Understanding The Reasons Why Your Social Security Disability Claim Was Denied

Social Security pays out benefits to people who are unable to work because they have a medical condition that’s expected to last one year or result in death, according to en.wikipedia.org. However, applying for benefits may not always guarantee an approval for benefits. It’s not unusual to talk to a few people who’ve applied and later realized that their social security disability claim was denied.

When making applications, most people only think about the reasons why they should be granted benefits. However, it may be useful to flip the coin and understand the reasons why you social security disability claim may be denied. In some cases, the reasons for denial may be beyond your control. In other instances, however, you may be able to avoid the common pitfalls that result in a denial.

Your Income Is Above the Limit

One of the main reasons why your Social Security Disability Insurance (SSDI) claim could be denied is that, when making your application, you were working above the “substantial gainful activity” (SGA) limit. That means that your earnings are more than enough to be considered disabled. The SGA limit is revised yearly, and you are not prohibited from working when making an application for and or collecting SSDI, but not over the limit. The limit shows your ability to work, therefore, only accounts for work income and excludes income from investments. There are special limits and rules for what counts as SGA for the self-employed and the blind.

Lack of Cooperation

To be granted disability, you need to release your medical records to the SSA, failure to which your claim is likely to be denied. According to www.ssa.gov, the SSA may require additional details about your impairments, either because you have no regular doctor or your medical records are incomplete. In such cases, the SSA will request that you be examined by an SSA doctor. Failure to attend an examination by an SSA doctor, referred to as a consultative examination (CE) or requesting that the SSA makes a determination based on the medical records already provided, may result in denied disability because of failure to attend a CE or inadequate medical information.

Your Disability Doesn’t Qualify for Benefits

en.wikipedia.org mentions that in order to qualify for SSDI benefits, the Social Security Administration (SSA), which is responsible for the processing of claims, must believe that your impairment is severe enough to last at least one year or result in death.

Many claims resulting from road accidents, which are based on bone fractures, are often denied because they are unlikely to cause disability for 12 months. The SSA evaluates each case on an individual basis. For instance, if you aren’t healed after six or more months due to severe bone fractures, the SSA may consider your impairment likely to last a year.

It’s also important to note that for you to qualify for SSDI, your medical condition must cause your severe limitations to be eligible for a claim. Denial may simply result from an applicant’s impairment not being severe enough.

Failure to Follow Prescribed Therapy

If you’re under treatment by a doctor, and fail to follow the prescribed therapy when you are able to do so, may result in a denial. However, the SSA recognizes certain legitimate reasons for failing to follow prescribed treatment.

Moreover, the SSA will deny your claim for failure to follow therapy only if the therapy not followed is expected to restore your ability to SGA. However, failing to follow therapy that is unlikely to result in your ability to work, if mentioned by your treating doctor to the SSA, does not constitute grounds for a denial.

The SSA Cannot Find You

The SSA and Disability Determination Service (DDS), which is responsible for determining your eligibility for benefits, must be able to communicate with you regarding your application. Your benefits may be denied if the agencies cannot reach you to communicate critical matters of schedule examinations. However, if you have named a representative or lawyer to handle your paperwork, getting in touch with the SSA may not be necessary, but be sure to stay contact with the attorney or representative. It’s important that the SSA knows how to contact you, especially if you move while your application is still being considered or processed. Claimants get denied every other day because the SSA is unable to reach them.

If you are unable to attend a scheduled CE because of location or time, contact your claim examiner for the DDS to arrange another CE at a place and time that’s convenient for you. Repeatedly failing to show up for a CE will most likely result in a denial of your claim.

Crime Conviction

The SSA explicitly sets out certain conditions related to incarceration or conviction that will prevent you from receiving SSDI benefits.

Drug or Alcohol Related Disability

The SSA denies benefits to anyone whose alcoholism or drug addiction contributes to his or her ability. A DDS medical consultant will consider whether or not, if you stopped using drugs or alcohol, the SSA would still find you disabled.

Fraud

Obtaining disability by dishonest means can lead to termination of benefits and prosecution for fraud by the SSA. Also, obtaining benefits through fraud on the part of an SSA employee will result in termination of your benefits.

Denial Notice

According to www.ssa.gov, a notice of denial from the SSA will contain the medical and nonmedical records considered, a brief history of your medical condition, the impairments considered and an explanation of the denial. Some denial notices will include a technical rationale that provides a detailed explanation of the medical issues that led to the denial decision.

Appeal

The fact that your social security disability claim was denied doesn’t not necessarily mean that you aren’t disabled. The moment your claim is denied means you can appeal, and the sooner you do so, gives you the best chance of winning your claim. According to www.ssa.gov, to appeal a denial, you’ll need to follow the instructions included in your notice of denial. There are four levels of getting your denial disability claim appealed through the SSA’s system.