How to Appeal an SSDI Denial in Chicago

If your claim for Social Security Disability Insurance (SSDI) benefits is denied, you can initiate the appeals process and have the SSDI denial decision overturned by giving accurate and complete information, following the Social Security Administration’s guidelines, and meeting all the set deadlines. There are four levels of the appeals process: reconsideration, a hearing in front of an administrative law judge (ALJ), a review by the Appeals Council (AC), and filing a federal lawsuit. Most SSDI recipients win disability benefits at some stage of the appeals process. Keep reading to learn more about navigating the process successfully in Chicago.

SSDI Benefits for Illinois Residents

SSDI is a program that pays disability benefits to people who’ve built up sufficient work credits by paying taxes into the Social Security system, but can’t work because of a medical condition that’s expected to last 12 or more months or lead to death. The SSA administers this disability benefits program.

Can you get disability after a workers’ comp settlement? You can still be eligible for SSDI disability benefits even if you receive workers’ comp payments, but your SSDI payments may be reduced.

The Illinois Bureau of Disability Determination Services makes initial determinations about the eligibility of applicants for SSDI benefits in Illinois according to the SSA rules and regulations. According to the 2022 Annual Report on the SSDI Program, there are 261,648 SSDI beneficiaries aged 18 to 64 in Illinois, representing 3.4% of the total resident population aged 18 to 64.

Rate of Initial Denials in Illinois

The initial disability claim approval rate is only around 40% in Illinois. About 60% of initial disability applications are denied in Illinois. These statistics shouldn’t discourage you from applying for disability benefits. However, they should show you the importance of not taking chances with your claim and taking a proactive approach to win at the initial or appeal levels.

Common Reasons for Denials

SSDI claims are denied for several reasons. Identifying the reasons the SSA presents for denying your claim is a critical step to correcting and supplementing your application.

The common reasons SSDI applications are denied include:

• Lack of sufficient medical information
• The applicant works and earns too much
• The medical condition doesn’t meet the agency’s requirement for disability
• Insufficient work credits
• Failure to respond to the agency’s request for additional information
• Failure to follow a treatment plan

Steps to Take If You Receive a Denial Notice in Chicago

After receiving a denial notice, the best option is often to appeal the denial rather than file a new SSDI claim. When you appeal the denial, you’ll get a larger amount of back pay if you’re approved for disability benefits. Back pay calculations are usually based on your original application date. If you appeal the denial and eventually win disability benefits, you’ll receive back pay according to the application date, along with your first SSDI benefits check.

Understanding how to go about the appeal process will increase your chances of finally winning disability benefits.

Seek Legal Assistance From an SSDI Attorney

When your SSDI claim is denied, a Social Security disability attorney is a vital asset in appealing the SSDI denial. Objectivity and legal understanding when seeking an appeal are essential. Without professional assistance, the mistakes made during the initial disability application could carry on to the appeals process.

Social Security disability lawyers know how the appeal system works and its written and unwritten rules thanks to their legal knowledge and experience handling similar disability denial cases. They understand why people get denied and can guide them on how to appeal disability claims.

Your Social Security disability lawyer will review your original disability claim to establish what wasn’t done correctly. Your lawyer will help you understand why the application was denied and identify and collect additional evidence that could strengthen your case in subsequent appeals. He or she will ensure you fill out the necessary paperwork properly.

Your SSDI lawyer will coach you on the questions you’ll likely be asked at a hearing and how to give an effective testimony. Your lawyer will represent you in court and ensure your case is properly prepared and presented.

One worry that claimants may have is the cost they’ll need to incur to hire a lawyer for Social Security disability. Fortunately, these lawyers usually work on a contingency basis. They only charge you when you’re ultimately approved. What’s more, even after your approval for SSDI, their charges are capped by federal law.

Gather Necessary Documentation

The SSA requires you to have certain documents and information when completing your disability appeal. The agency will require personal information like your name, address, phone number, and Social Security number, your representative’s name, phone number, and address, and the date of the denial decision. You’ll also need to gather medical information like the name, address, and phone number of a relative or friend familiar with your condition, a description of any changes to your medical condition, work, education, and daily activities, and the medicines you’re taking, why you’re taking them, and the doctors who recommended them.

The SSA allows you to submit any other documents that can support your appeal. You could submit additional documents that address the deficiencies the agency noted in the explanation for denying your claim. Additional evidence you could provide to increase your chances of winning disability benefits at the appeal stage include:

• New diagnoses received
• A written statement from your employer confirming how much you’ve worked and the difficulties you experienced on the job
• Written statements from your family, friends, and colleagues about your condition’s effects
• Medical test results
• Supporting statements from your doctors

A Social Security lawyer can advise you on the additional information that could benefit your claim.

The SSDI Appeals Process in Illinois

If your SSDI claim is inappropriately denied, you’ll have several chances to appeal and get approved for disability benefits. Generally, there are four levels of the appeals process in Illinois.

Reconsideration

Applying for reconsideration is the first step of the SSDI appeals process. It involves an examiner who didn’t participate in the first decision doing a complete review of your claim. Many claims are denied again at reconsideration because the same information that was initially reviewed is considered under the same guidelines.

Administrative Law Judge Hearing

If your claim is denied during your reconsideration appeal, you can ask for a second appeal, a hearing with an administrative law judge. The judge will be someone who wasn’t involved in the initial determination or reconsideration. An ALJ hearing gives you the best chance of reversing your denial. You can speak directly with the ALJ and present your argument for why you should qualify for disability benefits more compellingly and in more detail.

Preparation and having a competent SSDI attorney are critical to winning an appeal at this stage. A seasoned attorney will prepare you for questions and help you present your case, including the physical and emotional suffering you’ve endured, more clearly. Your attorney will also cross-examine witnesses effectively and present the evidence gathered persuasively.

Appeals Council Review

If an administrative law judge denies your SSDI claim, you can request a review by the SSA’s Appeals Council. The Appeals Council can review your case and issue a new decision, refer it back to the ALJ for rehearing, or choose not to review it.

Federal District Court Review

The last step of the appeals process — if the Appeals Council makes an unfavorable decision or refuses to review your request — involves asking for your case to be reviewed in federal court. You’ll \file a lawsuit against the SSA in the applicable U.S. District Court, such as the Illinois Northern District Court in Chicago. A federal judge will review your case without a jury. The Federal District Court can approve or deny your appeal for SSDI or send your case back to the SSA for reconsideration.

Timelines and Necessary Forms

You can initiate the SSDI appeal process by requesting an appeal online. You can also download the necessary appeal forms online or request them from your local Social Security office, complete them, and then send them to the SSA.

The form you’ll need to fill out to get a Reconsideration is the Form SSA-561. You’ll also need to fill out and submit forms SSA-3441 (Disability Report – Appeal), which lets you update your medical information, and SSA-827 (Authorization to Disclose Information to the SSA), which allows the agency to acquire more medical evidence. To request a hearing by an administrative law judge, you should fill out and submit Form HA-501 along with forms SSA-3441 and SSA-827. You’ll need to submit Form HA-520 to request an Appeals Council review.

You can draft a disability appeal letter and attach it to the forms for requesting reconsideration or hearing. You can outline the problems you find with the denial decision and address ailments not considered or missing evidence in the appeals letter.