Common Reasons SSA Denies Benefits

Posted October 25, 2019 by Premier Disability Services, LLC®

Every year, millions of Americans file Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims. 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.

  • 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 SGA Allowance. To be eligible for disability benefits, you must be unable to engage in what is known as substantial gainful activity, or SGA. 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 2019, the monthly income limit is $1,220 (or $2,110 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 SGA allowance amount, you will not be eligible to receive benefits.
  • Previous Denial. While it is crucial to file your initial 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. You may also choose to hire an attorney or advocate to help you with the appeal process.
  • 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 Claims Process. 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 may be denied. A full list of required documents and potential application questions is available online.

Contact our office today if you or anyone you know would like to learn more about qualifying for Social Security Disability benefits.

By: Joyce Trudeau of Premier Disability Services, LLC®