Whether to Appeal Your Social Security Disability Claim or Refile in Massachusetts

Many individuals applying for Social Security disability benefits in Massachusetts are denied on their initial application.  What is not commonly understood, however, is that it may not always be in your best interest to appeal your denial: whether you are denied on your initial claim or denied on reconsideration.  We’ll attempt to provide some guidance in this article as to some of the considerations you should have when deciding whether to appeal. 

Upon being denied on one’s initial application, it is important to understand that in the State of Massachusetts a request for reconsideration must be filed within 60 days of receiving the denial,  with an additional 5 days being provided  for mailing.  The reconsideration process carries with it a very high denial rate, in the 75-80% range, and the process can take an additional 3-6 months depending on how long it takes for Disability Determination Services (DDS) to receive the updated treatment records, updated reports from the claimant and the assessments from the doctors they request review the claimants’ file.  Likewise, the amount of time it takes can be affected even more should the Quality Review Branch in Boston pick up the case to determine if the recommended decision is correct.   While DDS is tasked with undertaking a new determination, with a new decision maker, the reality is that the process is many times a rubber stamp denial of the initial determination.   While New Hampshire, as part of a longstanding pilot project, has no reconsideration process and one proceeds directly to hearing, in Massachusetts, assuming you need to go to hearing, one can be looking at a year and a half wait to appear before an Administrative Law Judge.

There can be a number of reasons for an initial denial, and some of these reasons may relate to the fact that there was little helpful advice from a legal professional when initiating the claim.  First of all, if one initially filed shortly after going out of work, this can result in an initial denial that can easily be the reason for yet another denial on reconsideration and ultimately a year and a half wait to get to hearing.  One may have applied initially without the benefit of a lawyer, who could have obtained helpful documentation from the treating specialist that may have supported a favorable decision. Another reason for a denial could be a lack of sufficient treatment that appropriate documents the nature and severity of one’s illness.  It is important to consider the fact that ultimately an Administrative Law Judge will look at one’s timeline in applying for benefits and may consider it rash to file a claim just a few months after going out of work.  Rather than appealing the decision, sometimes one can benefit greatly by starting a new application down the road.  Sometimes, the passage of time alone can help show on a new application that treatment has been continued and that the individual is now 10-12 months out of work versus simply a few months out of work.  Likewise, having an attorney who can help steer you to the right kind of specialists for your conditions can help either 1)  improve your condition to the point where you are no longer disabled or 2) help establish through a specialist how severe your condition truly remains.

It is important to understand that Social Security’s reopening rules are quite helpful in allowing lawyers to reopen past applications so that you one would not lose benefits by refiling versus appealing the claim.  Consider the fact that a claim for Social Security disability insurance benefits has a 5 full month waiting period and does allow one to go back as far as 1 year prior to their filing date in terms of obtaining retroactive benefits.  Thus, waiting a few months would in no way risk the loss of past due benefits in many instances.  Moreover, Social Security’s rules allow one to reopen a past application for “any reason” simply by refiling what would be a new application within 1 year of the initial denial.  Even if beyond a year, Social Security rules allow for an old Social Security disability insurance application to be reopened within 4 years for, among other reasons,  new and material evidence.

Before considering an appeal of your recent denial, consider discussing with an experienced Social Security lawyer how you might obtain quicker relief from a new filing than from an appeal of what might have been an ill-timed or improperly supported claim.  You might find yourself pleasantly surprised in a matter of months versus going through what could be an extensive 2 year appeals process.