When a disability insurance claim is denied, it can be a frustrating and stressful experience, particularly if you’re relying on those benefits to support yourself and your family. Fortunately, there is often an opportunity to appeal the decision and potentially get the benefits you need. However, the appeals process can be complex, and there are many factors that can influence your chances of success.
Why Was the Disability Appeal Denied?
First and foremost, it’s important to understand the grounds for the denial. Disability insurance policies can be complicated, and there are often a variety of exclusions, limitations, and requirements that must be met in order to qualify for benefits. If your claim was denied because you didn’t meet one of these requirements, or because the insurer believes that your condition isn’t severe enough to qualify for benefits, your chances of success on appeal may be lower.
However, there are many situations in which a claim may be wrongfully denied, such as when the insurer misinterprets the policy language, fails to properly investigate the claim, or otherwise acts in bad faith. These cases will likely have a stronger basis for an appeal.
Disability Claim Statistics
According to data from the Social Security Administration, the national average approval rate for Social Security Disability Insurance (SSDI) claims at the initial application stage is around 30%. However, the approval rate can be significantly higher for those who pursue an appeal. The average approval rate for SSDI claims at the reconsideration level, the first level of appeal, is about 13%, while the average approval rate for cases that go to a hearing before an Administrative Law Judge (ALJ), the second level of appeal, is about 45%.
Maryland Disability Claim Statistics
According to data from the Social Security Administration, in 2020, there were a total of 8,980 appeals for disability claims in Maryland. Of those appeals, 3,505 were approved, which is a 39% approval rate. The remaining 5,475 appeals were denied.
So Maryland is doing better than the national average approval rate for disability appeals.
Main Factors in Winning a Disability Appeal
There are two key factors that correlate with winning a disability appeal:
Strength of Medical Records and Doctors’ Opinions
One key factor in the appeals process is the strength of the medical evidence supporting your claim. To qualify for disability benefits, you must generally show that you have a medical condition that prevents you from working. This requires documentation from your treating physicians, as well as any other medical professionals who have examined you. This documentation should include detailed information about your condition, its symptoms, and its impact on your ability to perform work-related tasks.
If the insurer denies your claim based on a lack of medical evidence, or if it challenges the medical evidence you’ve provided, your chances of success on appeal may depend on your ability to provide additional medical documentation that supports your claim. This may involve getting a second opinion from a specialist, undergoing additional testing or treatment, or otherwise working to bolster your case.
One key thing to keep in mind: don’t be a jerk to your doctor, the nurses, or medical stuff. You need them to go to bat for you.
Strength of Your Legal Argument
Another important factor in the appeals process is the strength of your legal argument. Disability insurance appeals are typically decided by a judge, who will review the evidence and arguments presented by both sides before making a decision. To win on appeal, you’ll need to present a compelling legal argument that explains why the insurer’s decision was wrong, and why you are entitled to benefits under the policy.
This can be a complex task, particularly if you’re not familiar with the nuances of disability insurance law. For this reason, many claimants choose to work with an experienced disability insurance attorney who can help them navigate the appeals process and present a strong legal argument. You saw above… you just have a better chance of winning- at least in most cases – with a experienced Maryland disability lawyer.
What to Expect with Your Disability Appeal
First, it’s important to understand that the appeals process can be lengthy and complex. You will need to gather medical evidence, submit paperwork, and potentially attend hearings. Maddeningly, it can take many months to receive a decision.
The first step in the appeals process is typically to submit a written appeal to the insurance company. This will require you to explain why you believe you are entitled to benefits and provide any additional medical evidence that you may have. The insurance company will review your appeal and make a decision.
If your appeal is denied, you may need to take additional steps. This can include requesting an administrative hearing or filing a lawsuit against the insurance company.
Throughout the appeals process, it’s important to work closely with an experienced Maryland disability attorney. They can help you navigate the process, gather the necessary evidence, and advocate on your behalf. Of course, getting a lawyer is not the only path to success. It is just the most proven.
Ultimately, the outcome of your appeal will depend on the strength of your case and the evidence that you are able to provide. While there are no guarantees when it comes to disability appeals, having a knowledgeable attorney on your side can improve your chances of success.
How to Improve Your Chances of Winning Your Disability Appeal in Maryland?
Here are five things you must do to win your Social Security appeal:
- Submit your appeal on time – The first step in helping win your appeal is to submit it on time. You have 60 days to file an appeal. Your denial letter should explain when the 60 days begins and when you should file an appeal by. If you do not submit an appeal on time, then you will need to start the process all over again.
- Use your denial letter as a guide – You have been handed a roadmap to win your appeal. Your denial letter can guide your disability benefits appeal. If your letter outlines a specific reason why your claim was denied, such as a lack of medical evidence, you will have a starting point on how to improve your appeal.
- Don’t exceed income limits – If you earn above the substantial gainful activity (SGA), then you will not qualify for benefits. This is a common mistake our disability lawyers see. When filing your appeal, make sure you do not exceed the SGA.
- Make sure your condition is listed in the Blue Book – The Blue Book is a list of impairments that the Social Security Administration (SSA) considers severe enough to qualify for disability benefits. Look over the Blue Book again to make sure you meet one of the listings. If you do not, then it may be difficult to win your appeal. Even if you were denied, you condition may still qualify for benefits.
- Gather new medical evidence – If you have any new medical evidence, or evidence that you did not include in your initial application, you should submit these with your appeal. If your initial claim was denied due to a lack of medical evidence, consider meeting with a doctor who likes you and will go to bat for you to find out if there are more tests that can be done or evidence a doctor can help you gather to submit.
Get a Maryland Disability Lawyer
If you have Social Security disability claim and need a social security lawyer in Baltimore, Maryland, call us at 410-553-6000 or get a free online case review.