The Social Security Administration (SSA) administers two Social Security disability programs. Each program is designed to provide disability benefits for individuals with a disabling condition. Many applicants are denied Social Security disability for a variety of reasons, even though they may be entitled to Social Security disability benefits.
Top 8 Reasons You May Have Been Denied Social Security Disability
- Lack of Medical Records or Evidence
- Errors and Omissions on Social Security Disability Paperwork
- Impairment Does Not Meet Definition of Disability
- Insufficient Work Credits for SSDI Application
- Failure to Follow Treatment Plan
- Failing to Cooperate or Communicate with the SSA during the Application Process
- Income or Resources Exceed Maximum Limits for SSI Application
- Disability is Primarily Caused by Drug or Alcohol Abuse
SSI or Supplemental Security Income is designed for low-income individuals who are unable to earn a minimum income because of a disability. SSDI (Social Security Disability Insurance), on the other hand, is a program that provides disability benefits for workers who cannot work any longer because of a disabling condition. Common mistakes when applying for these programs can lead to a claim denial, even though you may be eligible to receive disability benefits.
“I was denied Social Security disability,” is a phrase heard all too often. Whether you’re applying for SSI or SSDI, here are the most common reasons why you may receive a denial of Social Security disability benefits.
1. Lack of Medical Records or Evidence
To qualify for Social Security disability, you must provide medical evidence that proves you have a severe impairment. If you apply for disability without sufficient “objective medical evidence” from an “acceptable medical source” that proves you have a medically determinable impairment, the result will likely be a denied Social Security disability application.
Likewise, you may be denied for Social Security disability if you cannot provide sufficient medical evidence and other evidence that clearly demonstrates the severity of your impairment. The severity of your impairment must negatively impact your ability to function in a work environment. In addition to the required medical evidence, the SSA also considers nonmedical evidence when evaluating the severity of an impairment. Nonmedical evidence may include statements from caregivers, reports from social welfare programs, and statements from educational providers, neighbors, friends, family members, clergy, and employers.
The SSA may require an SSDI or SSI applicant to attend a consultative examination (CE). A consultative examination may be used when the SSA wants to confirm the information in the applicant’s medical records, or the applicant’s medical records are insufficient. The CE is conducted by an independent medical expert provided (and paid for) by the SSA. Failure to attend the CE and cooperate with the CE physician can result in a denied Social Security disability application.
2. Errors and Omissions on Social Security Disability Paperwork
One of the most common reasons why an SSDI application or SSI application is denied benefits is because the application contains errors or omissions. When you apply for disability through the SSA, you are required to submit detailed information.
You must first file an SSDI application. If you did not earn enough work credits, you then file an SSI application. Each application must be completed in full. The information contained in the disability application must be accurate. You must also attach all required documents to the application. While a single error may not result in an immediate denial, it can result in costly and lengthy delays.
If your Social Security benefits are denied because of mistakes or omissions on the application, you have the right to file an appeal for denied Social Security disability benefits. Some individuals file multiple appeals because their Social Security disability was denied three or more times.
How can I avoid a denial of my social security disability claim?
If you have questions about completing the forms or filing a Social Security appeal, you can contact the SSA for assistance. You may also want to consult with a Social Security disability attorney. A Social Security disability lawyer can help you avoid mistakes and help you file an appeal to get the SSI or SSDI benefits you are entitled to receive.
3. Impairment Does Not Meet Definition of Disability
According to the SSA, you may be disabled if you meet the following requirements:
- You are unable to work (engage in a substantial gainful activity or SGA) because of a physical or mental impairment or a combination of impairments.
- Your condition is a “medically determinable impairment,” which means that your condition or conditions can be verified through medically acceptable tests and procedures.
- Your condition or impairment has lasted at least one year, will last at least one year, or is expected to result in your death.
My doctor says I am disabled, so why was I denied social security disability benefits?
Your doctor may not have provided sufficient medical evidence to meet the complete definition of a disabling condition as set by the SSA. The SSA has a very specific definition of what it means to be disabled. If your impairment does not meet the definition of disability, your disability application will likely be denied. You can appeal the decision by providing additional information to prove your condition meets or exceeds the requirements for a disabling condition. Medical and nonmedical evidence are crucial for proving your condition meets or exceeds the definition of disabled to avoid a denied Social Security disability application.
4. Insufficient Work Credits for SSDI Application
If you are filing an SSDI application, you must provide evidence that you meet or exceed the requirement for work credits to be eligible for disability benefits. Workers earn a certain number of work credits each year they are employed and pay into the Social Security System. A work credit is earned each quarter if the employee earns above the minimum income set for that quarter.
When a person applies for SSDI or SSI, the SSA will first determine if the individual has sufficient work credits to qualify for SSDI (this is why you begin with an SSDI application). Typically, a person needs 40 work credits to obtain SSDI benefits. Twenty of those credits must have been earned in the past 10 years. However, the number of work credits required for SSDI benefits may be modified for younger workers and workers born during a certain year. If you have questions about SSA work credits, you can contact a Social Security office or consult a Social Security disability attorney for additional information.
