When applying for Social Security disability benefits it is important to think about the possible reasons your case may be denied. Most people are shocked when they receive a denial letter. You have worked hard all your life and have paid into the system, so why was your case denied? Here are the most common reasons the Social Security Administration (SSA) may deny your claim for benefits:
#1. You have too much income
To qualify for Social Security disability insurance (SSDI) the first hurdle you must overcome is the income requirement. A person who is earning more than a certain monthly amount is ordinarily considered to be engaging in substantial gainful activity (SGA), so if you are earning more than that substantial gainful activity, then you will not be eligible for the program. This monthly amount increases based on the national average wage index. For 2014, the SGA amount is $1,070. So if you are earning more than $1,070 per month you will generally not be eligible for SSDI.
#2. Your disability is not expected to last 12 months
To qualify for SSDI, you must meet the durational requirements. You must have a disability that is expected to be severe enough to last 12 months or result in death. For example, if you have a workplace injury that prevents you from working for 6 months but then you are able to return to work on the 7th month you will not be deemed to meet the durational requirement for the program.
#3. You lack medical treatment
In order to qualify for disability benefits, you must have a disability that falls under the official definition developed by the SSA. Medical records are the main piece of evidence used to prove this. If you lack medical treatment records because you have not gone to the doctor for your condition then you will most likely be denied. SSA follows a general belief that if you are not seeking medical attention, then your condition is not severe enough to be disabling. If you do not have medical insurance you can seek treatment through a free clinic, such as Medicaid or your state’s social services. SSA likes to see, at the very least, that you have made attempts to obtain treatment.
#4. Social Security Administration cannot contact you
When you apply for disability benefits, SSA will contact you to discuss your application. They will send you several forms concerning your condition and your work history. SSA may also want to schedule a consultative examination or speak with you directly about your treating providers. If SSA cannot reach you they will most likely deny your claim. If you move or change your phone number during the application process, be sure to let your representative or someone at SSA know about the change.
#5. Refusal to cooperate with SSA
For SSA to make a determination about your disability claim they need to contact your medical providers and review your medical records. If you refuse to give SSA access to your records they will ultimately be forced to deny your case. I recently had a client who told me they were seeing a certain doctor, but when SSA tried to obtain the records from that doctor they were told the client had never been treated there. Someone at SSA called my client to ask about the doctor; the client then yelled at the SSA employee and refused to give the correct medical information. Unfortunately, being rude or refusing to help SSA obtain the necessary information for your case will result in a denial. Keep in mind that it is you who asked SSA to consider your claim for disability. They are not required to approve the case, so it is in your best interest to be polite and cooperative with anyone who may contact you from the office.
#6. Failure to follow advice from your treating physician
If you are being treated by a doctor and decide not to follow their recommendations, you can be denied benefits. For SSA to deny your claim for failing to follow your doctor’s recommendations, the recommendation must clearly be expected to restore you to a condition that will allow you to perform substantial gainful work activity. Although it may not seem fair, your refusal to follow your doctor’s recommendations could be viewed as you not wanting to make efforts to better your health, and it could be held against you. But if you are unable to follow the medical recommendation due to financial constraints, SSA can make some exceptions. Some other reasons include religious beliefs, psychiatric impairment that prevents you from comprehending, or you have an intense fear of surgery. The best practice is to trust your doctor and to follow their medical recommendations.
#7. You commit fraud
If you have committed fraud in order to obtain disability benefits, SSA will terminate your benefits immediately. You will also be required to pay back the amount you fraudulently obtained. In light of the recent fraud cases, it is best to be forthcoming and honest with the Social Security Administration. It would be best not to defraud the government.
#8. You are under the age of 50
Unfortunately, if you are under the age of 50 your claim is more likely to be denied than someone who is 50+. The general attitude is that if you are 49 or younger you should be capable of doing your past work or being retrained to do some other type of work. Without severe medical records and treatment, your case will likely be denied. This is not to say that you will not be approved later on in the process. Don’t give up! Call an attorney and have them discuss the strength of your case with you.
When applying for disability benefits, the best course of action is to contact an attorney to help with your claim and to make sure you comply with SSA’s requirements. This way you may have a better chance of being approved for benefits.
Image courtesy of freedigitalphotos.net by Stuart Miles
Elizabeth Gormley, Esq. is LaBovick Law Group's lead Social Security disability and Veterans Affairs attorney. Ms. Gormley is well-versed in SSD law and reviewing medical records. She is a VA accredited attorney.