How to Reopen a SSDI Claim That was Denied
In Pennsylvania, qualifying individuals can apply for and receive benefits through the Social Security Disability Insurance (SSDI) program. The Social Security Administration (SSA) receives thousands of claims every year, many of which are denied. Fortunately, those whose claims for Social Security Disability benefits have been denied have the right to reopen those claims and appeal the decisions. If you were recently denied disability benefits, you should contact a Social Security Disability attorney who can walk you through the complex appeals process.
A claimant can only receive SSDI in PA after the SSA has evaluated his or her application and deemed the injury or illness disabling enough to justify benefits. Injured claimants are also required to fulfill additional SSDI requirements, including:
- Satisfying two earnings requirements tests;
- Establishing that they cannot fulfill the same job duties that they did before the injury; and
- Proving that their injury qualifies as disabling.
Once these requirements have been met, claimants will begin receiving monthly payments. However, in most cases, claims are denied, even when they are valid. Fortunately, claimants who are denied SSDI benefits can request a hearing before an Administrative Law Judge (ALJ) within two months from the date of the denial. The wait time for this type of hearing is usually around one year. When a claim is denied at this level, the injured party can request a review by the Appeals Council, which has the discretion to grant, dismiss, or deny the request. The Appeals Council is not permitted to dismiss a case without review if there is evidence:
- Of an abuse of discretion;
- Of an error of law;
- That the ALJ’s decision was not supported by substantial evidence; or
- That the case raises a broad policy or procedural issue.
The next and final step in the appeals process is to file a lawsuit in a U.S. District Court. These cases are reviewed by a judge who is directed to look only for legal errors.
Reopening a Claim
Unfortunately, many claimants are not aware that they have the right to an appeal of a denied SSDI claim, as a result of which, the denial becomes permanent. However, it is possible to reopen an old claim in certain situations. For example, a claimant can reopen a prior disability claim if:
- It is related to a current claim;
- The onset date of the disability on the second claim falls within 17 months of the initial application; and
- The first claim was incorrectly denied.
If, on the other hand, the prior claim involved a separate injury or illness, the claimant will most likely be barred from reopening it. Reopening a claim can be crucial to how much an injured party is able to collect, as Social Security generally calculates benefits back to the date of the original application, which makes it especially important that injured parties follow all necessary procedures when attempting to reopen a claim.
If these requirements are satisfied, a claimant can file a new application and request that the old claim be reopened. It is important to include the date of onset, as this date plays an important role in the SSA’s determination of whether to open a claim. For example, a prior SSDI claim that was denied by an ALJ can be reopened within one year of the decision for any reason. Once this date has passed, it becomes much more difficult to reopen this kind of claim. If a claim was denied in the last four years, it can still be reopened if the SSA finds that there is good cause to do so, which means that:
- New and material evidence about the claims has been discovered;
- A clerical error in calculation was discovered; or
- The judge’s written decision is erroneous on its face.
The SSA rarely reopens claims that are over four years old. However, even these claims can be reopened if:
- There is evidence of fraud;
- There was a mistake in computing benefits;
- The denial was based on a criminal conviction that was later overturned; or
- The decision was blatantly erroneous.
There are also specific rules about who is permitted to reopen a claim. For instance, a claim that was denied by an ALJ can only be reopened by another ALJ or the Appeals Council, while denials from the Disability Determination Services (DDS) can only be reopened by a DDS claims examiner, an ALJ, or the Disability Appeals Council.
Schedule a Consultation With a Dedicated SSDI Attorney
If you have recently been denied your Social Security Disability Insurance claim and would like to reopen it, please contact Krasno Krasno & Onwudinjo at (866) 948-9088. You can also reach us by initiating a live chat with a member of our legal team or by sending us a brief online message.