Common Reasons Why Social Security Disability Claims are Denied

A Social Security Disability claims being denied is not a unique situation. Some are turned down for financial reasons. Others are denied because of the claimant’s health status.

In case you have applied and been refused social security disability (SSD) benefits, some are left to wonder why? While there are various reasons for the Social Security Administration (SSA) denying a claim, there are some common reasons this could have happened. Read below to learn about reasons your social security disability would be denied.

You Get Too Much Income

For SSDI, which is the benefit program for workers that have paid into the Social Security system over multiple years, one of the very basic reasons you might be refused benefits is that, when you apply, you are working above the limit where it is considered “substantial gainful activity” (SGA). This implies you get too much money to be considered disabled. You’re allowed to work a little amount when you’re applying for and collecting SSDI, but not over the SGA limit, which is $1,170 per month in 2017 (for nonblind individuals). The figure is adjusted annually. Income from investments doesn’t count toward the SGA-only work income counts, as it shows your capacity to work. For the details, including what counts as SGA for the self-employed.

As to SSI, which is the disability benefit for low-income folks, when you apply for SSI, you can’t be making over the substantial gainful activity level (although after approval you can make more cash than that). But there’s a limitation on all earned and unearned income for SSI, around $1,500 per month, that implements both when you are applying for benefits and when you’re collecting benefits. And anytime your income is over $740-$800, your SSI payment will likely be reduced, by a somewhat complicated formula. Would be reduced to zero; in payment in the event you make about $1,500 or more, your other words, you won’t qualify for SSI.

Failure to Comply with Consultative Exams

You might be requested to attend a special exam performed by a third-party medical pro. In case you neglect to show up for the examination, you’re guaranteed you’ll be denied.

Lack of Hard Medical Evidence

To be able to justify paying a Social Security Benefits to claim out, the SSA requires considerable medical documentation in order to demonstrate you have a medically legitimate reason to avoid working. Officials assess the available evidence to paint a picture of all of your medical circumstances, including records from all medical professionals who have been treating you when determining eligibility. You may be able to work with your doctors to present additional evidence that’ll validate your claim if you are initially refused because of lack of hard medical evidence.

You Do Not Cooperate With the SSA

When working up your Social Security disability claim the disability examiner for the SSA will wish to order medical records from your medical providers and the claimant needs to work by signing medical authorizations enabling the SSA to obtain your medical records that are applicable. Further, the SSA may schedule one or more Consultative Examinations (CE) with a doctor that the SSA pays for to get advice regarding your medical conditions and residual functional restrictions. Your claim might be denied due to inadequate medical documentation, in case you refuse to show up for scheduled CE’s or refuse to submit to a CE.

Short-Term Affliction

Social Security disability benefits are only granted to individuals whose disability or injury will prevent them from working for a significant period of time. Usually, your condition must be expected to continue for at least one year in order for you to qualify for benefits. If your condition probably will improve with last or treatment for significantly less than a year, your claim might be refused.

This concern is most important in claims based on acute injuries, like broken bones, rather than continual medical conditions or mental handicaps.

Make sure that your claim meets the minimum requirements discussed above to reduce the risk of a claim deniable, in the event that you are still preparing your Social Security disability claim.

You Fail to Follow Prescribed Therapy

In the event that you are being treated by a physician, but fail to follow the doctor’s prescribed therapy when you have the capacity to do this, you may be denied disability benefits. However, the SSA recognizes particular valid justifications for failing to follow the physician’s orders (which can be for taking medicine, going to treatment appointments, or undergoing surgery).

Okay, medical excuses. Failure to follow prescribed therapy could be excused for reasons beyond your control. Some examples follow.

  • You are in possession of a mental illness so intense that you cannot comply with prescribed treatment.
  • You own a fear of operation so intense that surgery would not be suitable. Your treating doctor must support the harshness of your fear to the DDS consulting physician.
  • You physically cannot follow prescribed therapy without support for example, because of paralysis of the arms or cataracts brought on by diabetes.

Okay, nonmedical reasons. It is possible that you can’t follow a prescribed treatment for a motive that really has nothing to do with your medical condition. Satisfactory nonmedical explanations for neglecting to follow prescribed therapy follow.

