FM/CFS/ME RESOURCES - Beating the Appeals Cycle - Earn Benefits While You Wait

 

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Beating the Appeals Cycle - Earn Benefits While You Wait

Each year approximately 1.3 million people received letters from Social Security denying their claim for disability benefits that included the following or similar statement;

"We realize that this condition keeps you from doing any of your past work, but it does not prevent you from doing other jobs which are less demanding. Your overall condition does not meet the basic definition of disability as defined by Social Security."

If your claim has been denied and you're stuck in the appeals cycle, there's hope. You can file a winning second claim and receive benefits as early as three to four months. The steps to filing a second claim are:


Step 1: Have a denial date from the second appeals level on the first claim signed by an Administrative Law Judge (ALJ)

After you've been denied at the second level of appeals by an administrative law judge, a new claim can be filed. The second claim is processed and may be approved while your first claim waits to be heard at the Appeals Council (AC). The waiting period at the AC level is between two months and two years. While the first claim is waiting to be heard at the AC, you could be receiving monthly disability checks.


Step 2: Contact the Appeals Council, the third level of appeals, to confirm your waiting period is longer than six months

You need to know if you have the time to file a new application. If your case will be heard in six months or less then it isn't worth filing second claim. To find out when your case is scheduled just call the local Social Security office and ask for the Appeals Council phone number. Call the AC office and ask when your case will be heard. If your court date before the AC is between six months and two years or more then filing a second claim is a viable option.


Step 3: Confirm you are still eligible for benefits

When you file a second claim, by law the second claim must have a new starting date (onset date, Section 2, question E of the application). The new date is the day after the ALJ's decision. In order for your second claim to be valid with a new starting date, it's essential that you're still eligible and that your "disability insurance" is still in effect.

To find if you're still eligible, contact your local Social Security Office and ask them for the "last date insured". If the last date insured is after the new starting date, the day after the ALJ's decision, you can file a second claim.


Step 4: Make changes, improvements to your first claim

In order for the second claim to succeed, there must be changes or improvements to the first application or there is no reason to file a second claim. Improvements such as additional medical or non-medical evidence, thorough and detailed responses to questions, supplemental forms or questionnaires can make the difference between success and failure. The second application must unequivocally establish your disability. If you didn't include medical evidence with your first claim, now is the time to do it. More than likely your doctors have ordered additional tests or studies since you filed your first claim. This is considered new medical evidence that could be added to a second claim.

Many claimants answer the application's questions with short and simple responses that are unfortunately insufficient to prove the limitations of a disability. The majority of denials are because the claimant did not establish that they are incapable of working at the most basic of jobs. It's mandatory to convince Social Security that your disability is severe enough to significantly limit basic physical or mental work activities.


Step 5: Consider the pros and cons of submitting a second claim

Finally, there are risks in filing a second claim that need to be considered and weighed against the benefits of doing so. If the second claim is approved, you'll receive monthly cash benefits while the first claim waits to be heard at the Appeals Council. The AC can make a number of decisions: they can approve both claims, deny both claims or send the claims back to the ALJ. If the Appeals Council sends the first claim back to the ALJ for consideration, the instructions include a statement that vacates the second claim. Both the first and second claim are sent to the ALJ for a determination. If the ALJ ultimately denies both claims then the claimant runs the risk of having to pay back the benefits that were paid when the second claim was approved.

On the positive side, the Appeals Council is influenced by the new evidence in the second claim and frequently upholds the approved determination of the second claim. If the Appeals Council approves the first claim, you'll receive back benefits from the onset date of the first claim. In addition, with an earlier effective date, based on the first claim's approval, you'll receive Medicare sooner if not immediately.

It's a balanced choice that only you can make. If you are confident that the second claim proves your disability and inability to do the simplest jobs, then the risk is minimized and you have everything to gain by filing a second claim.


About The Author

Trudi Aviles Trudi Aviles is a passionate advocate for disabled adults filing for SSDI benefits. Before becoming disabled with CFIDS/FM she wrote technical training manuals for working adults. She applied her skills of strategic analysis, research and writing when completing her SSDI application. The process took six months but she won her benefits in three months. Distressed by the number of people denied benefits the first time they applied, 64%, she was determined to make a difference in the SSDI's culture of denial. Trudi has written a book entitled, Win Your Disability Benefits Now. It is a step-by-step, question-by-question guide to writing winning answers on the SSDI application. This book is her contribution to help others win their benefits the first time they apply. For more information about Trudi, her book, tips and techniques visit SSDI-Help.

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