Millions of people apply for Social Security Disability benefits each year. Out of those millions of applications received by the Social Security Administration, only thirty percent are approved at the initial level of the disability claim process. Why are so many Social Security Disability claims denied?
The reasons for a denial of Social Security Disability benefits vary from one claim to the next, but there are five common reasons for a claim to be denied. If you are applying for Social Security Disability benefits it is important to understand the top five reasons why the Social Security Administration denies so many claims.
The common reasons a Social Security disability benefits claim is denied are as follows:
#1: Lack of Hard Medical Evidence
Many Social Security Disability claims are denied due to a lack of solid medical evidence. If you want to qualify for disability benefits you will need to prove that you are unable to work due to your disabling condition.
In order to succeed in this, you must have medical records that show your disability has interfered with your ability to perform work activity.
For example, you may be seeing your doctor every month for severe back pain but if your doctor has not documented how that back pain interferes with your ability to work, your claim for Social Security Disability may be denied.
Many people assume that Social Security will send them to doctors who will gather the evidence needed to qualify and approve a claim for Social Security Disability benefits. This isn't the case. Even if you are sent for medical exam by the Social Security office, it may not be enough to prove your disability.
The medical records kept by your primary care physicians are what will be most important in determining the success of your claim for Social Security Disability benefits. Because of this, it is very important that you discuss how your disability is impacting your work life with your physician.
Doctor's notes excusing you from work or records suggesting a modified work schedule should be included with your medical files if possible. If you were working prior to filing for disability and had to miss time from work due to the disability, keep record of just how much time was lost.
This will help present your case for Social Security Disability to the Social Security Administration.
#2: Prior Denials
Many people think that filing a new disability claim is a better alternative than appealing a denied one. This is not the case. In some situations, a claim will be denied when the person reviewing the claim sees that you applied for Social Security Disability and were denied benefits before.
Because of this, it is important that you go through the appeals process rather than filing a new claim for Social Security Disability altogether if your initial claim is denied
#3: Your Income
This is only if you are applying for SSI benefits. Your income does not matter when applying for SSDI benefits. Some people who apply for SSI benefits can work part time and earn money during the process. However, If you are working and earning more than $910 per month when you apply for Social Security Disability, your claim could get denied.
The Social Security Administration will only approve Social Security Disability claims for people who are unable to work due to their disability.
#4: Failure to Follow Treatment
If you fail to follow the treatment prescribed to you by your doctor, the Social Security Administration will deny your claim. The reason for this is that the examiner will not be able to accurately determine whether or not your condition actually prevents you from being able to work if you are unwilling to cooperate with treatment.
If there is valid reason for not following through with the treatment prescribed by your doctor, you can bring this up during the appeals process. You will, however, want a Social Security Disability attorney representing you in this case.
#5: Failure to Cooperate
No matter how you feel about the people handling your Social Security Disability claim, it is in your best interests to cooperate with them during the application process.
If you fail to provide the Social Security office with requested documentation or fail to show up to your scheduled medical exams, your claim will be denied. Because of this, it is important to remain in contact with the person handling your case and provide any and all documentation requested in a timely manner.
Approval Rates For Denials
Social Security disability applications face an overwhelming 70% denial rate upon initial evaluation. That is a huge number but it is based upon several very different factors, such as applying for a condition that does not meet the criteria or lack of proper medical documentation.
Fortunately, the Social Security disability benefits program offers a comprehensive set of appeals guidelines that have a great success rate.
When you appeal a decision, the understanding at that point is that you truly believe you qualify for disability benefits. You might go back and review your medical documentation to ensure that you have provided everything that the SSA needs to make an informed decision.
In some cases, new information has presented itself since you initially filed, and this new information can help to make your case even stronger.
The reality, though, is that your initial request for reconsideration goes back to the SSA so this appeal level only has an average success rate of 13.8%.
The best chance for a successful appeal comes at the disability hearing level, where you have the chance to speak with an administrative judge about your condition. You are able to bring witnesses who can support and corroborate your claims. There is an average success rate of 62% at this stage.
The two remaining levels are the Appeals Council and taking the case to federal court. The Appeals Council approval rate is about 13% and only 40% of federal court cases receive favorable decisions.
Given the complexities of the appeals process, it is incredibly helpful to engage a Social Security disability lawyer to help you navigate the course and ensure that you have everything you need so that you are in the best possible place to win your case.
How to Use the Disability Blue Book to Your Advantage
The Social Security Administration evaluates each claim using a comprehensive list of medical conditions, the Disability Evaluation Under Social Security, commonly referred to as the Blue Book. The Blue Book features 14 different categories of conditions and their related diagnoses, symptoms and treatment. The idea is that the SSA can quickly locate a condition in the Blue Book and determine whether your condition qualifies you for disability benefits.
When you are in the initial application process or in the request for reconsideration phase, the Blue Book can help you determine what medical documentation will help to make your case as strong as possible. If you locate your condition in the Blue Book, you can see what information will be used to decide your claim and you can provide as much evidence to support your case.
In some cases, though, your condition is not enough to qualify you for disability benefits, and so the SSA will request that you complete a residual function capacity form (RFC). The RFC determines how much work you are capable of performing given the limitations of your condition.
Your doctor is the one who fills out the RFC form, thus ensuring that the information provided is based entirely upon your medical history.
The RFC form is your chance to present specific information about your unique situation to the SSA. Your doctor knows your case and understands your limitations based upon examination and observation.
In many cases, your doctor was the one to make the diagnosis and prescribe the treatment plan, so if there is any question about your ability to work this is where the SSA will turn to for answers.
Make sure you inform your doctor of your intent to apply for disability benefits as soon as possible, and if your claim has already been denied then make sure your doctor knows that the RFC form must be completed as quickly as possible given the 60-day appeal period.
Improving the Possibility of Success
While it is true that only 30 percent of initial Social Security Disability claims are approved, understanding the reasons why so many disability claims are denied can help you increase your chances of a successful Social Security Disability application.
Keep the above tips in mind when applying for Social Security Disability benefits if you want to increase your chances of falling into that lucky 30 percent.
In order to apply for Social Security disability benefits, you need to have paid Social Security taxes and you must have 40 work credits. You earn four work credits for each year that you earn a certain amount of money; in 2019, that amount was $5640. 20 of the 40 credits must have been earned within the last ten years prior to your diagnosis.
For younger applicants, the number of work credits needed is based on a sliding scale given that you might not have worked long enough to earn 40 credits. To receive disability benefits, you must be unable to work. If you are capable of working in your current position, or if you could work with accommodations for your condition or in a modified capacity, then you will not receive disability benefits.
However, the SSA provides opportunities like the trial work program for applicants who are unsure of their ability to work.
How an Attorney Can Help
The entire process of applying for Social Security disability benefits is overwhelming, from keeping track of deadlines to making sure that your application is complete.
As an expert, your attorney can help guide you through the appeals process so that you can be assured that you are doing everything the right way. Though there is no guarantee that hiring a disability benefits attorney will make you win your case, it can greatly improve your chances of success.
You can bring in a disability benefits lawyer at any point in the application or appeals process. Your attorney will know what information should be included in your initial application, as well as what should be added to strengthen your appeal. He or she will know when the deadlines are, and your attorney will be able to help you through every stage of the appeals process so that you do not have to do it on your own.
Most disability benefits attorneys work on a contingency fee basis, so you do not have to pay anything unless you win your case. They will collect their fees from any back pay you are owed, which can either be 25% of the back pay or $6000, whichever is less. Since you do not have to pay up front and you only pay if you win your case, there is a major upside to working with a lawyer through the process.