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Why are disability benefits denied?

If you are disabled and unable to work, you may be able to apply for disability benefits through the SSA to help you cover the costs of medical and living expenses. In some cases, the SSA will deny your application for benefits for any number of specific reasons.

Lack of Medical Evidence

If you don’t see a doctor regularly for your condition, it means that there will likely be fewer records to back up the disabling effects of your condition and less evidence for the disability examiner to use when determining your case. The SSA will usually send you for a “consultative medical exam”, which is when they hire a doctor and arrange for them to perform a medical assessment on you, but this exam is usually very brief and does not provide enough information on your symptoms or the physical limitations brought on by your disability.

If you are worried about your lack of medical evidence, but you don’t heave health insurance and can’t pay out of pocket expenses, you can make the most out of your situation by using free clinics, emergency room visits, and sliding scale doctors to build up your medical history.

Other Medical Reasons

Your disability benefits application may also be denied if your disability isn’t severe enough or is not expected to last more than 12 months. Also, if your disabling condition is based on your drug or alcohol addition, or you do not follow through with prescribed medical therapy for your condition, you will also most likely be denied benefits.

Lack of Work History

Work history plays an important role in your disability benefits application for four main reasons.

  1. Your work history confirms you are insured, as you pay into social security disability insurance (SSDI) through your payroll taxes. To be eligible for SSDI benefits, you must have recently paid into this program.
  2. Work history confirms that you are fully insured. You must have paid SSDI payments totaling in 40 “quarters of coverage” to be considered fully insured. You can earn up to four quarters of coverage a year.
  3. Work history documents determine whether your disability prevents you from doing past work. The disability examiner will look at the work you did in the past to see if you can be able to do this work with your disability. Having some type of work history will be helpful in their decision.
  4. Work history determines the amount of benefits. The SSA tracks your earned income and payments to SSDI to see what amount of disability benefits you can receive.

SSI Applicants Earning Too Much Income

Supplemental Security Income (SSI) is a type of disability benefit that is available to low-income people. The SSA may deny you for benefits if you earn over the income cap to be eligible for this bracket:

  • Over $1,500 per month makes you ineligible
  • Over $740 a month reduces your payments

Other Reasons for Denial

Other various reasons you may be denied for social security disability benefits include, but are not limited to, this list:

  • The SSA cannot find you when they attempt communication
  • You don’t cooperate with the SSA’s requests, such as for a consultative medical exam
  • You have been convicted of a crime
  • You committed fraud

Hire a Lawyer to Appeal

If you feel that you were wrongly denied disability benefits and wish to appeal, you can hire a disability lawyer or advocate to help you gather additional evidence and start the process with the SSA. You can get into contact with one by filling out this free evaluation form, which will be sent to qualified lawyers who can fight on your behalf.