About 65% of all Social Security disability benefits claims are denied at the initial application stage.
Suffering an injury or being diagnosed with a disability can be a very stressful and frightening time. More than likely you will be worried about how you will support yourself and your family, especially if the disability prevents you from carrying out your job.
Applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits can alleviate some of these worries. Unfortunately, there is a significant chance that your application will be denied, even if you rightfully qualify for disability benefits.
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Getting an Unfavorable Decision
If your initial disability application was denied, you are not alone. Approximately 65-70% of all initial applicants are denied disability benefits. Though this may seem like a large amount, claims are denied for all different reasons. After you are denied, you will have the option to appeal your decision and improve your claim.
If you have applied for Social Security Disability benefits and are faced with an unfavorable decision, do not panic. If you are denied Social Security disability, you can fight the decision. The SSDI and SSI application process includes an involved reconsideration and appeals process, so with the help of a Social Security Disability lawyer or advocate, there is a good chance that you will eventually be awarded the benefits that you rightfully deserve.
Why a Claim May Be Denied
One reason to not panic if your application is denied is that the vast majority of claims (approximately 65%) will be denied at the initial level. This is not to say that they all should have been approved, as false and inappropriate claims are common. As a result, a great deal of scrutiny goes into the application review process used by state-run Disability Determination Services (DDS) in conjunction with the SSA.
Applications that are not well developed run a high risk of denial at any stage. It is an unfortunate fact that due to the overwhelming volume of applications, reviewers at the DDS often wrongfully deny Social Security Disability applications out of hand, particularly if they are perceived as incomplete, improperly filled-out, or simply lacking the medical evidence necessary to prove total disability or inability to work.
SSI Denial Reasons
Some of the reasons for denying SSI benefits are relatively obvious, while other reasons are more difficult to notice.
Violation of Income Limitation
You cannot have SSI income that is more than $2,000 per year. This includes wages and the income generated from self-employment. The $2,000 limit also applies to assets, such as stocks, government bonds, and a life insurance policy. Even if you do not generate more than $2,000 income from a rental property, the real estate value of the property cannot exceed $2,000.
Lack of Proper Documentation
As one of the more obvious reasons to deny SSI, failing to submit the proper documents to the SSA leads to the denial of your claim. If you did not receive the correct paperwork, the SSA still denies your claim for inadequate documentation. The SSA has established strict deadlines for submitting documents. If you missed a filing deadline, you can expect the SSA to deny your SSI claim. The SSA has a list of documents you need in your application in the SSA's Blue Book for that condition.
Not a United States Citizen
Here we have a less obvious reason for having an SSI claim come back denied by the SSA. The rules for establishing citizenship are complex, with eight different categories defining a non-citizen. Any non-citizen that files a claim for SSI benefits will receive a denial letter from the SSA.
Failure to Return a Phone Call
Disability caseworkers from the SSA often follow up on applications to get more information out of applicants. They are not as interested in your income as they are interested in the type of work you have done. You get one phone call from a disability caseworker and if you miss it, you have a limited amount of time to return the call, or else you receive a denied claim letter from the SSA.
If you believe the SSA denied your SSI unjustly, you should speak with a Social Security disability attorney to determine the best course of action.
The Disability Appeals Process
The first step in the appeals process for a denied disability claim is called reconsideration. As the name implies, reconsideration is an appeal made to the SSA concerning your denied disability claim.
Another team of medical examiners from the federal agency reviews your appeal to determine whether the SSA should overturn its initial decision to deny you financial assistance. The SSA also denies a majority of appeals of denied disability claims, which means you move on to the next step in the process.
Filing an Appeal
While some may feel a great sense of indignity over being denied at the initial stage of a disability application, it is important to remember that such initial-stage denials are actually quite common. By understanding the reconsideration and appeals procedures that are built into the disability application process, and perhaps with the help of a qualified Social Security Disability attorney or disability advocate, you may still have an excellent chance of receiving disability benefits.
Although there is no way to be certain whether you will be awarded SSDI or SSI benefits upon appeal, you can drastically increase your chances by understanding the reasons for denial and then properly addressing them in your appeal. If you have been denied because your medical history is unsubstantial or incomplete, working closely with medical professionals to ensure that you have submitted the appropriate medical documentation and Residual Functional Capacity (RFC) form may have an extremely positive impact on your case.
