The absence of financial security is one of the worst aspects of disability. Although federal assistance is available, navigating the benefits application process can take time and effort. In actuality, the majority of applicants for benefits are initially turned down.
Multiple Social Security Disability Insurance (SSDI) denials may occur for several reasons, such as a lack of sufficient medical documentation to support the disability claim, an inability to meet the SSA’s requirements for eligibility, or incorrect and incomplete application submissions.
It can be helpful before starting the SSDI benefits process to be aware of the many reasons your request may be denied. This article will examine the top 11 reasons why SSDI applications are denied and how to avoid it.
Leading Causes Of SSDI Claims Denial
About 60 to 70 percent of the initial disability applications the Social Security Administration receives each year are denied. Applicants who are initially denied must go through the appeals process for disability benefits.
Unfortunately, it may take two years or longer to pursue such a denial. Therefore, it is crucial to understand why so many disability claims are initially rejected if you want to prevent the same outcome.
Avoid making one of the following errors to improve your chances of getting your initial benefits claim granted:
1. Absence of Adequate Medical Evidence
When a Special Security Disability (SSD) applicant prepares a claim for benefits, they frequently forget to provide enough objective medical documentation to support their impairment claim.
The Social Security Administration must reject the applicant’s disability application without this crucial information. Providing the Social Security Administration as much factual medical proof as possible is critical in order to improve your chances of disability claim approval.
There is no such thing as too much proof regarding a SSD benefits claim, so always be cautious. Review the Social Security Administration’s Blue Book with your doctor to ensure you have all the tests and paperwork listed for the problem you are experiencing.
Complex medical evidence is required by Disability Determination Services (DDS) to substantiate your claim. This includes test findings and records from your doctor that show the severity of your condition and the restrictions and limitations you experience due to the issues.
You should speak with your doctor if you need access to the records. Your doctor might need to request further medical tests or make more thorough notes.
Your claim will be more likely to be accepted if the supporting medical documentation is included. Detailed medical evidence of your disability is essential to having your claim accepted.
2. Your Income or Assets Exceed the Allowed Amount
You will encounter a lot of complicated information on income and asset thresholds when determining the eligible disability payments. The most obvious warning sign that a denied disability claim is exceeding the thresholds.
For instance, you must be unable to work or work insufficiently to be eligible for SSDI. While filing for and receiving SSDI, you can do a limited amount of work as long as you don’t exceed the Substantial Gainful Activity (SGA) threshold. In 2023, this amount is $1,470 monthly if you’re not blind and $2,460 if you are.
Supplemental Security Income (SSI), on the other hand, is intended to assist people who have been unemployed for at least a year and have little income and assets.
You can earn up to the SGA level at the time of your application for SSI. All earned and unearned income for SSI is capped at about $1,600 per month.
3. You Completed the Claim Forms Incorrectly
When filing a Social Security Disability benefits claim , there are numerous papers that must be completed, and these claim forms must be completed accurately if you want to be granted the requested payments.
Because the claims procedure is intricate, you must make sure to completely fill out all paperwork and provide all the supporting documentation to establish the impact your disability has on you. Never skip a question.
Ensure that you have provided accurate and thorough responses to all inquiries.
You must ensure that you react to requests for more information or proof quickly and effectively while adhering to deadlines. Your disability claim may suffer if you skip one question or don’t provide a thorough response to one.
It will help if you include supporting information with each response. For example, if you claim that you cannot stand for extended periods, you must explain how long you can stand and why this is the case. You will need to offer medical proof to back up this assertion.
4. You Don’t Respond To Messages
It might seem obvious, but making yourself accessible during the application process is essential. If the Social Security Administration and the DDS are unable to get in touch with you to schedule exams and talk about important issues, your claim might be denied
After you submit your application, they will typically seek follow-up papers, such as the “Work History Report” and the “Function Report,” which you must submit within 10 days of their request. Maintaining your contact information is essential because the SSDI and SSI application processes might take a while.
Keep in touch with your representative or attorney if they are handling your case, and let them know if any of your information has changed.
5. Not Following Through With a Consultative Exam
The Social Security Administration may occasionally ask a candidate to go to a consultation examination conducted by a private medical professional.
Your claim for SSDI payments is likely to be rejected if you fail to take this exam or do not attend your appointment. It is in your best interest to abide by the Social Security Administration’s request if they ask you to take a consultation exam.
The Social Security Administration may request a consultative exam to be carried out by a third-party medical expert that they employ if they feel that they need more information or if they have concerns about the data provided by your healthcare practitioner.
You must be sure you show up for this appointment.
The exam date, time, and place will be included in the communication they send you about the appointment. Make transportation plans in advance to go to the evaluation site if necessary.
