appeals Process Work?

If the SSA denies your initial claim, contact a North Carolina Social Security Disability attorney. You have sixty days from receiving the denial to file an appeal. If you miss the deadline, you may have to start over. The appeals process consists of these stages:

1. Reconsideration: Reconsideration is the first level of appeal. Your case will go to the North Carolina Disability Determination Services in Raleigh for review. A different claims examiner and medical consultant will examine your case.
2. Administrative Law Judge (ALJ) hearing: If your reconsideration fails, you may request a hearing before an ALJ. The wait time for this hearing can be lengthy, from sixteen to twenty months.
3. Appeals Council: If an ALJ denies your claim, you may request an Appeals Council review. The Appeals Council can grant the review or return the case to the ALJ. It can also deny the review, at which point the ALJ’s decision is final.
4. Federal court: This is the final step in the appeals process. You and your North Carolina Social Security Disability lawyer may file a lawsuit in a U.S. District Court if your appeals have failed. The court provides one last opportunity for a favorable outcome.

How Can a Social Security Disability Attorney Help?

A North Carolina Social Security Disability attorney will help you understand why the SSA denied your initial claim and review your application for mistakes or missing information. Then, your attorney will help you gather the documents you need and take these steps:

1. Obtaining a medical opinion: Your lawyer can obtain a formal opinion from your physician. A formal medical opinion can be a powerful tool in a disability case, as a doctor’s statement about your functional capacity may carry weight with the SSA.
2. Preparing you for your hearing: If your case reaches the ALJ hearing, your lawyer will explain what you should say about the impact of your disability on your daily life and work. Your lawyer can also prepare witnesses to testify on your behalf.
3. Handling paperwork and deadlines: Your attorney can prepare and manage the legal paperwork and ensure that forms like the SSA-3441 “Disability Report-Appeal” and the SSA-561 “Request for Reconsideration” are completed accurately and on time.
4. Representing you at hearings: At an ALJ hearing, your attorney is your advocate, presenting your case, cross-examining any vocational or medical experts called by the SSA, and ensuring that the court hears and understands your testimony.

Is Hiring an Attorney Worth It?

The Government Accountability Office has found that applicants with an attorney are up to three times more likely to succeed when seeking Social Security Disability benefits than applicants without an attorney.

Most Social Security disability lawyers represent clients on a contingency fee basis, so they are paid only if they win and their clients receive benefits. The fee is a set percentage, capped by law, and provides a powerful incentive for lawyers to secure successful outcomes.

Take Your Disability Claim Denial to Brent Adams & Associates

A denied Social Security disability claim is disappointing, but it’s not a reason to give up. The attorneys at Brent Adams & Associates offer the guidance and experience you need to build a strong case and turn a denial into an approval.

Brent Adams & Associates advises and represents the injured and disabled in North Carolina with offices across the state. We’ll provide you with a free, no-obligation, in-depth case evaluation. You’ll receive sound and personalized advice.

If you are disabled, we will put our experience, knowledge, and record of success to work for you. To learn more or begin the disability benefits appeals process, call Brent Adams & Associates now at 910-249-6891.