Denied Social Security Claims

Social Security Benefits Denied?

A question that we are frequently asked is, “Will I be approved for Social Security Disability benefits” and “how do I qualify for Social Security Disability benefits”? The short answer is that you may be eligible for Social Security disability benefits (SSD) or Supplemental Security Income (SSI) benefits if you are unable to work due to a physical or mental condition that has lasted or is expected to last at least 12 months. However, often a more detailed evaluation of your eligibility for SSD or SSI is needed in order to determine if you qualify. The Pensacola Social Security attorneys at the Law Office of J.J. Talbott P.A. have the experience and ability to help you with your claim for disability benefits. Call us today for your free consultation.

Social Security Disability (SSD) Claims

According to the Social Security rules and regulations, an individual is disabled if he or she cannot “engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which has lasted or can be expected to last for a continuous period of not less than 12 months.” However, to be eligible for Social Security disability benefits, you must first meet two earnings tests. These tests assess how many work quarters (credits) you have earned in your employment history and whether those are enough to meet the Social Security disability standards. If you have enough credits, then Social Security will use a 5-step sequential process to determine your disability status:

  1. Have you engaged in substantial gainful activity?

    At Step One, the issue is whether you have worked after the date you said you became disabled. Most Social Security applicants meet test one because they have not worked since their disability began. If you have worked after the date you said you became, disabled, we can determine whether that work may disqualify you from entitlement to benefits.

  2. Do you have a severe impairment?

    Step 2 is designed to weed out cases that involve no medically determinable impairment or a slight impairment that imposes only minor limitations on the ability to work. Most Social Security applicants meet test two.

  3. Does your medical condition meet the criteria in the Listing of Impairments?

    At Step 3, the Social Security Administration refers to a Listing of Impairments which has been created for most physical and mental conditions. Each condition has a detailed list of medical signs, findings, symptoms, and functional limitations resulting from those symptoms. If the medical records show that your condition meets or is equal to a condition listed in the Social Security Administration’s Listing of Impairments, you will be found disabled based on the medical evidence alone without consideration of your age, education, or work history. Unfortunately, the Listings are very narrowly defined, and thus, most cases do not meet a Listing. At the Law Office of J.J. Talbott P.A., we review the medical records to determine whether they show the necessary criteria to meet a listing and if necessary contact your physician for additional documentation to support your claim. If disability cannot be determined at Step 3, the decision process proceeds to Step 4.

  4. Can you return to your past relevant work activity?

    At Step 4, the question is whether you can return to the lightest job you actually performed in the last 15 years. Social Security consulting physicians normally review the medical records and render an opinion on your capacity to work. The consultants generally find that the claimant is capable of performing light-duty work activity. In most cases, this results in a denial of the claim. The opinion of your treating physician regarding your functional capacity and his willingness to complete functional capacity forms are crucial to winning at this stage.
    If the Social Security Administration determines that you can return to the lightest job you held in the last 15 years your claim will be denied. However, if the Social Security Administration determines that you cannot return to your past relevant work you still have not won your case! You must proceed to Step 5.

  5. Can you perform other work that exists in the national economy in significant numbers in view of your age, education, and transferable skills?

    At Step 5, the burden shifts to the Social Security Administration to show that you retain the capacity to perform other work and that such other work exists in significant numbers in the national economy. In making this determination, the Social Security Administration uses Medical-Vocational Rules which are commonly called “grids”. These grids are biased against younger and more educated workers. In other words, the younger and more educated you are the less likely you will be able to prevail under the grid rules. If you do not meet the Grids, the key to winning at step five is to present evidence that demonstrates that the combined effect of your physical and/or mental impairments, chronic pain, and side effects of medication prevents you from performing even sedentary work activity on a regular and continuing basis, that is 8 hours per day, 5 days per week.

Do you qualify for Supplemental Security Income?

Whether you are eligible for Supplemental Security Income (SSI) benefits depends largely on your income and your resources (things you own). Supplemental Security Income benefits are generally paid to people who have low income, have few resources, do not have enough credits to receive SSD, and are either over 65 years of age, blind, or disabled. Supplemental Security Income may also be available for your child if they have a physical or mental condition(s) that severely limits their activities and the condition(s) have lasted, or are expected to last, at least 1 year or result in death. These benefits can be paid from birth until the child reaches 18 years of age. However, to determine if someone qualifies for SSI, Social Security will use the same 5 step criteria as outlined for SSD claims. Contact us to discuss the eligibility requirements for SSI benefits.

Time is a Factor in the Appeals Process

Time is limited to appeal a denied claim. For a more detailed explanation of eligibility requirements and how they apply to your case, please contact us today for your free consultation.