The Social Security Administration (SSA) denies many disability claims, even good claims that may ultimately win on appeal. This can be frustrating for people struggling with a serious illness or injury, especially when their claim is rejected without any clear explanation. However, there are many reasons why your claim could be denied, and we want to help you understand some of them so that you can avoid them or, if necessary, address the problem if your application is turned down.
Disapproved Due to Work Activity or Not Meeting Non-Medical Program Requirements
Social Security will disapprove your claim if you are performing “substantial” and “gainful” work activity when you apply. Any type of full time work will generally be disqualifying. In general, part-time work with lower earnings will not. The earnings amount that Social Security considers to be substantial and gainful is adjusted yearly. You can see the current amount here [https://www.ssa.gov/oact/cola/sga.html].
The Disability Insurance Benefit program has a non-medical requirement that you worked enough and recently enough in Social Security covered employment to be “insured” against disability. You have to be “insured” when you first became “disabled.”
The Supplemental Security Income (SSI) program has non-medical financial requirements. It is a program to help people with very limited income and resources. If your income or resources are too high, you don’t qualify for SSI benefits.
Incomplete or Untimely Documentation
In addition to the application itself, there are often several supporting documents required, such as recent wage and work information and reports of your functioning and activities. Social Security will sometimes schedule consultative examinations for you to attend (at their expense). Attending such examinations is part of making sure that Social Security has the documentation about your disability. If you don’t provide all the requested information or you fail to attend a consultative examination, your application will likely be denied. Pay attention to all mailings from Social Security, and make sure you understand when you need to take action.
You also must also submit requested documentation on time. Social Security will not wait indefinitely for the documentation they request. If you have difficulty providing documentation within the time requested, contact the adjudicator assigned to your case to explain the reasons you need more time and ask for the additional time. Reasonable requests are usually granted. If you send documentation in late, Social Security may have already made a decision denying your claim.
Also, be sure that you send the documentation to the right place, as requested. Pay attention to the instructions that come with any Social Security requests. It won’t help if you send the right document at the right time but it doesn’t get to the right place.
Insufficient Medical Proof
If you want to get the disability benefits that you deserve, it is your responsibility to provide proof of your disability. This means having records from medical providers that show evidence of your diagnoses, the severity of your symptoms, and the resulting work-related limitations. Your diagnoses must be made by “medically acceptable” sources, which include medical doctors (MD), doctors of osteopathy (DO), certified nurse practitioners (CNP), physician assistants (PA), podiatrists (DPM), and licensed vision and hearing specialists. It does not include chiropractors, acupuncturists, or alternative medicine practitioners.
While you can directly provide medical evidence to Social Security, you are not required to collect it yourself. Social Security is required by law at the initial determination stage to collect records from the medical providers that you tell them about.
Lack of Obvious Disability
Disability is defined as “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
The disabling nature of some conditions is more obvious that others. Some conditions are so clear just by diagnosis that Social Security has placed them on a list of “Compassionate Allowances” so that they quickly identify and approve claims with these severe conditions. These conditions include some types of cancers, brain disorders, and some rare childhood disorders. On the other hand, some conditions that result in fatigue or pain but don’t have clear objective medical findings and mental limitations are often not so clear. And there are a whole range of situations that fall somewhere between absolutely clear and very hard to prove due to the lack of objective medical findings.
If you believe that your condition(s) meet the definition of “disability,” you should provide clear statements about your symptoms and how your symptoms result in work-related limitations that prevent you being able to engage in “substantial gainful activity” (think full-time work) and sustain it over time.
If you cannot identify reasons that your condition(s) do not result in work-related limitations that prevent you being able to engage in “substantial gainful activity,” you may not have a condition that will permit Social Security to find you “disabled” under its standard.
Contact our law firm today if you need assistance with your Social Security Disability claim.
Contact our law firm today if you are applying for Social Security Disability and need help. We have a team of experienced social security disability attorneys who will fight for your rights and get you the benefits you deserve.
We are here to help you with your Social Security Disability claim. We will review your case and assist you in getting the benefits that you deserve.