Every year, millions of Social Security disability claims are filed in the United States. Of these, roughly 70% are denied at the initial level of the claims process. There are various reasons why disability benefits would be denied, and there are a number of different ways that applicants can be better prepared for the process. Here, the disability advocates at Disability Associates break down some of the main reasons claims are denied.
Lack of Medical Evidence
One of the most common reasons Social Security disability benefits are denied is the lack of concrete medical records. In order for your claim to be approved, you must provide substantial evidence to show that your medical condition hinders your ability to work your current job and will keep you from working in a similar role for at least one year.
Having medical records from your primary care physician—indicating that your condition has affected your ability to work—is a requirement for the application process and is carefully reviewed by the Social Security Administration (SSA) during the claims evaluation.
Income Exceeds the Substantial Gainful Activity Allowance
To be eligible for disability benefits, you must be unable to engage in what is known as substantial gainful activity. The SSA defines substantial gainful activity as work that involves significant and productive duties and work that pays more than the current monthly income limit. In 2018, the monthly income limit is $1,180 ($1,970 for those who are visually impaired).
If you are working part-time while applying for disability benefits, the SSA will consider your monthly income when deciding whether to approve your claim and how much you may receive in benefits. If your part-time income exceeds the substantial gainful activity allowance amount, you will not be eligible to receive benefits.
Previous Denial of Disability Benefits
While it is crucial to file your claim as soon as you and your doctor determine that a medical condition may keep you out of work for more than a year, you should not immediately file a new claim if your original one is denied. If you do so, and nothing has changed, your new claim will be denied as well.
If you are denied benefits for either a medical or non-medical reason, you may appeal the denial. If you need to file an appeal, the SSA allows you to complete an online appeals process, or you can reach out to a local Social Security office. Having an attorney to walk you through the appeals process is very beneficial and will help to ensure that your appeal is fairly considered.
Failure to Follow Prescribed Treatment
It is imperative that you follow any treatment prescribed by your doctor, as this is a key variable in the claims decision process. If you do not follow your treatment plan, SSA examiners will not be able to accurately determine whether your disability truly prevents your ability to work because you are not taking the proper steps to treat the condition.
Failure to follow treatment also indicates a lack of care as to whether you get better and re-enter the workforce, which is a red flag for reviewers and will result in a denied claim.
Failure to Cooperate with the Social Security Administration
When applying for Social Security disability benefits, always follow the instructions for the application process and provide all documents and information needed by the SSA. If you fail to provide any necessary documentation—or fail to attend any scheduled meeting or medical exams—your claim will be denied. A full list of required documents and potential application questions is available online.
A Disability Benefits Attorney Can Help to Ensure you Get the Benefits you Need
When applying for disability benefits, it is important to provide the right documentation and follow the procedures fully, as this will greatly improve your chances of approval. If you wish to apply for Social Security disability benefits or need to appeal a denied claim, it is also helpful to consult an experienced attorney who will be able to help you face the obstacles you may encounter along the way.