  • You don’t have the money to pay for treatment.
  • Your religious beliefs prohibit you from receiving medical treatment.
  • Your doctor prescribes treatment that another physician disagrees with. 

Moreover, for the SSA to deny your claim for failing to follow therapy, the treatment that you don’t follow must be one that is definitely anticipated to restore your ability to do substantial gainful activity. In case your treating doctor tells the SSA that the prescribed therapy isn’t likely to result in your capability to work, the SSA will not fault you if you do not follow such treatment.

Different Tips to Win Social Security Disability

A percentage of individuals experiencing significant medical and/or mental ailments may not ever win their Social Security disability or SSI benefits. Unfortunately, it isn’t enough to have a severe impairment to win disability benefits from the social security management. Both Social Security disability programs (SSD and SSI) have rules and regulations that govern both handicap and non-medical impairment requirements that must be satisfied to be able to win Social Security or Supplemental Security Income.

Claims for Social Security Disability Insurance – which pays out $143 billion annually to more than 11 million Americans unable to work due to a serious illness or impairment – have been ticking upward. The Social Security Administration received nearly 2.7 million applications for the software in 2013, up from 1.9 million a decade earlier, according to its most recent annual report.

The rate of applicants who are ultimately approved, however, has remained slim – averaging just 36 percent for claims filed from 2004 to 2013, as stated by the report. About a quarter are given benefits on their initial claim, while another 2 percent are approved on 11 percent and appeal at hearings.

Request Appeal on Time

After every conclusion, you have only 60 days to submit your appeal in writing. If you wait more than 60 days to request an appeal, your appeal will most likely be dismissed. At the first three degrees of appeal (reconsideration, ALJ hearing, and Appeals Council review), you must file your appeal by submitting special forms. You can find these forms on the SSA website or by stopping by your local Social Security office.

Write an Appeals Letter

The Social Security forms for appealing a decision give you just several lines to write your explanation on why you think the choice was incorrect, but you should feel free to write the phrase “see attached page” on the form and submit a letter along with the form that carefully outlines the problems you see with the judgement.

The denial letter you received from the SSA that denied your eligibility for benefits will include an “explanation of determination,” which is sometimes called the “disability determination justification.”

This explanation of decision will include issues such as what sources the SSA used to assess your claim, why the SSA denied your claim, what handicaps the SSA assessed, and a description of your medical condition. If anything is incorrect or missing in your explanation of conclusion, include this in your letter to the SSA. Also submit any statements, records, or other information that makes your claim stronger.

Start Right Away

Don’t wait until your financial resources become tight. Success in your claim is based only on your handicap, not on how much money you have in the bank. In the event you need to request a hearing or appeal an unfavorable decision from the Social Security Administration applications can take over a year to process, and up to two years. You don’t have to deplete all of your assets to be able for Social Security disability. It’s possible for you to receive benefits from multiple sources at precisely the same time without affecting your Social Security Disability claim.

Record all your disabling symptoms and afflictions

Every symptom, physical or mental, may be related to your claim. Many medical impairments result in psychological strain, and often there are powerful emotional and mental components to disabling illnesses. If you are undergoing any type of mental strain or pressure following your disability, or if you’ve been diagnosed with depression or anxiety, document your mental state in your handicap notebook/journal.

Contact an attorney to help you file your claim

Attorneys who represent you to the Social Security Administration and Veteran’s Administration ordinarily are paid in the event you win an attorney fee that’s a portion of your benefits. This means that it doesn’t cost you any cash up front to get help in filing and asserting your claim. An attorney can assist you through the entire claim process from filing to appeal. They are trained and practiced at arguing your case in front of an administrative decision maker or before a judge in the hearing, collecting medical records and evaluations from medical providers, and navigating the complicated forms that have to be filled out. Legal counsel can even help you file an appeal if your claim is refused provided that you file an appeal in time.

Continue medical treatment for your disabling medical difficulties

It’s important that you just continue to receive and document the clinical treatment that you are receiving, even if you lose your medical insurance. Oftentimes, you can obtain free medical services through your local free clinic or regional hospital clinic. Ensure your doctor writes down your symptoms and problems, and explain to him how these symptoms affect your work throughout the house, your interactions with your family, and how you get around. These written records are critical to the eventual success of your claim. Without written records explaining how your functioning affects, you are going to be at a disadvantage when trying to establish your disability.

