Why Will A Social Security Disability Application Get Denied?

Most Social Security Disability, or SSDI, claims are denied because an individual was not found medically disabled under the Social Security Disability guidelines (This article focuses on non-medical denial reasons, so for more on this topic: Social Security Disability Denied? The Reasons Why).

However, disability claims can be denied for reasons other than medical reasons. When an individual applies for SSDI disability benefits with Social Security, their disability application has a possibility of being denied without the case ever being evaluated by a disability examiner and without ever receiving a medical determination.

For example, individuals who file a disability application while working and earning above the substantial gainful activity amount, with no special considerations or subsidy from their employer, are denied prior to their case even being sent for a disability medical determination.

Translation: if you working and earning too much at the time you apply for disability, your medical records will never be gathered and reviewed and you will very quickly receive a technical denial.

Note: SGA is an earnings limit that, if exceeded, will make a person no longer eligible for disability benefits. Special considerations or subsidy are special help from employers that help an individual remain employed.

The definition of disability states that an individual has been unable to perform SGA for twelve continuous months, or that they expect to be unable to perform SGA for twelve months due to a medically determinable impairment. So it stands to reason that an individual who is working above the SGA monthly earnings limit would be denied prior to having their case sent to a disability examiner at DDS (disability determination services) for a disability determination.

Truthfully, there are many individuals who suffer from significant medical or mental problems who are working and earning over the SGA monthly earnings amount. But for Social Security purposes, their medical or mental problems must be considered to be significant enough to prevent substantial work activity. It really does not matter what their condition is, or what the severity of their condition is if they are working over the SGA earnings limit.

Other reasons a case can be denied

There are other ways, aside from work activity, that can cause a disability claim to be denied without a medical evaluation of the claim being conducted. For example, many individuals who take the time to file an application by phone, or online, are denied because they fail to return their medical release forms (forms that are signed by the applicant that enable Social Security to request medical records). If an individual fails to provide the information needed to process their disability claim, such as medical releases, their disability application will be denied on the basis of "failure to cooperate".

In addition to failure to cooperate denials, disability claims can be denied for failure to attend a scheduled consultative examination (these are medical examinations that are scheduled by disability examiners to get needed medical information).

Avoiding being denied

Some of these types of disability denials can be avoided if an individual simply does what is necessary for the processing of their disability claim. If an individual files for disability, they should make sure that Social Security has a valid address and phone number in case the disability examiner handling their claim needs more information. Also, disability applicants should always complete all necessary forms and provide any information requested during the disability claim-processing period.

Lastly, if an individual is scheduled for any medical or mental consultative examinations, they should make sure that they attend the examination or notify the disability examiner prior to the date of the examination that they need to reschedule their examination. Just following these simple instructions can save disability applicants from needless claim denials.

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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