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7 Reasons Of Denial Of Disability Benefits

The eligibility requirements for social security disability can be complicated and even though you believe that you meet these requirements, you may still be denied benefits and be left wondering why. If you get your disability benefits denied by the Social Security Administration (SSA), it can be heart breaking. There are many common reasons for a denial of benefits, however, there are also many reasons to appeal social security disability denial.

The reasons for denial often have to do with not providing enough evidence to the SSA for them to be able to determine if you meet the health and work-related eligibility criteria, however, the reasons for denial can be much more complex. Here, you gain a better understanding of seven common reasons that social security disability benefits applications are denied by the Social Security Administration and how to work to overcome these obstacles.

Reasons For SSI Denial

Insufficient Medical Evidence

One of the most common reasons people are denied disability benefits is failure to provide sufficient medical evidence. The social security administration wants to see evidence that you truly have a disability that is preventing you from working and disability denials often result from having insufficient medical evidence.

Medical evidence that is timely, accurate, and sufficient is what the social security administration wants to see to approve an application.  For information to be considered timely, it must be recent enough to be relevant to your medical condition and show that you still have a disability. Generally, the Social Security Administration likes to have information that is no older than six months old.

Additionally, you will need to have medical information that is accurate. Basically, this means that the information from your doctor must correspond to the condition that you are claiming a disability for.

Finally, the medical evidence must be sufficient to demonstrate that your condition exists and is preventing you from working. A doctor’s note will not be enough, the SSA will want things like X-Rays or biopsy results.

Ineligibility Due to Work Credits

To be eligible for Social Security Disability (SSD) you must meet certain work-related requirements.  The SSA requires you to have gained 40 work credits with 20 of these credits acquired in the last 10 years to be eligible for disability benefits.  A person can earn up to a maximum of four work credits per year for working and a work credit is based on the amount of money you pay in social security taxes.

If you don’t meet these requirements, this could be one of the reasons for SSDI denial. However, the work requirements for eligibility are loosened for younger people. These requirements vary by age range but will still require you to have earned a certain amount of work credits within a certain recent period. Disability lawyers can help you understand the work eligibility requirements of SSD and work with you to understand if you meet these requirements and should apply for disability benefits.

Failure to Follow Treatment Plans

Another common reason that a person is denied for disability or cut off is a failure to follow a treatment plan. The SSA expects you to make an attempt to improve your condition and get back to work. If your medical team has suggested a treatment plan for your condition, you are expected to follow it. This can include many things such as a chemotherapy regime, physical therapy, or a change in diet and exercise. 

You need to be able to show to the SSA that you are following any recommended treatment plans from your medical team. This can include documentation that you are making all of your appointments for physical therapy or chemotherapy. As long as you follow your treatment plan as recommended by your medical team and provide documentation to the SSA that you are doing this, you should be eligible, or remain eligible, for social security disability benefits.

Income and Asset Limitations

Another common reason for disability denials is that a person has too much income or too many assets. The SSA has prescribed certain income and asset limitations that can prevent a person from being eligible for disability benefits. If you are working, even part time, and earning over a certain amount of income, you may be ineligible for disability benefits. 

This amount you make from employment is called substantial gainful activity (SGA). As of 2023, the maximum amount you can make through SGA is $1,470.00 per month. One of the social security disability denial reasons could be that you make more than this. The amount of assets you have does not affect your eligibility for Social Security Disability Insurance (SSDI), but it can affect your eligibility for a separate program known as Social Security Insurance (SSI) which is designed for low-income individuals and is needs based instead of entitlement based.

Lack of Professional Guidance

The application process for social security disability benefits can be complicated and can be filled with many obstacles. If you don’t have assistance from a qualified disability attorney to help you with your Social Security Disability Claim, you can run into many of these obstacles. A disability attorney understands the process for applying for disability benefits and can help explain to you the eligibility requirements and help you determine if you should apply.  They will also help you gather all the required medical evidence and information and help you submit your application.

Additionally, if your claim is denied not having professional guidance could result in you not knowing how to appeal the decision. With a disability attorney at your side, you will know your appeal options. Additionally, your chances of overturning your denial at the appeals level greatly increased with a disability attorney because they know the evidentiary and procedural requirements of the appeals process.

Inconsistent Statements

Another reason that social security disability benefits are often denied is that an applicant provides inconsistent statements to the Social Security Administration.  This is because inconsistent statements destroy your credibility in the eyes of the SSA. Inconsistent statements could be statements about your pain or condition that do not correspond to your objective medical tests or information from your doctor. 

This issue could also come up if you need to appeal a denial of benefits from the SSA. If in your initial application, you made one statement such as you have trouble getting around and then at the hearing it comes out that you regular get out or maybe even use public transportation, this can destroy your credibility in the eyes of an administrative law judge. You want to ensure that all of your statements are true and consistent. If you do this, you will have the best chance of having your disability benefits approved.

Pre-Existing Conditions

Generally, pre-existing conditions such as diabetes or a heart condition will not be a reason for a denial of benefits for SSDI. However, you still must meet the disability requirements to be eligible for benefits. The SSA considers a person to be disabled if they have a condition that has lasted, or is expected to last, longer than a year or is expected to result in death and this condition is preventing the person from continuing their employment or finding other work that they can perform. 

Even if you have a preexisting condition from before the injury or illness that is preventing you from working, you should be eligible for disability benefits. If you are concerned that you may not be eligible or do not completely understand the eligibility requirements, a qualified disability lawyer can help you. They can explain the requirements and work with you to see if you are eligible and should apply.

Get Legal advice? Contact Disability Lawyer Today

If you are considering applying for disability benefits or have had a denial of disability benefits, you might want to consider getting legal advice. Contacting a qualified disability lawyer in Houston can be a great step in winning your disability benefits. 

A lawyer can be a great asset when initially filing for disability benefits because they know what the SSA wants to see on the application and how to help you gather the critical medical evidence. Additionally, they can help you appeal social security disability denials. They know the process and evidentiary and procedural requirements of the SSA and can be essential in having a disability benefits denial overturned.

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