If the applicant is denied Social Security benefits for lack of work hours, the person then may file for benefits under SSI.
5. Failure to Follow Treatment Plan
Some Social Security applications are denied because individuals failed to follow the treatment plan prescribed by their physician. While everyone has the right to make decisions about their health care, when a person does not follow a treatment plan, it can be very difficult for the SSA examiner to determine if your disability or impairment is severe enough to prevent you from working. In other words, if you followed your treatment plan, the treatment may improve your condition and allow you to return to work.
Should I appeal if my Social Security claim has been denied?
If you have a valid reason for not following a treatment plan, you may want to file an appeal of the denied Social Security disability application. SSDI and SSI denials have been overturned by a judge when a good cause for non-treatment is presented. Acceptable reasons for not following a treatment plan may include:
- The severity of your mental illness makes it impossible or highly unlikely that you can comply with prescribed therapy.
- You physically cannot comply with a treatment plan without assistance, and you do not have that assistance.
- Your treating physician determines that your fear of the treatment is so severe that the treatment would be inappropriate in your situation.
- You cannot complete the treatment because you do not have the money to pay for the treatment.
- Your religious beliefs prohibit treatment.
- Your doctors disagree about whether you should have the treatment.
6. Failing to Cooperate or Communicate with the SSA during the Application Process
When filing for disability, you are expected to cooperate and communicate with the SSA during the application process. If the SSA examiner cannot get in touch with you, you do not respond to correspondence, you fail to appear for a consultative examination, or you do not provide the requested information and documentation, your disability application may be denied.
If you are unable to comply or cooperate for a specific reason, you should talk to your SSA examiner. For example, if you cannot find a ride to the CE or your appointment at the SSA, the case examiner may be able to reschedule the appointment or give you information about programs that may assist you with transportation. You may also want to consult a Social Security disability lawyer who can process much of the information and paperwork for you so that you do not need to worry about some of these requirements.
7. Income or Resources Exceed Maximum Limits for Social Security Disability Application
For both SSDI and SSI applications, you must meet certain income limits to be eligible for disability benefits. You will be denied Social Security disability if your income exceeds the maximum income allowable for Substantial Gainful Activity (SGA) for that year. The current SGA for non-blind workers in 2019 is $1,220 per month. For blind workers, the SGA in 2019 is $2,040 per month. SGA applies to SSI non-blind individuals, but gainful activity requirements do not apply to SSI blind individuals. You may be able to earn a small amount while applying for and receiving SSDI benefits, but you must be very careful not to exceed the limits, or you will be denied for Social Security disability benefits.
SSI is intended for low-income individuals, and SSI benefits are treated differently than SSDI benefits. While individuals filing SSI applications cannot exceed the SGA, they also have other income and asset requirements they must meet. Anyone exceeding the maximum income and resources guidelines will not be considered low-income and, therefore, will not be eligible for low-income Social Security disability benefits.
However, the SSA encourages applicants to return to work whenever possible. An SSI applicant may receive benefits and work. If the amount of income exceeds a certain amount, the person’s SSI benefits may be reduced according to the income the person is receiving each month.
Income, resources, assets, and returning to work are extremely complicated issues that applicants must deal with when applying for disability benefits. A Social Security disability attorney can be of great assistance to ensure the information is provided correctly, reducing the risk of a denied Social Security disability application.
8. Disability is Primarily Caused by Drug or Alcohol Abuse
Social Security disability benefits may cover some conditions related to drug or alcohol abuse. However, the SSA typically denies an SSDI claim or SSI application when a person’s alcoholism or drug addiction was the primary cause of the person’s impairment or disability.
You may be able to avoid a denied Social Security disability application if you can prove that your condition would have developed despite your drug or alcohol addiction. You might also avoid a denied application if you can prove your condition would continue and meet the definition of disability if you stopped using alcohol or drugs.
What Should I Do If My Social Security Disability Application is Denied?
If you received notification that your application for SSDI or SSI benefits was denied, you can appeal the denial. The SSA has four levels of Social Security appeals for disability benefits. Receiving a denial of disability benefits is not a final decision, and you can begin the appeals process. You must act quickly, though; there are short-term deadlines for filing Social Security appeals and very strict requirements for filing disability appeals.
Social Security disability appeals can be complicated, especially when your case reaches the appeal levels handled by the administrative law judge, the Appeals Council, and the Federal Court Review. A Social Security disability attorney can provide legal advice and guidance during your hearing, and help you obtain the disability benefits you deserve.
The Social Security disability lawyers of Acadia Law Group can help you with your Social Security disability application. Our law firm can also help you file an appeal if you have been denied benefits. Contact our office online or by calling 1-800-653-4600 for your free consultation.