According to the Social Security Administration, nearly 2 million Americans filed for disability benefits in 2023. Kentuckians accounted for nearly ten percent of these recipients.
In fact, Kentucky is second only to West Virginia for working-age adults receiving disability benefits in the US.
But how do you determine if you’re eligible for disability benefits? What happens if the Social Security Administration (SSA) rejects your claim? What does the appeals process look like?
Fortunately, you don’t have to navigate the challenges of filing for disability benefits alone. Read on to learn how to initiate a Social Security disability claim, and what steps you’ll need to take if your initial application is rejected.
Who’s Eligible for Social Security Disability Benefits?
First things first— how do you know if you’re eligible for social security benefits?
The Department of Health and Human Services once oversaw the Social Security Administration, but all social security programs have been administered by the Social Security Administration since 1995.
The Social Security Administration created a predetermined set of requirements for all Social Security disability claimants over the age of 18.
1) Does your disability keep you from working?
The claimant cannot participate in what the Social Security Administration calls “substantial gainful activity” due to their disability; in other words, they can’t earn more than $1350/month for applicants or $2260/month for blind applicants.
2) Does your disability keep you from working any job or a job in your chosen field?
Depending on your age, education, previous work and transferable occupational skills, in order to prove your claim, you may need to prove you cannot work at any job in the national economy or that you cannot perform a job with particular physical requirements in for example, a heavy, medium, light or sedentary job. These are circumstances where the claimant only needs to prove he/she cannot work in their previous field due to their disability. For instance, if you were a factory worker but your disability made you unable to stand for a prolonged period of time, you would be considered unable to work in your chosen field, thus disabled.
3) How serious and long-lasting is your disability?
If medical evidence provided by a physician proves that the claimant’s medical condition will extend for more than a year, is permanent, or it could result in death, they would be considered disabled and therefore eligible for disability benefits.
4) How long did you hold a job covered by Social Security?
If the claimant worked long enough and recently enough in a job requiring them to pay into Social Security, they would be considered eligible for disability benefits. Check your paychecks for social security coverage information.
If the applicant doesn’t meet all of these requirements, their claim will be immediately rejected. If you’re unsure, a Social Security attorney can help you determine if you’re eligible for disability benefits.
What Information Do You Need to Provide for Disability Benefits?
A lot of information is needed to file a new claim.
This includes:
- A birth certificate
- A Social Security number
- Discharge papers from the US military if you served before 1968
- Contact information for the doctors, hospitals, and clinics where you’ve received care since your disability began
- Dates of medical treatment
- Names and dosages of medication you’re currently taking
- Complete medical records from all medical professionals whom you’ve seen since your disability began
- Lab and test results
- A complete work history
- A copy of your most recent W-2 form and tax returns, if you’re self-employed
- Proof of workers’ compensation benefits, including pay stubs or settlement agreements
- An adult disability report
- Evidence of your marital status
- Names and ages of children, if applicable
In addition to this, you’ll need to fill out any required related forms. They could also ask for additional evidence as needed.
What’s the SSD Claim Procedure in Kentucky?
The office responsible for determining if you’re eligible for disability benefits is called the Disability Determination Services (DDS) office. This field office has trained staff, including doctors and disability specialists who work with the medical professionals who have treated you to get the information they need about your condition.
Your disability claim will likely be reviewed by a vocational expert as well; that person looks at
the jobs you performed in the past and determines the skill level and exertion required to perform them. This helps them determine if you are too disabled to continue to do this work.
The Disability Determination Services employees work together to determine your eligibility for Social Security disability benefits.
There are three ways to file disability claims. You can apply online at www.ssa.gov/applyfordisability, call the Social Security Administration’s toll-free number, 1-800-772-1213, or visit your local office to apply for Social Security disability benefits in person.
You must call the number listed above to make an appointment to visit your local office in person or request that they take your information over the phone. If you are deaf or hard of hearing, the number to get appropriate assistance is 1-800-325-0778.
The disability claims process can be complex and can take time. Beyond supplying medical evidence, treatment sources, and other information about your disability, it takes a long time for the Disability Determination Services office to evaluate your file. They see many cases every month in every field office in the country, so you must prepare for a long waiting period.
