Takeaways

• A denial of Supplemental Security Income or Social Security Disability Insurance benefits is common and not final. Many denials are overturned through the appeals process.
• Older adults may have better odds of success on appeal by acting quickly, gathering detailed medical evidence, and clearly explaining their functional limitations and work history.

Receiving a denial for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits can feel discouraging, especially for older adults who may already be dealing with health challenges, reduced income, or caregiving responsibilities. The good news is that a denial is not the end of the road. Many people who are initially denied benefits are later approved through the appeals process.

Understanding how appeals work and acting quickly can significantly improve your chances of success.

Understanding SSI and SSDI

Although SSI and SSDI are both administered by the Social Security Administration (SSA), they serve different purposes. SSI is a needs-based program for people with limited income and resources who are age 65 or older, blind, or disabled.

SSDI is an insurance program for people who have worked and paid Social Security taxes but can no longer work because of a qualifying disability. Being eligible for SSDI does not depend on your income or assets.

Each provides eligible recipients with a modest monthly benefits amount. The appeals process is similar for both programs.

Why Applications Are Often Denied

Initial denials are common. Some frequent reasons include:

• Insufficient medical evidence
• Failure to show that a condition meets the SSA’s definition of a disability
• Income or asset limits exceeded (for SSI)
• Incomplete paperwork or missed deadlines
• SSA determination that the applicant can still perform some type of work

A denial does not mean the SSA believes you are not disabled or do not need help; it often means the documentation didn’t clearly support the claim.

The Four Levels of Appeal

If you receive a denial, you generally have 60 days from the date on the notice to file your appeal. Missing this deadline could mean having to start over.

Request for Reconsideration

At this first stage, the disability agency does a second review of your claim. You may submit new medical records or updated information. Many claims are still denied at this stage, but it is a necessary step to move forward.

Hearing Before an Administrative Law Judge

Older adults often have the best chance of success with their appeal at this stage. You can explain your condition in your own words. Medical and vocational experts may testify. Judges may be inclined to take age, work history, and limitations more fully into account.

For older applicants, especially those over age 50, SSA rules may be more favorable if medical conditions limit the ability to transition to new types of work.

Appeals Council Review

If the judge denies your claim, you can ask the SSA’s Appeals Council to review the decision. The council may uphold the decision, reverse it, or send it back for another hearing.

Federal Court Review

As a last resort, you may file a lawsuit in federal court. A judge reviews whether the SSA properly applied the law. You do not typically introduce new evidence at this stage. Given the complex legal nature of this step, it is a good idea to get legal representation.

Strengthening an Appeal

Older adults may be able to improve their chances by focusing on the following:

• Detailed medical records. Include diagnoses, test results, treatment notes, and statements from doctors explaining functional limitations.
• Consistency. Make sure your medical records, application, and testimony tell the same story.
• Functional limitations. Explain how your condition affects daily activities such as walking, standing, concentrating, or using your hands.
• Work history. Clearly describe why your disability prevents you from performing past work or adjusting to new work.

Should You Get Help?

Many applicants choose to work with disability attorneys, nonattorney disability representatives, legal aid organizations, or other advocacy groups. Most of these types of representatives work on a contingency basis, meaning they are only paid if you win, and fees are capped by federal law. Having representation can be especially helpful at the hearing stage.

Special Considerations for Older Adults

The SSA considers age as part of its disability evaluation. Applicants over 50, and especially those over 55, may have an easier time arguing that their disability and age limit their ability to retrain or adapt to new work. This makes appeals particularly important for older adults who may have been initially denied despite serious health conditions.

Don’t Give Up

Appealing an SSI or SSDI denial can be a long and frustrating process, but persistence matters. Many successful claims are approved only after one or more appeals. If your disability limits your ability to work and meet basic needs, it is often worth continuing the process. Understanding your rights, meeting deadlines, and gathering strong evidence can make all the difference.

To get started on your estate plan or elder law planning, contact the Laiderman Law Firm.