Top 5 Reasons You May Be Denied Disability Benefits

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Top 5 Reasons You May Be Denied Disability Benefits

Social Security disability (SSDI) benefits denials fall into two broad categories: technical denials and medical denials. You may be surprised to learn that more claims are denied for technical reasons than medical ones. Some of those denial triggers are within your control, so it’s important to educate yourself before filing your claim. Understanding the reasons claims are commonly denied can help you increase your chances of approval–and, increase your chances of receiving disability benefits earlier in the process. 

Common Reasons for Technical Denial of Disability Benefits

Technical denials are typically based on issues like legal and financial eligibility. Here are some common reasons your claim may be denied for non-medical reasons: 

  1. Not enough work credits. Eligibility for Social Security disability benefits depends on having accrued enough work credits during your working life, and within a certain time period before you became disabled. This number is different depending on how old you are when you become disabled. 

You can’t go back and change the number of work credits you have after you become disabled. But, if you’re denied due to insufficient work credits, it’s important to look closely at your record and do your own math–or get help from an experienced Social Security disability advocate. The Social Security Administration (SSA) is aware that its records aren’t perfect, and provides a process for correcting work records

  1. Too much income. You can only collect SSDI benefits if the SSA determines that you’re unable to engage in “substantial gainful activity.” As of 2023, “substantial gainful activity” means earning $1,470 or more in a month. The cut-off is higher ($2,460/month) for applicants who are legally blind. 
  1. Not doing your part. Sometimes it can feel like the disability benefits application and appeals process is a series of complex hoops you have to jump through to get the benefits you earned through your years of work and payroll taxes. That’s frustrating, and can be especially difficult for people with certain types of disabilities. But, dropping the ball can mean a quick denial. To keep your claim moving forward, it’s essential that you respond to all requests for documentation in a timely manner, show up for any medical examinations, and otherwise provide everything SSA asks you for. 

If you’re having difficulty assembling that information or have run into roadblocks in communicating with the SSA, a Social Security disability advocate can help. 

The best next steps after a technical denial depend on your circumstances and the reason for the denial. For example, if you were denied due to not having enough work credits and your work record is accurate, you may not be eligible. But, it’s important to do your homework and get some advice before deciding to simply abandon your claim. If there are work credits missing from your record or the SSA has miscalculated or used the wrong date for when you became disabled, you may be eligible. 

Common Reasons for Medical Disability Benefits Denials

The SSA definition of disability is that you are: 

…unable to engage in any substantial gainful activity (SGA) because of a medically determinable physical or mental impairment(s) that is either:

  • Expected to result in death.
  • Has lasted or is expected to last for a continuous period of at least 12 months.

You may know that the SSA maintains a list of conditions that may qualify a person for disability benefits, broken out by category and with specific listed criteria. But, the assessment isn’t quite as simple as it may sound. 

First, even if you fall neatly into one of the listed categories and conditions, it’s up to you to provide sufficient medical documentation to support that. Second, not every disability falls neatly into one of those categories. Some people qualify for SSDI based on a combination of medical conditions. 

Some of the most common reasons for “medical denial” of disability benefits aren’t actually about whether or not you are medically disabled. For example: 

  1. Failure to provide adequate information. The SSDI process isn’t like workers’ compensation, where you go to an approved doctor for an examination and benefits are based on what they find. Social Security disability benefits are intended for long-term or terminal disabilities. In most cases, you’ll need a record of the symptoms and limitations you’ve experienced and how they are progressing. 

This can present a problem for applicants who rarely go to the doctor, or who don’t talk to their doctors about the limitations they’re facing. Whether you are considering applying for SSDI or have already been denied and want to appeal, it’s important to build a medical record. 

  1. Not following medical advice. People ignore medical advice for many reasons: they don’t believe the recommended treatment will help, it’s too expensive, or their conditions have already progressed to a point where pursuing treatment can be difficult. Some even miss out due to simple obstacles like lack of transportation. 

Unfortunately, this can be a dealbreaker. Imagine, for example, that you have serious back problems and have applied for disability benefits. Your doctor recommended physical therapy for your back, but you haven’t followed up because the facility is some distance away, you can no longer drive, and the cost after insurance will stretch your budget. 

Would you be able to work if you completed physical therapy? You may not think so. But, from the SSA’s perspective, this is missing information. Your disability benefits claim may be denied because they don’t know whether treatment would alleviate the disability and allow you to return to work. 

Because of the complexity of medical determinations and the amount of evidence required, many medical denials could have been avoided. And, those denials may be overcome on appeal. Often, the success or failure of an application or appeal depends not on your medical condition but on how thoroughly you have addressed key issues and the documentation you provide.

Whether you are preparing to file an initial SSDI claim or your claim has been denied, an experienced Social Security disability advocate can help you navigate the system to avoid unnecessary denials or delays. To learn more, contact us or call (800) 800-3332 right now.

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