Once you’ve begun the evaluation process, it can take as long as 3-9 months to advise whether your application and related forms were approved and you’ll receive social security disability benefits. Nationally, the average time claimants wait for their claim to be initially processed is around 7.5 months.
It’s important to note that claimants who wait more than five months to get their Social Security disability claims approved could be eligible for back pay if their claim isn’t denied. The evaluation process is lengthy, but the Social Security Administration is required to ensure approved claimants are compensated for the time it took to process or prove their disability claims.
If the Disability Determination Services office requests additional information, you could be asked to undergo a consultative examination (being seen by a doctor contracted by Social Security). This exam is meant to obtain evidence about the nature of your disability that wasn’t necessarily supplied in your medical records; an independent source can conduct it or your physician can be the preferred source.
Once the evaluation has been completed and the evidence gathered to the DDS office’s specifications, the DDS returns with their initial determination.
If your request for Social Security Disability or Supplemental Security Income is approved, the SSA completes the outstanding non-disability development and calculates the benefit amount you’ll be paid.
When the Disability Determination Services office makes that assessment, it begins paying benefits the first full month after the date they decided your disability began; your disability benefits will not start before the sixth full month that you’ve been disabled, as set forth in the Social Security Administration’s regulations.
The national average for approval of a new disability claim in the first round is 38%; 62% of applicants are denied disability benefits after their initial application is filed.
Why Are Claimants Denied Benefits At This Point in the Claims Process?
There are several reasons, including:
- Insufficient medical records or medical support/information
- The disability in question is believed to be short-term, or lasting less than twelve months(durational requirements)
- Suspicion of fraud
- Applicant earns too much to be eligible for disability benefits
- Failure to comply with the Social Security Administration’s requests
- The disability benefits application was filed too late
- The applicant failed to follow the recommended treatment plan for their disability
- The claimant has a criminal conviction on their record
- The claimant had previous Social Security disability benefits denials
- Errors on related forms
If the Disability Determination Services office should deny your initial application, you do have legal recourse. Just because your application was rejected after it was initially processed, it doesn’t mean that you won’t receive benefits or that you’re not eligible.
An attorney experienced with Social Security disability claims can help explain what you need to submit so that your claim is approved and help you take appropriate action if your claim is rejected.
Can You Appeal the Disability Determination If You Are Denied?
In a word, yes. After your claim is processed and denied, you do have recourse. The first stage of the appeals process is known as “reconsideration” – you file a “request for reconsideration” commonly known as the “first appeal”.
When your disability benefits claim is denied at the initial determination, you can return to the local Social Security Administration office to repeat the process— but this time, it will be overseen by a different set of reviewers. This appeal needs to be filed within sixty (60) days from the initial denial.
In theory, this should be easier; you’ll already have your information collected and you know what to expect from the claims process. You submit the appropriate paperwork again and wait for the Disability Determination Services office to evaluate it.
Nationally, around 15% of applications submitted for reconsideration (the first appeal) are approved. Denial can be devastating for a disabled person. After all, this stage of the appeals process can take between 3-6 months; in most cases, claimants have been awaiting disability benefits for nearly 6-12 months at this point in the process.
Of the 85% of social security disability benefits claimants denied during the reconsideration process, 77% chose to file an appeal.
The next step in the appeal process is a hearing with an Administrative Law Judge.
What Can I Expect at a Disability Determination Appeal Hearing?
It’s important to move quickly if you plan to take your case before an Administrative Law Judge, or ALJ; you only have 60 days after your denial to request a hearing.
An Administrative Law Judge will make an independent decision based on the evidence presented to him/her, including updated medical evidence in addition to your personal testimony.
Most attorneys would recommend that you present the administrative law judge with more medical records/requests or current test results that will prove that your disability is, in fact, worthy of Social Security Disability benefits. Seeing clear progress of your disability, or at the very least proof that your condition hasn’t improved, will give the judge the information they need to make a fair judgment.
