Author: James C. Beardsley, Esq., Portland, Maine
A Denial Isn’t Always the End of the Road. Our Green Bay Social Security Lawyers Will Help You Understand Your Options.
It can be difficult to know how to move forward after suffering a disabling injury or illness, especially if it prevents you from holding a job.
The Social Security Administration (SSA) manages two programs – Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) – that provide monthly benefits for disabled individuals who cannot earn a living due to their condition. Unfortunately, the application process for disability benefits is tedious and claims are often denied during the initial stages.
While receiving a denial can be incredibly stressful and frustrating, it’s not always the end of the road. If your application for SSDI and/or SSI has been denied, don’t lose hope. Our Green Bay Social Security lawyers at Fitzgerald and Bomier are here to help you understand your options.
Why Does the SSA Deny so Many Claims?
Millions of people apply for disability benefits every year. In 2017, “Disability benefits were paid to almost 10.1 million people,” the SSA reported. Out of those millions, it is not uncommon to come across claims that are false, misleading, or fraudulent. As a result, the SSA is quick to deny any claim they believe is insufficient.
The Disability Determination Services (DDS), a state-run agency that works with the SSA, scrutinizes every claim during the review process. Their efforts to weed out fraud attempts combined with the overwhelming volume of applications they receive causes reviewers to be strict and, sometimes, overzealous when processing claims.
Even if the applicant is truly disabled and entitled to benefits, there is a high chance their application will be denied if it is incomplete, improperly filled out, or lacking substantial medical evidence.
Four Common Reasons Applications Are Denied
If you’re in the process of applying for disability benefits or your claim was already denied, it is important to be aware of the mistakes applicants make that lead the SSA to deny so many claims.
While there are many possible explanations for a denial, these are four of the most common reasons the SSA denies disability applications:
1 – Insufficient Medical Evidence
The SSA frequently denies applicants who do not provide enough medical evidence to prove their disability prevents them from working. In order to qualify for benefits, you must meet the SSA’s strict definition of ‘disability:’
- Your condition prevents you from continuing the type of work you were previously doing.
- You are unable to perform any other type of work for which you are qualified due to the nature of your condition.
- Your disability is expected to last for at least one year or result in death.
In many cases, people assume that simply describing their pain or providing proof of doctors visits will be enough to meet the SSA’s requirements. This is false.
For your claim to be approved, you will need to include significant evidence documenting the severity of your disability and how it impacts you in the workplace. Medical records and paperwork from your primary care physician stating why you are unable to work will be essential to proving the validity of your claim. Additionally, it can help to include a detailed record of any time you missed from work due to your condition.
If you didn’t include these items and your application was denied, you should consider speaking with your doctor to collect the necessary documentation to demonstrate your limitations.
2 – You Don’t Meet the Non-Medical Requirements
The SSA will not even consider your medical records if you don’t meet their basic eligibility requirements. Applications that are denied for non-medical reasons are known as ‘technical denials.’
Despite your medical condition, you can receive a technical denial for both SSDI and SSI if your monthly income exceeds what’s known as the ‘substantial gainful activity’ (SGA) limit. The reason for this is that disability benefits are designed for individuals whose disability prevents them from working. If the SSA sees that you are capable of earning more than the SGA limit, they won’t consider you to be disabled. The SGA limit for 2019 is $1,220 for non-blind individuals.
Here are the specific non-medical requirements for each program:
Social Security Disability Insurance (SSDI)
SSDI is available for individuals who have earned ‘work credits’ through previous jobs that pay into Social Security. If you don’t have enough work credits or your monthly income exceeds the SGA limit, your claim will likely be denied.
Supplemental Security Income (SSI)
SSI benefits, on the other hand, are intended for individuals with limited work experience and few resources. Therefore, the SSA has set income and asset limits for SSI applicants. For example, to be approved for SSI benefits in 2019, your monthly income can’t exceed the SGA limit and you must have less than $2,000 in the bank as an individual or $3,000 as a couple. While these rules generally apply to all SSDI and SSI applications, there are exceptions when it comes to determining which streams of income count towards the SGA limit. An experienced attorney can help you understand the tricky regulations surrounding disability benefits.
3 – You Ignored Doctor’s Orders
When it comes to SSDI/SSI applications, being able to show that you have followed your doctor’s orders and are continuing to do so is vitally important. If you don’t abide by your doctor’s treatment plan, claims examiners will not be able to determine if your inability to work is actually due to your disability or the fact that you’re ignoring the prescribed treatment.
While there are exceptions to this rule, the SSA typically doesn’t grant benefits to applicants who aren’t actively trying to help their condition.
4 – You Didn’t Play by the SSA’s Rules
Although the process can be time-consuming and inconvenient, it’s necessary to cooperate with the SSA representative handling your claim. If they can’t reach you or you fail to show up for scheduled meetings and/or medical examinations, your claim will almost certainly be denied.
With this in mind, it’s essential to play by the rules and provide your claims examiner with everything they need in a timely fashion.
Appealing a Denied Claim
If your claim was denied for one of these reasons, it can be easy to give up on the entire process. However, remember that denials are common and you may still have options.
After receiving a denial, many applicants are able to obtain disability benefits through the appeals process. Filing an appeal essentially asks the SSA to reconsider your claim. You may also need to present your case in front of an Administrative Law Judge.
Understanding the reason why your claim was initially denied is vital, so you can be sure to address it during your appeal. For example, if the SSA denied your claim due to insufficient medical evidence, you may just need to provide the correct documentation during your appeal in order to be approved.
How an Attorney Can Increase Your Chances of Approval
If you’re dealing with a denied disability claim, hiring a qualified attorney is in your best interest. The rules of the Social Security system are complex and difficult to comprehend. An attorney can coordinate with the SSA and help you understand why your claim was denied.
Don’t let a missing medical form stand in the way of you and the benefits you deserve. Consult an experienced lawyer who can ensure you have everything you need for a successful appeal.
At Fitzgerald and Bomier, we exclusively represent the legal needs of disabled individuals. We have assisted countless Wisconsin families through the application and/or appeals process to receive Social Security disability benefits.
To speak with one of our knowledgeable and compassionate Green Bay Social Security lawyers, call our law office today at (800) 928-2667 or fill out our free consultation form. We’ll advocate on your behalf and help you pursue the disability benefits you need.
About The Author
James C. Beardsley is a personal injury lawyer in Portland, Maine. Since 2006, James has worked for Lowry & Associates, one of the leading personal injury law firms in the state of Maine. James is also a graduate of the University of Maine School of Law and previously served in the United States Marine Corps.