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What is the appeal process if my Social Security Disability Claim has been denied?



Just about everybody who has a long term disability insurance policy that was issued by their employer which would be governed by ERISA is required to apply for social security disability. And if many of these people are denied, what is the appeal process for social security disability that a claimant would expect to go through and talk a little bit about the time frame and how that process works if they are denied at the initial level?

The initial step is to file a claim and it may take on an average 3 to 5 months for a decision to be rendered on that claim. If denied, the individual can file a reconsideration. That too can take 3 to 5 months on an average for a decision and if the claim is denied, the individual can file for a hearing before an administrative law judge. The initial two claims, the initial two levels rather are determined by state agencies, the determinations, and then, if denied the second level, the person files for a hearing where they go before an administrative law judge. The timing to get before the administrative law judge varies depending upon the region and the location where the individual resides. It could take less than a year once a hearing is filed and it could take more than a year. In some administrative law situations it could take couple of years to get before a judge.

There are 4 opinions so far. Add your comment now.

Mario Chavez:

Will long term disability companies stop payment if Social Security has denied benefits at the ALJ level?

Attorney Greg Dell:

Mario,

Great question. The Social Security administration is a separate entity than your disability insurance company. The important factor to consider is how your disability insurance policy defines “disability”. If you have an “any occupation” definition of disability, then the disability carrier will rely very heavily on your SSDI denial of disability benefits. You may have an “own occupation” definition of disability which is completely different than the SSDI definition of disability. You need to read your policy and see if the definition of disability is different than the SSDI definition of disability. If they are similar, then you need to be concerned that your disability carrier will likely deny your benefits as soon as they find out. If you would like assistance please contact us at your convenience.

Laura W.:

I am a RN and have been receiving LTD for a back related condition for 2 years now. LTD is thru UNUM. They have assigned me a GENEX attorney who told me I have to apply for SSDI beneifts so UNUM no longer has to pay me I presume. My doctor may release me to part-time work which would be 4 days a week. If I do return to work am I obligated to repay UNUM anything?

Laura

Attorney Stephen Jessup:

Laura, if you return to work it could result in your benefit ending or at the very least an offset of your benefit going forward each month. Please feel free to contact our office if you would like to discuss your claim further.

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