The good news is that, nationally, 51% of applicants who take their claim to an Administrative Law Judge are approved for social security disability benefits. This stage of the appeals process sees the most success for people who have submitted disability claims, largely because they’ve had more time to accumulate medical evidence and fine-tune their application and related forms and develop the medical evidence to be considered.
The bad news is it might take as long as a year to get your case in front of a judge. This waiting period is brutal for disabled people who need Social Security disability benefits to pay their bills, but this is the process if you file an appeal after your disability benefits claim is denied.
Of the 49% of applicants whose appeal was denied by the Administrative Law Judge, 35% chose to continue the appeals process and requested an Appeals Council review.
What’s the Appeals Council?
Once again, the claimant must act quickly. They have to submit their request within 60 days from the date the Administrative Law Judge denied their claim or 65 days from the date listed on the official denial. The Appeals Council is the last stop for claimants to appeal the process through the administrative level.
Founded in 1940, the Appeals Council has offices in Maryland and Virginia, but they hear cases across the country. Originally a 3-member council, they have grown out of necessity, as they process nearly 200,000 cases each year.
The Appeals Council has the power to grant, deny, or dismiss a claimant’s request for review of their disability claim. If they choose to grant the request before them, they can decide the case on their own or they can remand it to an Administrative Law Judge for a new decision.
A paltry 1% of disability benefits cases heard by the Appeals Council were approved. 84% were denied outright, while 3% were dismissed and 12% were sent back to an Administrative Law Judge for a new hearing or “rehearing” of the case.
What’s My Final Option If My Initial Application is Denied?
People whose disability benefits claims were denied in all previous administrative appeals processes have the option to file a civil action in federal court. The federal court where you will file your case depends on your judicial district.
Kentucky is home to two federal judicial districts; the Western District of Kentucky is housed in Louisville, while the Eastern District of Kentucky is in Lexington.
However, you aren’t guaranteed a federal court reversal or remand of your case;; they only accept less than 1% of cases nationally. There is a fee required to file a civil action against the Social Security Administration’s decision to deny your disability benefits; you can request to have it waived if you are unable to afford it, but there’s no guarantee that will occur.
When you take this action, you’re not suing the Social Security Administration, but rather your region’s Social Security commissioner.
If you can present your evidence to a federal judge, but your claim is denied yet again, you can file yet another appeal, but it’s even harder to have your case heard beyond the federal district court to the federal circuit court of appeals.
This coupled with the fact that years have passed since your initial request for social security disability benefits results in very few people resorting to any further appeals.
When Can I Expect to Receive Benefits?
No matter the stage in which you are awarded benefits, the Social Security Administration begins paying benefits one full month after you’re considered disabled and eligible for benefits, as long as it’s after the sixth full month that you were determined to be disabled.
The amount of your benefits depends on your disability.
Should I Hire a Social Security Attorney?
A Social Security attorney can help you navigate the disability benefit filing process. It’s far from simple, with many points along the path where you could easily make a mistake that would cause your claim to be denied.
So many people lose hope after their initial claim is denied; the prospect of facing months or years of appeals is definitely daunting. That’s why you need to work with someone with experience and an in-depth understanding of the Social Security Administration.
If your claim was denied for any reason, it’s time to work with a Social Security lawyer who can advise you about the best steps to ensure your disability claim is approved. They can help shorten the waiting period that seems to be inevitable when filing for Social Security disability benefits.
This is particularly the case if your appeal process moves beyond the reconsideration phase; a hearing is intimidating, but knowing that you have a knowledgeable attorney working with you will surely provide some relief.
An attorney can provide beneficial advice to help you avoid losing more time to the appeals process, cutting short the time to get your disability benefits.
Contact the Social Security Attorneys at Rhoads & Rhoads
For more than 45 years, residents of Western Kentucky seeking disability benefits have depended on Rhoads & Rhoads to fight for them. We have the experience and know-how to help you as you seek Kentucky State Social Security benefits.
If your medical condition merits disability benefits, don’t let the appeal process stop you from taking the appropriate action to get the benefit amount you deserve. From your initial application to the moment your claim is approved, we will fight by your side.
Have questions? Contact us today for a free initial consultation at 888-709-9329.