Can You Appeal if an ALJ Denies Your Disability Benefits?

It’s not uncommon for first-time applications for Social Security Disability Insurance (SSDI) benefits to be denied. The reasons vary but can include not having worked long enough to qualify for benefits or not having enough medical evidence to prove an impairment or disability.

If you are deemed ineligible for disability benefits for any reason, you have options. First, we would make a request for reconsideration. If that was not successful, we would request a hearing before an Administrative Law Judge (ALJ), who will then make a decision on your claim. But what if the ALJ denies your disability benefits, too? Can you appeal that decision?

Why an ALJ would deny your request for SSDI benefits?

There are many reasons an ALJ might return a “Notice of Decision — Unfavorable” verdict. The reason for the denial of benefits will be stated in the “Findings of Fact and Conclusions of Law” section of the letter you’ll receive with your paperwork. It’s important to be prepared for what to expect from an unfavorable decision. Here are a few of the most common reasons an ALJ would deny your disability benefits request after an appeal.

The ALJ may agree with the vocational expert.

A vocational expert (VE) will provide evidence at your benefits hearing. The VE will determine your Residual Functional Capacity, or RFC. They will likely list a number of jobs they feel you are qualified to perform based on their evaluation of your case and any exhibits the hearings officials have provided. These may be jobs you have done before or a different type of work the VE thinks you would be suitable for.

The VE will not specifically state that you would be able to perform certain job duties. They will simply state that a person with a certain disability would hypothetically be able to do that job or a similar job. If the ALJ agrees you would, in fact, be able to perform the job the VE has described, they may determine that you do not meet the SSA’s disability requirements.

The ALJ may agree with the medical expert.

Similarly, a medical expert (ME) such as a doctor or psychologist may provide their expert opinion as to why you are physically or mentally able to perform the work in question. Though MEs are meant to be independent and impartial, they are bankrolled by the SSA. An ME knows the system and is familiar with the SSA’s “listing of impairments.” They generally try to tailor their case to prove (or disprove) a disability or impairment on the approved SSA list to make it easier for an ALJ to make a ruling on your case. If the ME doesn’t prove that you have an impairment from the official SSA list, the ALJ may rule that you do not meet the criteria for an official medical disability.

You’ve been making too much money to qualify.

The SSA uses a measurement called substantial gainful activity (SGA). The SGA is used to calculate how much work you have been able to do since your injury or disability. The time of your injury is considered your “alleged onset date” and is the date on which you became unable to work any longer. The SSA has a set dollar amount (it changes annually) that you are allowed to make while collecting or being eligible to collect disability benefits. In 2023, the number is $1,470 per month. Once you earn equal to or greater than that amount, you may no longer qualify to receive SSDI benefits. The ALJ will tally your earnings starting from your alleged onset date. They may then determine that your disability has not prevented you from doing a significant amount of work during that time period.

You’ve been doing too much volunteer work.

Yes, volunteer activities can count as SGA, too! There’s no hard science for assessing an individual’s volunteer activities, but an ALJ will make the official call based on certain factors. If you spend more than a handful of hours a week performing your volunteer activities, you may be deemed ineligible to collect disability benefits. You’ve basically proven to the judges that you are mentally and physically able to carry out a job, albeit in an unpaid capacity. If your volunteer work had a salary, would it exceed the monthly allowance? If so, the ALJ can rule against your eligibility for SSDI payments.

You don’t have any “severe impairments.”

In SSA speak, an impairment is a health issue for which you are receiving some sort of medical treatment. Impairments are also judged on whether they are short-term or permanent. A broken leg from a slip and fall will likely heal without long-term disabilities (The SSA doesn’t handle short-term disabilities that resolve within one year’s time). But other more serious injuries can present lifelong challenges. The SSA does evaluate severe, long-term injuries that prevent a person from:

• Performing physically
• Comprehending mentally
• Communicating effectively
• Functioning properly in a workplace

Nevertheless, no matter how sick or injured you are, the ALJ may ultimately determine that your impairments are not severe enough to bar you from doing your job.

What to do if the ALJ denies your request for benefits

So your benefits have been denied. Now what?

You can appeal the judge’s decision through the Social Security Administration’s Appeals Council. A word of warning, however. The council does not have to review the claim. In fact, they can outright refuse to even look at the claim further if they agree with the ALJ’s ruling.

If the appeals council does decide to review your claim but then also denies your request, your last and final resort is to file a lawsuit in federal court for your district – in this case, the U.S. District Court of Nevada. One of our attorneys in Las Vegas or Reno (the Court has offices in both cities) can represent you in this civil case. We send copies of the complaint to the Court within 60 days to ensure that you are not time-barred from appealing.

You do have the right to secure an attorney at any stage in this high-stakes claims process. You do not have to tackle the SSA or the federal court system all on your own. Remember, you can’t just go back and start the application process over again if things don’t work out. Therefore, it’s in your best interest to hire a lawyer to help you if you are dealing with the SSA Appeals Council or looking to file a federal lawsuit for disability.

The Social Security disability lawyers at Claggett & Sykes Law Firm are experienced trial attorneys licensed to practice in all courts in Nevada, including the U.S. District Court. Our appellate team has a national reputation and has handled hundreds of cases. If your Social Security Disability benefits have been denied, let us help. If you need a Social Security Disability attorney in Reno or Las Vegas, fill out our contact form today and let our professionals handle the legal proceedings. Your consultation is free.