8 Common Reasons Social Security Disability Claims May Be Denied

Written by John Horn. Posted in Social Security Disability

For many individuals, a Social Security disability claim provides hope for receiving enough income to support oneself in spite of physical or mental health issues. A claim denial can be frustrating or even frightening, but understanding the common reasons claims are denied can help you process your emotions and decide whether or not to appeal.

In this blog, we list eight common reasons Social Security disability is denied.

  1. Disability Dependent on Substance Abuse

If you currently suffer from drug addiction or alcoholism, abbreviated as DAA, a medical consultant will consider your case. The medical consultant must determine whether you would still be considered disabled if you were clean and sober.

Should the consultant find that your disability stems from a DAA factor, your claim will be denied. If you complete a rehabilitation program and are still unable to work, you may be able to appeal your denial.

  1. Disability Related to a Criminal Conviction

If your disability is directly related to a criminal felony conviction, you may not qualify for benefits. For example, if you were injured while committing a crime or while completing a prison sentence, that injury cannot be used as the basis for a Social Security disability claim.

  1. Failure to Follow Treatment Plan

When determining whether or not someone qualifies for disability benefits, the Social Security Administration considers the treatment you have received and how the treatment has affected your ability to work.

If you have been prescribed specific treatment but have not followed your treatment plan, your claim could be denied because it’s unclear if your disability would persist if you complied with the recommended treatments.

  1. High Income

Social Security disability benefits are intended to help people who cannot make sufficient income on their own due to their disabilities. You may be able to receive benefits while working in certain cases, but your claim could be denied if you make more than the substantial gainful activity limit, or SGA. In 2016, the official SGA limit was $1,130 per month.

  1. Insufficient Documentation

When you submit a claim, you must present evidence that you have a disability and that your disability prevents you from working. This evidence usually comes in the form of physician notes, medical records, and treatment history. If you have not seen a doctor or therapist regularly for your condition, it’s possible that this lack of documentation will lead to your claim being denied.

  1. Lack of Communication

While your claim is being considered, the Social Security Administration may reach out to you or to your designated legal representative. If the Social Security Administration cannot communicate effectively with you, your claim will be denied.

To prevent this lack of communication, update your address or phone number if necessary and respond to any official communication you receive. If you have a legal representative, like an attorney, the Social Security Administration will primarily communicate with your representative but may need you to come in for an examination or interview sometime during the process.

  1. Lack of Cooperation

You will need to cooperate with the Social Security Administration while your claim is being processed. Your cooperation may include providing permission for your medical records to be released to the Social Security Administration.

If you have inadequate or incomplete records, you may also need to consent to a consultative examination, or CE, conducted by a doctor who works for the Social Security Administration. You may need to complete multiple CE visits before your claim is granted or denied. Failure to appear at a CE could be grounds for denial, so it’s important to let your claim examiner know ahead of time if you cannot make it to an appointment due to scheduling or traveling conflicts.

  1. Short-Term Condition

Social Security disability benefits are only granted to individuals whose disability or injury will prevent them from working for a significant period of time. Typically, your condition must be expected to persist for at least one year in order for you to qualify for benefits. If your condition is likely to improve with treatment or last for less than a year, your claim could be denied.

This consideration is most important in claims based on acute injuries, like broken bones, rather than chronic medical conditions or mental impairments.

If you are still preparing your Social Security disability claim, ensure that your claim meets the minimum requirements discussed above to reduce the risk of a claim deniable.

Has your Social Security disability claim been denied? Do you need help preparing your first claim? Schedule a consultation with the experts at Horn & Kelley, PC Attorneys at Law. We help you gather evidence and complete the paperwork necessary to complete a claim. Additionally, our team can help you determine if your claim was wrongfully denied and how best to proceed.


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