Attend the exam, follow the doctor’s instructions, and answer questions honestly. Inform the medical professional of the intensity of your symptoms and how they prevent you from doing work-related activities and daily responsibilities. You must allow them to observe your overall state of health and how the severity of your medical issues affects you.
6. Your Illness Is Not Considered Severe Enough
It is important that your condition is severe enough to prevent you from working for you to be eligible for SSDI. The Social Security Administration maintains a comprehensive list of diseases that may qualify you for benefits, but depending on your situation, you will need to present an array of medical documentation.
This list is a terrific place to start to learn the fundamentals of what you must do to be eligible, but every person’s situation is unique. You might think about hiring a disability attorney to help you navigate the legal jargon and identify the supporting documentation you will need to submit.
7. A Case That Is Simply Insufficient
Even though your impairment precludes you from completing the work you have previously performed, the Social Security Administration may not decide that you cannot undertake any labor.
If the Social Security Administration finds that you can perform other forms of work, your application for Social Security disability payments will be rejected. This is why it’s crucial that your medical documentation and residual functional capacity forms specifically state how your handicap limits your ability to perform daily activities, not simply those necessary for your current or most recent work.
The severity of your condition may not always be adequately represented in your medical record, or the disability examiner may not understand all your limitations and restrictions due to your medical needs.
A residual functional capacity (RFC) form can be helpful when medical data are not sufficient to give the disability assessor a clear picture of your condition.
The RFC is a thorough paperwork that outlines your rights and obligations. It clearly illustrates how your medical issues impact your capacity to carry out daily tasks. The RFC will detail everything, including your walking distance, how much weight you can lift, whether you can reach or bend, how long you can stand, how frequently you need to change positions, and whether you can operate around specific materials like inhalants or dust.
If there are any occupations you can accomplish, the RFC should demonstrate that to the disability examiner when it is examined.
8. Your Disability Is Brought on by Long-Term Drug or Alcohol Abuse
In the disability community, substance use disorders (SUDs), often known as drug and alcohol addiction (DAA), are closely scrutinized. Even if they qualify as impairments under the Americans with Disabilities Act (ADA), there are complicated mechanisms in place that may impact your ability to get benefits.
A DDS medical consultant will focus on the question of determining whether you would still be considered disabled if you stopped using drugs or alcohol.
The Social Security Administration won’t provide disability payments based on drug addiction alone. If drugs or alcohol were not involved, your medical records would be used to evaluate if you would still be impaired.
9. Not Adhering To Your Treatment Plan
To be eligible for disability benefits, you must take part in the therapy your doctor has prescribed for you if you are receiving treatment for your disease. The Social Security Administration and DDS views disobeying your doctor’s orders as a major red flag.
There are some valid medical and non-medical reasons to be excused from things like taking medication, having surgery, or going to therapy appointments.
Medical justifications include uncontrollable factors like anxiety about surgery, a reaction to certain medications,a severe mental condition that compromises your judgment, or physical restrictions that prevent you from participating in therapy alone.
Non-ethical justifications can consider other considerations, such as the fact that you cannot afford the prescribed therapy or that your religion forbids you from receiving a particular treatment. These justifications have nothing to do with your impairment.
10. Being a Convicted Criminal
You may not be eligible for SSDI if you meet specific criminal conviction or incarceration requirements. Let’s dissect it.
Your chances of being granted SSDI will be significantly impacted by the length of your sentence and release. You won’t be accepted if incarcerated due to a felony conviction.
This is not applicable if you are enrolled in a rehabilitation program approved by the court that will likely lead to work after your release.
If you were hurt while incarcerated, you cannot utilize the disability to qualify for benefits. However, you might be eligible for benefits if your impairment persists after release.
Even though this information may sound discouraging, don’t let it discourage you from applying, even if you have a criminal record. The Social Security Administration will occasionally decide on a grace period of benefit-free disability rather than providing you with cash benefits.
Your earnings record is effectively frozen, protecting your future eligibility for disability benefits.
11. Not Seeking Legal Advice
If the applicant had contacted a reputable disability lawyer before submitting their SSD paperwork, there is a high chance that the submitted claims that were denied may have been accepted.
These experts may aid applicants in properly completing their papers and will help guarantee that the Social Security Administration received the medical documentation required to support the applicant’s claim for benefits.
Conclusion
Because disability benefits are so important for financial stability for those with disabilities and yet so elusive, understanding the reasons for multiple SSDI claim denials is essential. A thorough understanding of the hazards can significantly improve your chances of obtaining your desired support.
These pitfalls range from needing more acceptable medical evidence to income requirements and treatment compliance. By avoiding these typical mistakes, you can confidently navigate the challenging application procedure and increase your chances of a successful claim.