Hiring a qualified Social Security Disability attorney or advocate to help you fully understand and prepare for your appeal, as well as to ensure all appropriate paperwork is in order, can greatly increase your claim’s chances of success. In many cases, disability lawyers and advocates will not only have a vast knowledge of the Social Security application process, but may also have specific insights into the specific requirements for approval at your regional SSA office.
Hearing in Front of an Administrative Law Judge
Up until now, every interaction with the SSA took place via email, snail-mail, and over the phone. The second step of the appeal process puts you in front of an Administrative Law Judge (ALJ).
A few weeks before your ALJ hearing, the SSA sends you a letter confirming the date, time, and location of your hearing. If you fail to appear at the hearing, the ALJ will dismiss your claim.
Working with a Social Security disability attorney can help you prepare for the ALJ hearing. You should know most of the questions the ALJ asks, as well as how to deliver your side of the story in the most convincing way possible.
During the ALJ hearing, the judge will ask you to explain the reasons why you can no longer work. You have to demonstrate why the medical condition that you suffer from limits your ability to complete ordinary job functions. Your lawyer will ask medical experts to testify on your behalf as well.
Denied SSDI, But Approved SSI
There is typically just one way for you to receive approval for Supplemental Security Income (SSI) but denied for a Social Security disability claim.
The SSA requires you to be insured to receive financial assistance for a disability. Your status as insured is calculated by the amount of payroll taxes you have paid.
Look at your payroll taxes as insurance premiums when it comes to qualifying for Social Security Disability Insurance (SSDI). When you stop working, you should have about five years of payroll taxes to back up your insurance claim.
If the SSA approves your disability claim, but your disability happened after the date when you last were insured for SSDI benefits, then you will be denied SSDI, but approved for SSI.
Can the Social Security Administration (SSA) deny you SSDI, but approve you for SSI? The answer is yes because the SSA applies two different standards for becoming eligible for each safety net program.
Your work history plays a significant role in determining whether the SSA approves you for SSDI benefits. The SSA evaluates your work history and reviews your medical records to determine whether you suffer from a disability that qualifies you for financial assistance. You also have to prove you have paid Social Security taxes from your income. On the other hand, you do not have to submit your work history when applying for SSI benefits
The SSA calculates the number of work credits you have earned to determine your eligibility for SSDI. Applicants typically need to accumulate 40 work credits over their careers, with the last 20 work credits coming over the past 10 years. However, younger workers might qualify for SSDI by proving they suffer from a disability listed in the SSA medical guide called the Blue Book.
In 2021, workers gained one work credit for every $1,470 earned in wages or self-employment income.
How to Avoid a Denied Disability Claim
Each claim for disability benefits brings different issues to the table, but there are a few common reasons why claims get denied by the SSA.
Lack of Sufficient Medical Evidence
Welcome to the number one reason why applicants receive denial letters from the SSA. The heart of your disability claim is the medical evidence you submit that verifies your disability.
Results of diagnostic tests can prove the severity of your symptoms, which the SSA needs to see before approving your claim. You also want to submit compelling medical records, such as the prognosis made by your physician for a full recovery.
Failure to Follow a Treatment Program
Results of diagnostic tests often make the difference between denied and approved disability claims. However, your diagnostic tests might present overwhelming evidence of your disability, but failing to follow your doctor’s treatment instructions can lead to a denied disability claim.
Refuse to Cooperate
The SSA might ask you to submit additional information or undergo an assessment called Residual Functional Capacity (RFC). Failure to comply with any request made by the SSA is a sure way to get your disability claim dismissed. Always cooperate with the SSA if the federal agency requests additional information.
You Make Too Much Money
The SSA approves disability benefits for applicants that cannot work. If you continue to work, you risk getting your disability claim denied because you earn too much money.
The SSA establishes a limit for how much a claimant can earn to receive financial assistance for a disability. If you have been denied disability and can’t work, you should file an appeal for reconsideration with the SSA.
Filing a new claim after getting one denied simply leads to the same decision made for the first claim. Work with a Social Security attorney to get the compensation you deserve for your disability.