Common Causes for Denial of Social Security Disability Benefits
In terms of background, Social Security Disability benefits are part of U.S. federal programs designed to compensate disabled people with limited capacity to perform standard work duties. The U.S. Social Security Administration (SSA) manages these programs, which include Social Security Disability Insurance (SSDI).
In today’s post, we will examine the most common causes for denial or rejection of a claim for Social Security Disability benefits. We will examine this issue through the lens of SSDI benefits. Before we delve into the common causes of denial or rejection of SSDI claims, however, we need to take a step back and review the definition of Social Security Disability benefits.
Definition of Social Security Disability Benefits
Social Security Disability benefits provide monthly payments to disabled workers. These payments help compensate these individuals for a disability that prevents them from working or severely limits their working capacity. In order to qualify for SSDI benefits, the individuals must demonstrate an eligible disability and adequate employment history.
Interested parties wishing to learn more about Social Security Disability benefits are encouraged to check out our recent blog post: SSDI in PA – Social Security Disability Benefits Defined.
Armed with a definition of SSDI benefits, we will now examine the evidence needed to support a claim.
Evidence Needed to Support Case for Social Security Disability Benefits
In order to support a case for Social Security Disability benefits, the applicant must provide medical and employment documentation.
The medical documentation must include detailed records of hospital visits, doctor examinations, and treatment plans. The applicant must prove through medical records that they have a disability that qualifies under SSA regulations. Such a disability must be long-lasting or permanent and result in an impaired ability to conduct normal work duties.
The employment documentation must include detailed work history and tax returns. For SSDI benefits, the applicant must show that they worked long enough and paid enough taxes to qualify.
Individuals who wish to gather more information about proving a claim for Social Security Disability Benefits can review our recent blog post: What Evidence Do I Need to Support My SSDI Case?.
Now that we understand the types of evidence needed to support a claim, we can move on to the common causes for denial or rejection.
Common Causes for Denial or Rejection of a Claim for SSDI Benefits
Unfortunately for many applicants, it is fairly common to deal with denied Social Security benefits. Most denials or rejections relate directly to the evidence provided in support of a claim for benefits. In other words, the applicant did not adhere strictly to the evidentiary requirements outlined in the previous section.
The most common causes for denial or rejection of a claim for Social Security Disability benefits include:
- Inconsistent information provided in the application;
- Application submitted after applicable deadline(s);
- Medical records are incomplete or missing altogether;
- Insufficient employment history to qualify for Social Security;
- Failure to adhere to doctor recommendations or treatment plan;
- Medical records do not demonstrate a qualifying disability; and
- Present wages exceed the maximum threshold(s) for Social Security.
Outside of the common causes listed above, there are many reasons for which the SSA may deny or reject an application. The SSA reviews all applications for disability benefits on a stringent basis. As a result, it is crucial to provide information in a timely, clear and convincing fashion. Any errors or omissions are likely to result in a denied or rejected claim. At that point, the applicant will consider whether to file an appeal to challenge the SSA’s decision.
Filing an Appeal to Challenge a Denied or Rejected Claim
Luckily for applicants dealing with a denied or rejected claim, there are ways to challenge the SSA. After the initial application and denial or rejection, the applicant can file a Social Security Disability appeal. This appeals process features four distinct levels:
- Reconsideration: In this stage, a different SSA official will review your application and newly submitted documentation. The SSA official must not have any prior participation in your case to preserve objectivity. If the SSA denies or rejects your claim during reconsideration, you may ask for a hearing.
- Hearing: In this stage, an administrative judge will conduct a hearing to review your claim for benefits. The administrative judge must not have any prior participation in your case to preserve objectivity. During the hearing, you and the government will present evidence and expert witnesses. Then the administrative judge will make a decision. If the administrative judge denies or rejects your claim during the hearing, you may ask for a review from the appeals council.
- Appeals Council: In this stage, a council of judges will review your case and the administrative judge’s decision. Then the appeals council will either render a decision or send your case back to the administrative judge for another hearing. If the appeals council denies or rejects your claim during the hearing, you may ask for a review from a federal court.
- Federal Court: In this stage, a federal court will review your case and the appeals council’s decision. At this point, your case moves from the Social Security system to the standard legal system.
If you are curious about the appeals process for a denied or rejected claim for Social Security Disability benefits, we provided an in-depth look at that process in a recent blog post: Social Security Disability Insurance: The Appeals Process.
Switching gears from the appeals process, we will now explore the right to legal representation when conducting business with the SSA.
Legal Representation for Social Security Disability Claims
Whenever conducting business with the SSA, you have the right to legal representation. If you retain an attorney, they can act as your representative in all Social Security matters.
For anyone attempting to claim Social Security Disability, it is highly advisable to retain legal counsel. That way your attorney can act on your behalf throughout the entire process, ensuring adherence to all requirements and deadlines.
Your attorney can help you collect and organize your application materials, including medical and employment records. Your attorney can also represent you in meetings, hearings, and appeals. In cases featuring testimony from expert witnesses, your attorney can present evidence to support your case and challenge the government’s evidence. Where it is necessary to challenge a denial or rejection, your attorney can help you navigate all necessary rules and regulations.
In order to learn more about the effectiveness of legal representation when handling Social Security Disability Benefits claims, please review our recent blog post: When Do I Need a Social Security Disability Lawyer?.
Do You Have Legal Questions?
If you are dealing with a denied or rejected claim for Social Security Disability benefits, it can be advantageous to obtain the services of a skilled Social Security Disability lawyer. The lawyers at Krasno, Krasno & Onwudinjo have proven capabilities handling a diverse mix of Social Security matters. If you have legal questions, please do not hesitate to contact us at 800-952-9640 or by filling out an online form for a free consultation. There is no fee unless we win.