Social Security disability (SSDI and SSI) helps disabled workers and their families in many ways. For example, you can use SSDI benefits for housing, food, transportation, and other necessities – keeping your family out of poverty.
Unfortunately, the disability application process is confusing, causing many worthy claimants to give up.
And the Social Security Administration (SSA) denies many disability claims. Statistics show the SSA approves only 26 percent to 37 percent of initial applications in any given year. So, though you probably have many reasons why you should receive disability benefits, the SSA will likely deny you, at least at first.
Understanding the reasons for your SSDI denial is necessary to decide the next step. Sometimes the best decision is to appeal the denial (requesting reconsideration or a hearing before an administrative law judge). However, in other cases, submitting a new application (reapplying) after getting medical treatment or stopping work is the right move.
This article explains the reasons why you may receive a disability denial. And how to determine if one or more of these reasons applies to your Social Security claim. You increase the chance of getting approved for disability if you avoid these mistakes or address weaknesses in your case.
If you have questions about your situation after reading this article and want to talk with one of the best disability lawyers in Virginia, contact us today by calling (804) 251-1620 or completing this form. We have helped thousands of disabled workers nationwide and want to help you.
Each claim for SSDI or SSI benefits is unique. However, the reasons for a disability denial usually fall into one of these categories.
Social Security disability is a safety net for people who cannot work or earn more than the substantial gainful activity amount (SGA) because of their medical impairments.
If you apply for disability while working and you earn too much, the SSA may deny your claim without reviewing your medical documents. Social Security considers your ability to work and earn money as proof that you are not disabled, even if multiple doctors state you have limitations that seem to preclude competitive employment.
Oral and written testimony from you and your friends, family members, former employers, and clergy can help you get approved for disability. But written and oral testimony is rarely enough. You also need medical records and reports.
Social Security denies many SSDI claims due to insufficient medical evidence. Therefore, you will likely receive a denial letter without consistent medical care or a doctor’s disability letter explaining your diagnosis and specific work restrictions.
We understand that it can be challenging to find healthcare providers when you are out of work with no income. And some mental health providers (psychiatrists, psychologists, licensed clinical social workers) hesitate to produce reports. But we can point you toward helpful community resources that can get you under care. Or we can request that Social Security send you for a consultative examination (CE) to build evidence for your case.
There is no limit on how many times you can apply for disability benefits. I have won SSDI cases for disabled workers who had received three or more past denials after hearings before administrative law judges (ALJs).
But a past denial often makes it more challenging to get approved. The people reviewing your new claim at the initial and reconsideration levels (disability examiners with Disability Determination Services) usually defer to past findings on residual functional capacity (RFC). And if an examiner uses the same RFC the judge used to deny the past claim, you will likely receive another denial.
However, there are exceptions.
For example, if you changed age categories, you might be found disabled based on the past RFC because the Social Security regulations make it easier to get approved when you turn 50 (then 55, 60, etc.).
Federal regulations prevent Social Security from finding you disabled if you do not follow prescribed treatment.
For example, suppose the SSA finds you disabled from osteoarthritis. But the medical records state you refuse to take prescribed medication or undergo surgery likely to succeed. Naturally, then, Social Security may deny your claim.
However, there is an exception to the rule. If you have a good reason for failing to comply with treatment, Social Security cannot hold it against you.
Common reasons considered good cause for failing to follow prescribed treatment include:
Disability claims often involve lots of paperwork:
A failure to cooperate with these requests for information will likely result in a denied disability claim.
In addition to requests for documents and information, the SSA may ask you to attend a consultative examination (CE) or several, depending on your medical impairments. Usually, this means Social Security needs more information before allowing or denying your case.
A CE is a one-time medical appointment with a physician hired by the SSA. This doctor will interview you and may conduct a limited physical examination. It is similar to an Independent Medical Examination (IME) in workers comp and auto accident claims but more neutral.
You should attend all CEs requested. If you do not, Social Security will likely deny your claim, forcing you to appeal to the next level.
Unlike workers’ compensation laws, the Social Security Act does not permit benefits for temporary total disability or permanent partial disability. Instead, you must prove that you have a medical impairment that has lasted at least 12 months (or that doctors expect to last that long) and that prevents you from doing your past work or other work in the national economy, given your age, education, and job experience.
Therefore, you do not automatically qualify for Social Security disability after a motor vehicle crash or a construction accident resulting in missed time and lost wages. For example, a letter from an orthopedic surgeon or neurologist stating you cannot work for several months after a rotator cuff injury, torn meniscus, or head injury is rarely enough to get approved at the initial levels. Instead, Social Security will likely deny your claim because you have not met the disability duration requirement.
The SSDI program works like other types of insurance – you must pay premiums to have coverage.
But instead of paying premiums directly, you qualify for SSDI with enough work credits.
You earn work credits by earning wages and paying FICA taxes into the Social Security system. You can earn up to four credits per year.
Generally, you must have at least 40 work credits, with 20 coming in the last ten years. However, there are exceptions.
Social Security will deny a claim for SSDI benefits if you do not have enough work credits or allege you became disabled after the last insured (DLI) based on work credits.
You may qualify for Supplemental Security Income (SSI) benefits if you are medically disabled but do not have enough work credits for SSDI.
However, the SSI program is means-tested. Therefore, the SSA will deny your claim if household income or assets exceed the resource limits – no matter how disabled you are.
If Social Security finds you disabled, it may still deny your claim if it considers drug addiction or alcoholism as a material contributing factor. This denial reason is more common in disability claims based on mental health than those alleging orthopedic injuries.
A substance use problem is not material if the SSA determines you would still be unable to work despite quitting alcohol or other drugs.
Typically, you can overcome a materiality decision by presenting credible evidence that you use these substances to self-treat.
Social Security will deny your disability claim if you are imprisoned after a felony conviction unless your release will happen soon.
Further, you cannot receive disability for injuries that occurred while committing a felony or if you were hurt while in prison.
However, you should apply for disability if you believe you meet the medical requirements and the above situations do not apply. Social Security will grant a period of disability, even if you cannot receive the benefits. This helps because it freezes your earnings, allowing you to seek cash payments when released.
Your medical impairments must prevent you from doing past work or other work (based on age, transferable skills, and education) to get disability. It is not enough to have an injury or mental health condition that lessens your ability but still allows you to work.
For example, suppose you are a truck driver, warehouse associate for Amazon, or nurse who must lift 100 pounds or more at work (furniture, patients, etc.).
You suffer a cervical sprain (neck injury) that impacts your ability to lift and carry. Before the injury, you could lift 200 pounds with no problem. But now, you are limited to lifting 125 pounds.
Under Social Security, your disability is not severe enough to qualify for SSDI or SSI benefits. Though the neck injury has lessened your work capacity, you can still perform your pre-injury employment.
Social Security denies many legitimate SSDI and SSI claims. So do not give up if you receive a denial letter. Instead, contact an experienced disability attorney to determine the reason for the denial and what to do next.
We will help you avoid and correct mistakes and weaknesses to turn that disability denial into an award of cash payments and medical care