Why Do Disability Claims Get Denied?
Disability claims get denied for lots of reasons. While some individuals who have their claims denied are not eligible to receive disability benefits, many simply make mistakes during the application process. The Social Security Administration (SSA) also wrongly denies benefits in some cases. If you need to file for disability, understanding why claims get denied—and avoiding common mistakes—will help you maximize your chances of success.
The Orlando Social Security Disability lawyers at Colling Gilbert Wright & Carter have extensive experience helping people get their SSDI benefits. If your claim was denied, contact our office right away. If you haven’t started the SSDI application process, we can help ensure it is completed correctly and promptly.
10 Common Reasons for Social Security Disability Denials
Here are 10 common reasons for Social Security disability insurance (SSDI) denials:
1. You Are Not “Insured”
As the SSA explains, “[t]he SSDI program pays benefits to you and certain family members if you are ‘insured.’” To be “insured” for SSDI benefits, you must have paid enough into the federal Social Security system through your employment.
2. You Are Not “Disabled”
The federal Social Security system has a very strict definition of what it means to be “disabled.” If you do not have a qualifying medical condition, then you aren’t eligible to receive benefits. The SSA maintains a list of qualifying conditions (provided that they significantly limit an applicant’s ability to work for at least 12 months). If your condition is not on this list, then the SSA, “must decide if it is as severe as a medical condition that is on the list”—and this can add to the challenges of filing a successful claim.
3. Your Disability Application is Incomplete
To receive consideration for disability benefits, you must submit a completed application to the SSA. If your application is incomplete in any respect—whether you left out information about your medical condition or you forgot to sign at the end—this may cause the SSA (or Florida’s Division of Disability Determinations) to issue a denial.
4. You Provide Insufficient Medical Evidence
When filing your application for Social Security disability benefits, you must include medical evidence which proves you are disabled. If you fail to include this evidence, or if the government decides that your medical evidence is insufficient to prove that you qualify for benefits, this will also lead to a denial.
5. You Fail to Follow Your Doctor’s Treatment Recommendations
The SSA expects individuals who file for disability benefits to do what they can to regain their ability to work. As a result, if you fail to follow your doctor’s treatment recommendations, this can also lead to a denial. However, there are some circumstances in which the SSA will excuse an applicant’s failure to obtain treatment. These include physical inability, religious objections, and inability to pay.
6. You Are Earning Too Much
Social Security disability benefits are intended for individuals who are unable to earn enough money to support themselves and their families through employment. The SSA refers to this as being unable to engage in “substantial gainful activity” or “SGA”. For 2022, the SGA income amount is $1,350 for non-blind individuals and $2,260 for blind individuals.
7. You Don’t Respond to the SSA
Seeking disability benefits is not simply a matter of filing an application and waiting to start receiving checks in the mail. Applying for disability benefits is an interactive process, and you may need to communicate with the SSA at various stages. If you do not provide the information the SSA requests, the SSA will deny your claim.
8. You Fail to Attend a Consultative Examination (CE)
While your disability application is pending, the SSA may ask you to attend a consultative examination (CE). This is an examination performed by a doctor who works for the SSA. If you fail to attend a CE as required, this will also result in a denial of your claim.
9. You Provided False or Misleading Information
If you provide false or misleading information on your SSDI application, this will result in an immediate denial. This is true even if your mistake was unintentional. While unintentional mistakes can generally be corrected (as long as you appeal your denial on time), intentionally submitting false information can lead to allegations of Social Security disability fraud.
10. The SSA or Florida Division of Disability Determinations Made a Mistake
Finally, even if you do everything correctly, you may still find that your disability claim is denied. This is an unfortunate reality of the Social Security disability system. As a result, whether you are thinking about filing for benefits or you have received a denial letter from the SSA or the Florida Division of Disability Determinations, it is best to seek help from an Orlando social security disability lawyer who can guide you through your next steps.
Do you have more questions about filing for Social Security disability benefits? If so, we encourage you to schedule a free, no-obligation consultation at Colling, Gilbert, Wright & Carter.
To speak with our experienced Orlando Social Security disability lawyers in confidence, call (800) 766-1000 or tell us how we can help online today.