What Veterans Should Know About Social Security

Americans who participate in military service can suffer from mental and physical side effects lasting a lifetime. These veterans who’ve become disabled may be entitled to receive disability benefits from the Social Security Administration. Veterans who are already receiving VA benefits can potentially be eligible for either Supplement Security Income (SSI) or Social Security Disability Insurance (SSDI). In order to qualify for SSDI, a veteran needs to fulfill the basic work history requirements and must have worked at least 5 out of the last 10 years. For SSI, a veteran must meet the income and asset limits established by the SSA.

Veterans who have a VA disability with the U.S. Department of Veteran can possibly qualify for additional disability benefits from social security. Sadly, if a veteran is receiving a pension from the VA and doesn’t fulfill the work history requirements, the veteran is not any longer eligible for SSDI benefits and merely qualifies for SSI. Remember it is great to bear in mind that SSI is an income-based program along with a veteran who has a pension may qualify for additional disability benefits through the Social Security Administration.

How Does Social Security Disability Work?

A person applies for disability benefits at a Social Security office or online, and receives an initial decision within three to four months. (Veterans with service-connected disabilities can have their cases expedited by asking Social Security to file a form called I-2-1%95-95. Display – Vital Request Evaluation Sheet.)

The claimant’s file is then assigned to a disability examiner, a specialist who will assemble the claimant’s medical records and, afterward, in consultation with a physician and/or a psychologist who is delegated to the examiner’s unit, make an approval decision or denial choice. Regrettably, the judgment that is made is often a refusal. If the claim is accepted, the claimant is considered 100% disabled and will be paid either SSDI benefits based on their past wages or SSI benefits based on the total amount of income they’ve (only those with low income and low assets qualify for SSI).

In case the claim is denied, the claimant gets a reconsideration review and may follow the disability appeal process. Then, after a very long wait, the claimant can get a hearing with an administrative law judge (ALJ). It can take an incredibly long time to truly have a hearing date set. Depending on which portion of the nation the claimant resides in, and backlogged the local hearing office is, it may take a year or longer to have a hearing date. Asking Social Security to expedite your case for a service-connected disability can help.

When Are Veterans Eligible for Social Security Disability?

You are only eligible for disability benefits from Social Security (called Social Security Disability Insurance, or SSDI) if you have worked full-time at least five of the last ten years. You may no longer be capable of receiving them, in the event, you wait too long after you stop working before you apply for Social Security benefits.

Often you can receive Social Security disability benefits in addition to any impairment compensation you are paid by the VA. On the other hand, in case you have a VA pension, Social Security payments may put you above the income limitations of the system and disqualify you for your pension.

Who Can Receive VA Benefits?

Generally, most VA benefits programs have two overarching requirements. Firstly, the applicant should have participated in active service. Secondly, if they aren’t any longer serving, they need to have been discharged under conditions other than “dishonorable.”

Active military service commonly applies to those serving full-time in the United States Army, Marine Corps, Air Force, Navy or Coast Guard, in Reserve branches or the Army National Guard and who have been activated for duty, or cadets and midshipmen enrolled at official U.S. Military, Air Force U.S. Naval or Coast Guard academies.

Moreover, in some scenarios, enrollment service in certain other designated national organizations or even having gone through armed forces training, at a military or Coast Guard academy prep school can qualify as active service for purposes of establishing VA benefits eligibility.

Honest discharges, most general discharges, and discharges under honorable conditions can suffice. Every VA program has particular conditions and exceptions, however. Moreover, the VA is frequently willing to appraise program eligibility on a case-by-case basis.

Concurrent Retirement And Disability Payments (CRDP)

Some individuals could be qualified to receive both a pension and disability payments at exactly the same time if they have both served more than 20 years of active service and incurred a service-connected disability of 50% or more.

Combat-Related Special Compensation (CRSP)

Particular military retirees might qualify for CRSP benefits should they’ve served at least 20 years or are on medical retirement, have a service-connected and battle-related impairment and have entire handicap rating that is higher or 10%.

VA Health Care And Nursing Home Care

Most veterans who meet the minimum general requirements can receive VA health care, even if they truly are being treated for a condition unrelated to service. The single constraint is that people who enlisted after September 7, 1980, or who entered active duty on October 16, 1981, must have performed two continuous years of service. That discharged non-dishonorably for a service-connected disability or hardship may also be eligible.

