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The application process for Social Security disability benefits is similar across the country. Social Security disability claims are initially processed by local Social Security Administration (SSA) offices and state agencies that may be called Disability Determination Services. There are three stages when denial of a Social Security Disability claim can be made:
When applications for disabilities are denied at the initial stage, an appeal can be made within 60 days. If you decide to appeal your initial disability claim, the claim enters the reconsideration stage. If it is denied at this point, you can request a hearing before an ALJ. Because the hearing before an ALJ is your last and best chance to obtain disability benefits, you want to be well-prepared for the hearing.
A competent Social Security disability lawyer can review your application to identify the reasons you were denied disability benefits and craft a response that specifically addresses the issues identified that resulted in the previous claim denials.
Statistics show that the vast majority of Social Security disability benefits will be denied. The Social Security Administration reports that the percentage of people being awarded benefits at the initial claims level averaged 22% for claims filed from 2008-2017. Denied disability claims averaged 64% during this time period. According to the statistics, there is a real possibility that your first attempt at applying for Social Security Benefits will result in a denial. It is not uncommon for this to happen.
In addition to the complexity of the forms making it difficult to successfully complete the application, there are some common reasons why SSA disability claims are denied including the following:
The first thing to do after receiving a denial letter from the SSA regarding your Social Security disability claim is to read the decision carefully to identify the reasons you were denied. At that point, you can collect the required documentation to support your claim.
There are several reasons why your claim may be denied.
To be able to collect disability from the SSA you must be unable to engage in substantial gainful activity (SGA). In other words, you are continuing to work, and your income is too high. The approved amount of monthly earnings depends on your disability. Benefits for blind persons is higher than those with other kinds of disabilities.
The SSA must determine that your impairment is severe enough that it will last at least 12 months or result in your death. If that determination is not made, you will not qualify for disability benefits. In addition, your medical condition is evaluated for the severity of limitations on your ability to function. An exception is made for blind SSI applicants.
To qualify for SSD benefits, you are required to provide access to your medical records to the SSA. This is an important part of obtaining assistance. Your medical records are evidence to support your claim. The SSA needs to review your medical records to verify the level of disability. In some situations, the SSA could recommend that you be examined by an SSA doctor at a consultative examination. If you refuse to cooperate with the SSA’s requests for access to medical information or your cooperation with the consultative exam, your disability claim may be denied.
If you fail to follow the doctor’s prescribed therapies or medications, or miss follow-up appointments, your disability claim has a high probability of being denied. Your doctor will have difficulty determining whether your disability is keeping you from being able to perform your duties at work if you are not doing the therapies or taking the medicine that was prescribed to you. While there are some reasons that may be acceptable for not participating in the treatment such as lack of money to pay for treatment, severe mental illness, or conflicting recommendations for treatment, you need to show that you are seeing a specialist for your medical condition and working towards recovery so that you can get back to work.
Maintaining communication with the SSA is critically important as you move through the disability claims process. The SSA may need more information about your disability if some information appears to be missing. You need to be available to answer questions, supply missing information, and keep your contact information up to date. If the SSA cannot reach you, they could deny your benefit claim.
If you obtain disability benefits dishonestly, your benefits can be terminated, and you may be prosecuted for fraud. Your benefits may be terminated if someone working for the SSA fraudulently assisted you in getting those benefits. If you are unable to work due to alcoholism or addiction to drugs, the SSA will deny your claim for Social Security Disability benefits.
You may want to have a social security disability lawyer review your initial claim and subsequent denials from the SSA. An experienced lawyer can assist you with preparing the documentation needed to support your disability claim. Should your claim advance to the third round of reviews where you appear before an administrative law judge, having a local disability and benefits claims attorney lawyer is beneficial. The lawyer is familiar with the various ALJs and the court processes. They know how to prepare the defense of your claim to obtain a successful ruling in your favor.