What Are The Reasons For Social Security Disability Cases Being Denied?

Social Security Disability and SSI cases are primarily denied for one reason: a claimant's medical records will fail to prove that the individual has enough physical or mental limitations that will prevent them from being able to go back to work--either performing one of their past jobs (past relevant work potentially includes any job that was done in the last 15 years) or performing some other type of other work (that Social Security may claim you can do based on your age, education, medical limitations, and skills and training).

When Social Security finds that a person filing for disability benefits is disabled, this means they have determined that they have either A) met the requirements of a listing in the Social Security List of Impairments, or B) that they have successfully passed through the five-step evaluation process known as sequential evaluation.

Now, most individuals will not be approved on the basis of the approval criteria for a listing. This is because many medical condtitions are not included in the listing book. And when they are the criteria for approval is very high. The simple fact is that most of the time a claimant's medical records will not contain the information needed to prove that they qualify for disability under a listing.

When a person is approved it will be because they have gone through all five steps of the sequential evaluation process, meaning that:

1) They are not currently working and earning a substantial and gainful income,

2) They have a severe impairment,

3), They do not meet a listing in the listing book,

4) Their condition or conditions prevent them from being able to do their past work, and finally

5) Their condition or conditions are severe enough that they cannot do any other kind of work, work that, if they were not disabled, they might easily be able to switch to.

We can distill the way the entire disability system works by making this one statement:

Most claims are denied because an SSA adjudicator--a disability adjudicator or a judge--will decide that the person can still do some type of other work, even if they can no longer do their past work.

The trick to winning a disability claim, of course, is proving that your condition is so severe that you cannot do other work, in addition to being unable to do your past work. And we address that topic more in length on this page: How to Prove you are disabled and Win your Disability Benefits

Non Medical Reasons for being denied disability

There are a variety of reasons an individual's disability claim can be denied that do not involve their alleged disabling condition or conditions.

For instance, disability cases can be denied because they do not meet the non-disability criteria, or eligibility requirements, of Social Security Disability and/or SSI (Supplemental Security Income disability) program. If an individual has not worked, or has not worked in a long time, they may not be insured for Social Security Disability.

Insured status is gained only through work activity and lasts a limited amount of time once an individual stops working. If an individual files a disability claim on the basis of need, their disability claim may be denied because A) the value of their resources is too high (currently, the income resource limit for an individual is two thousand dollars and the couple's resource limit is three thousand dollars) or B) they have income that is over the income limit. Like all need-based social welfare programs, individuals who file for SSI must meet certain income and resource limits to be eligible for disability benefits.

Disability claims can be denied for other reasons as well. If an individual files a disability claim and they are working, their disability claim can be denied for the performance of substantial gainful activity (SGA) prior to their case being sent to a disability examiner (at disability determination services, the agency that makes case decisions for social security) for a medical decision.

SGA is a monthly earnings amount that the Social Security Administration has determined to be self-supporting. If an individual is earning over the SGA amount, if does not matter what their disabling condition is or how severe it is; their claim will be denied.

Social Security Disability claims can also be denied either in the Social Security office, or at the state agency responsible for making disability determinations, for failure to cooperate. Failure to cooperate denials involve a failure on the part of the disability applicant to provide forms or information needed to process their disability claim.

Often, too, the state disability processing agency denies disability cases because they are unable to get in touch with the disability applicant. This is why it is so important for all disability claimants to provide Social Security with updated addresses and phone numbers if there are any changes during the processing of their disability cases.

The state disability agency (DDS) may also deny a disability case if a disability claimant fails to attend a scheduled consultative examination. If a disability applicant cannot attend their consultative examination for any reason, they should contact the disability examiner responsible for their disability case a reschedule examination rather than miss it.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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