5 Reasons That You Might Be Denied for Disability Benefits

Applying for disability benefits through the Social Security Administration (SSA) can be a long and sometimes frustrating process. When you’re already grappling with a disability, the last thing you want is a denial from the SSA that further complicates your life. This post outlines five reasons your application for disability benefits could be denied, whether you are applying for Social Security Disability or Supplemental Security Income benefits.

1. Incomplete Medical Documentation

The backbone of any disability claim is comprehensive and consistent medical documentation. The Social Security Administration will look for:

• Clinical records that describe your condition and how it affects you.
• Diagnostic tests confirming your diagnosis.
• Treatment plans and medications prescribed showing that you are trying to control your symptoms and that you have complied with treatment.
• Medical opinions from experts, doctors, physician assistants, and nurse practitioners explaining how your conditions interfere with functioning.

If your documentation is sparse, out of date, or contradictory, the chances of being denied are high.

Expert Tip

Always work with your healthcare providers to ensure that your records are thorough and up to date. Make sure you get a statement from your treating doctors explaining how your condition interferes with the functions required to perform full-time competitive work. Expert representation can be crucial to guide you through this aspect effectively.

2. Recent Employment in Conflict with Claim

For disability claims, the SSA will evaluate your work history and the nature of your job roles. It will also have access to your earnings record.  If you are engaged in “Substantial Gainful Activity” (SGA) under SSA’’s standards, after your disability onset date, your application for disability will be denied. The first question the Social Security decision-makers must answer before evaluating your claim is, “Is the person working?” If the answer is yes, your claim will be denied.  The evaluation of your claim will end if the answer to the work question is yes.

Expert Tip

Be cautious of part-time work or freelance engagements that could imply your ability to work, contradicting your claim. Consult an expert to understand the implications of even part-time work.

3. Lack of Cooperation During the Application Process

The SSA may request additional documents, clarification, or even a consultative examination by an SSA-approved physician. A failure to cooperate with these requests can lead to immediate denial. The system can be challenging at times.  It can be tough to get in contact with anyone at Social Security.  The hold times to get answers to simple questions can be ridiculously long.  Calls are often disconnected even after waiting on hold for a long time.  The paperwork can be overwhelming and confusing. People often grow frustrated by the process and stop responding to Social Security’s requests.  Failure to respond can result in denials that have nothing to do with your actual disability.

Expert Tip

Maintain open communication lines with the SSA and adhere strictly to any deadlines or requirements they have.  Working with experts who understand the forms and the procedures can make things easier.

4. Short-Term or Non-Severe Disability

Both SSDI and SSI aim to provide assistance for long-term, severe disabilities that have lasted or are expected to last at least 12 months or result in death. Conditions that are short-term or not severe do not qualify.

Expert Tip

Understand the SSA’s definitions of “severe” and “long-term” disabilities. If your condition is not likely to improve within 12 months, it is crucial that you get an expert opinion from your healthcare provider to that effect.  Sometimes,  the person reviewing your case does not understand the nature of your condition.  A narrative from your doctor explaining how your condition affects you and why they believe it will not likely improve can help get you over this hurdle.

5. Previous Denial Without New Evidence

If you’ve been denied benefits before and are reapplying without presenting new, substantial evidence or a change in circumstances, the likelihood of another denial is high.

Expert Tip

Always consult an expert when considering an appeal or reapplication. New evidence or legal arguments may significantly alter the SSA’s decision.

Bonus Tips

Financial Considerations (Specific to SSI)

For those applying for SSI, that program is means-tested. Failing to meet the financial eligibility criteria can lead to denial. Your income and assets must be below certain thresholds to qualify.

Work Credits (Specific to SSD)

In order to be eligible for SSD, you must have the “work credits” required for disability.  Work credits essentially serve as “tokens” that individuals earn through taxable work. For 2023, one work credit is earned for each $1,470 in earnings, and a maximum of four credits can be earned in any year.

How Many Credits Are Needed for SSD?

The number of credits required for SSDI eligibility depends on the age at which the individual becomes disabled. There is also a requirement that credits be earned within a particular time frame.  This can get a bit complicated.

Expert Tip

You can create an account on the Social Security website and see your earnings record.  Based on the earnings record, you can see if you have the credits necessary to be eligible for Social Security disability.  Sometimes, it can be hard to figure out if you have the needed credits, especially if you have had long gaps in your work history or you have already been out of work for a few years.  An expert can help you decipher your eligibility.  Feel free to call us for a free consultation.

Bonus Tip

Do not give up if you are denied at the initial or the reconsideration levels of the application process.  Consult an expert for a review of your case. Call us for a free consultation.  We take on new clients at all stages of the Social Security disability process.  We can help get your case back on track and present it, so you have the best chance of winning the benefits you deserve.

Takeaways

Being aware of these red flags can equip you with the tools you need to tackle potential issues that may arise during the application process. That said, each case is unique, and it’s advisable to consult an expert in Social Security disability to navigate the intricacies of the SSA system effectively.

• Do Not Give Up:  Sometimes, it seems the system is designed to encourage people to give up.  The long delays, the forms, and the difficulties communicating with real people at the Social Security Administration.  It no doubt encourages many people with valid claims to give up in frustration.  Don’t give up.  Call us for a free consultation.  We have helped people get the benefits they deserve at every stage of the process, and we take on new clients every day after their case has been denied.

• Representation Matters:  Every case is unique and presents its own challenges.  Some cases are tougher because of the nature of the person’s disability.  We know what specific medical evidence is needed to prove a case of disability and know the rules and regulations concerning complex conditions.  At Binder & Binder, we are experienced in handling the most complex cases, and we work to resolve them as early as we can for the client.  We review our clients’ cases multiple times before they are ever scheduled for a hearing and develop the medical evidence that we know the Social Security Administration, and if necessary, a Judge will need to see to make a favorable ruling. 

If you have a complex case or would like to schedule a free consultation to discuss your situation, please contact us.

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