What You Should Know About Social Security Disability

Tens of millions of people rely on Social Security benefits, with all the vast majority of those payouts going to retirees and their families. But of the approximately 59 million Americans who’ll receive Social Security benefits in 2014, disabled workers, as well as their dependents, make up almost 11 million, along with the Social Security Administration pays out about $11 billion monthly to support them.

Disability benefits could be even more valuable than retirement benefits. You can plan for retirement (and you probably are planning for it) but you can’t forecast when an injury or illness might leave you unable to work, and sorely in need of financial support. Under, you’ll learn four of the most crucial facets of Social Security disability benefits so that in the event the time comes that you simply need them, you will know the fundamentals.

The monetary side effects of becoming disabled

As long as we’re on this cheerful issue, let’s review the means that a long-lasting condition or disability can clobber your financial well-being.

Those benefits can run out more quickly than you think while disability insurance through your work or purchased on your own may help keep your head above water. After that, the disabled regularly turn to the Social Security Administration for help by applying for benefits from the Social Security Administration disability insurance program (SSDI). It’s important to know your qualification and whether you qualify for these disability benefits based on impairment so you can understand the way to make an application for Social Security disability.

Work Credits

How many work credits you have to qualify for SSDI benefits depends on how old you were when you became disabled. For instance, if you are 50 years old when you become disabled, you need 28 work credits, or to have worked for seven years (and at least five of these years must have been within the last 10 years).

Medical Qualification

You also must have a medical condition that satisfies the SSA’s definition of incapacity. SSDI benefits are eligible only to those with a severe, long-term, total impairment.

Serious means that your condition must interfere with basic work-related actions.

Long-term means your illness has lasted is expected to last at least one year.

Total disability means that you aren’t capable of performing “substantial gainful activity” (SGA) for at least one year. In the event that you are now working and make over a particular amount ($1,170 per month in 2017 for handicapped applicants, $1,950 for blind applicants), the SSA will find that you’re performing SGA and that you’re not disabled enough to qualify for SSDI benefits.

Medical and Vocational Qualification

The claimant meets the test for either SSI or DIB, and once the fiscal conclusion is made, the claimant must then qualify medically and vocationally for a finding of impairment. In Social Security disability cases, the claimant should be determined to be totally disabled and unable to be gainfully employed. There’s no percentage finding, as in veterans service-connected compensation claims. Social Security is an all-or-nothing process. Advantages usually do not require a finding of permanent disability, nonetheless. Someone can receive benefits if he or even she is disabled for a minimum of 12 months.

These medical and vocational determinations are made in a succession of decisions referred to as the Five-Step Disability Determination Process. A claimant move on to the next phase must pass each stage in order, and finish out the process. In the event the claimant fails any period, the process stops and the claimant will undoubtedly be denied benefits. Each step is in the type of a question.

Bigger wages if ex has ‘departed’

And we have another dirty little secret for you. When you haven’t remarried, chances are your spouse is worth more to you dead than alive — especially if he or she was a high earner. Once an ex-spouse passes away, you’ll be treated just like a widow or widower. If you’re at least 60, you will have the ability to collect your late spouse’s benefit and permit your own benefit until you reach age 70, when you can switch if your own advantage is higher, to grow unclaimed.

Presuming your ex will dwell on Planet Earth to a ripe old age, the longer your ex-spouse delays asserting Social Security, the better it is for you. So, should you get a chance, encourage your ex-husband to work until age 70. Afterward, when it’s all over, you’ll get to claim half of her or his maximum Social Security.

More flexibility for widows and widowers

Social Security does a superb job of explaining widow and widower benefits, but it doesn’t clearly spell out a key difference between widow/widower benefits and spousal benefits. A widow/widower can begin benefits predicated on his or her own earnings record and later change to survivors benefits, or start with survivors benefits and after a switch to benefits based on her or his very own record even if the surviving partner is filing before full retirement age. You can not do that with spousal benefits.

When she is as young as 60, but only at a reduced rate, in other words, a widow can begin drawing on a survivor’s advantage on her late husband’s Social Security. Then she can elect to leave her own Social Security alone, allowing it to grow in value until her full retirement age — or even age 70. This works for widowers, too.