Navigating the Social Security Disability Insurance (SSDI) application process can be overwhelming, especially when the outcome is a denial. For many, understanding why claims are denied is the first step in securing the benefits they need. Here, we’ll explore common reasons why SSDI claims get denied and how you can improve your chances of approval.
Insufficient Medical Evidence
A key factor in any SSDI claim is proving that a disability limits your ability to work. Claims are often denied because of insufficient medical documentation to support this claim.
The Social Security Administration (SSA) requires extensive evidence, including medical records, test results, and physician statements that show the disability’s impact on your daily life and work abilities. Without this evidence, claims are often swiftly denied.
Tip: Keep a detailed medical history and submit updated records regularly. Ask your doctor to provide documentation that details not just your diagnosis, but also specific work-related limitations.
Earnings Are Too High
SSDI benefits are intended for those who cannot engage in substantial gainful activity (SGA) due to their disability. If your monthly earnings exceed the SGA threshold, the SSA may determine that you’re able to work at a substantial level, disqualifying you from benefits.
Tip: Be mindful of income limits and keep track of all of your income sources. If you are earning a small income, make sure it’s below the SGA threshold to avoid denial based on earnings.
Non-Compliance with Treatment
If the SSA finds that you have refused or stopped treatment, it may deny your claim on the grounds that your condition could improve with proper care. However, there are exceptions, such as cases where the treatment may exacerbate your condition or cause severe side effects.
Tip: Keep records of all treatments attempted and reasons for any adjustments or refusals. This documentation can serve as evidence if you cannot pursue certain treatments due to adverse effects or financial constraints.
Failure to Follow Up on SSA Requests
Throughout the application process, the SSA may request additional information, forms, or evaluations. Missing deadlines or failing to provide the requested documentation can result in a claim denial.
Tip: Respond promptly to any SSA communications and consider setting reminders for due dates. Staying organized is essential. Please keep copies of everything you submit and maintain contact information for SSA representatives who can answer questions about your case.
Lack of Recent Work History
SSDI benefits are based on work credits, and eligibility requires sufficient recent work history. If you don’t meet the work credit requirement, which varies based on your age and work history, you may be denied benefits.
Tip: Review your work history through the SSA website or speak with a representative to ensure you meet the work credit requirements before applying. In some cases, additional documentation can help clarify any gaps in employment.
Disability Not Expected to Last 12 Months
SSDI benefits are typically granted for conditions that are expected to last at least one year or result in death. Temporary conditions or those expected to improve within 12 months generally do not qualify for SSDI benefits.
Tip: Include documentation that confirms the long-term nature of your condition. If your doctor’s notes or records don’t reflect the duration of your impairment, consider requesting a more detailed statement.
Alcohol or Substance Use Impacting Disability
If the SSA determines that alcohol or drug use is a contributing factor to your disability, it may deny your claim. This rule applies when the condition would likely improve if the applicant stopped using these substances.
Tip: If you’re in recovery, provide documentation showing a commitment to sobriety and highlight how your disability affects your ability to work independently of any substance issues.
In the End…
While SSDI claim denials can be disheartening, understanding common reasons for denial can help applicants address potential issues from the outset.
For those who have received a denial, appealing the decision is always an option.
Remember, preparation, thorough documentation, and professional guidance can make a significant difference. Seeking the advice of a disability attorney can also help clarify the process and improve your chances of a successful claim.
Empowered Disability is Here to Help!
At Empowered Disability, our social security disability attorneys believe that our clients in the Pacific Northwest and across the nation deserve a compassionate legal advocate who will do everything possible to get their claims approved, whether on initial application or through the appeals process.
SSDI is all that our firm handles, and we devote 100 percent of our energy to every single case we accept. We offer free consultations, and you pay no fees unless we secure your disability benefits. Contact us now!
* Main image at top by freepik