If you have a medical condition that renders you unable to work, you may be eligible for disability benefits through the Social Security Administration’s benefit programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). However, due to the limited resources for these programs, the Social Security Administration imposes strict eligibility requirements on these programs, which results in many people having their benefits claims denied upon initial review. Fortunately, applicants who have their claims rejected on initial review can remedy the issues that resulted in the denial and pursue the administrative appeals process to seek approval. Here are some of the most common reasons that a claim might be denied initially.
Insufficient Medical Evidence
One of the most frequent reasons for SSDI/SSI denials is a lack of sufficient medical evidence to establish that a claimant has a qualifying disability. To meet the Social Security Administration’s definition of “disabled,” a person must have a condition on the Administration’s list of impairments or another condition that equals the severity of a listed impairment. As a result, a lack of medical evidence proving that an applicant has a qualifying condition may result in the denial of their benefits claim. Insufficiency of medical evidence may occur due to a lack of medical records or inconsistencies in the records.
Earnings Above the Substantial Gainful Activity Threshold
The Social Security Administration may deem an applicant not disabled if they can still work and earn income above the Substantial Gainful Activity limit. The Social Security Administration has established a monthly income that a person may earn; earning that amount of income or more constitutes “substantial gainful activity.”
Failure to Follow Through with Treatment
An SSDI/SSI applicant may have their benefits request denied due to their failure to follow prescribed medical treatment. Failing to follow through with treatment or rehabilitation may undermine the credibility of an applicant’s disability claim. However, the Social Security Administration may waive an applicant’s non-compliance with their prescribed treatment regimen if an applicant can demonstrate a legitimate reason for not complying with treatment, such as:
- Financial hardship/inability to afford treatment
- Sincerely held religious beliefs that preclude obtaining the treatment
- Severe side effects caused by the treatment
If you cannot follow your treatment plan for a legitimate reason, you should let the Social Security Administration know why you’ve put off treatment.
Temporary or Non-Severe Disability
A qualifying disability that may entitle an individual to SSDI or SSI benefits must have lasted for at least 12 months or be expected to last at least 12 months or result in death. As a result, the Social Security Administration will deny an SSDI/SSI claim if it finds that an applicant’s disability will not last more than 12 months, no matter how severely the applicant’s condition impairs their ability to work or perform daily activities.
Insufficient Work Credits
To qualify for SSDI, an applicant must have sufficient work credits. A person earns a work credit when they earn a specific amount of taxable income; people may earn a maximum of four credits per year. The number of credits a person needs to qualify for SSDI depends on their age, with younger workers needing fewer credits. Applicants also need a sufficient number of recently earned work credits, with the specific number also based on an applicant’s age.
The SSI program, which focuses on providing benefits to low-income individuals, does not require a work history.
Assets/Income Above Threshold
Under the SSI program, applicants must earn monthly income and have countable assets that fall below the thresholds set by the Social Security Administration. The monthly income limits change regularly to reflect inflation. For the asset limit, applicants must have less than $2,000 in total countable assets ($3,000 for married couples); however, the Social Security Administration excludes certain assets from this number, such as:
- The applicant’s primary residence
- One vehicle used for transportation
- Household goods and personal items
- Life insurance policies with a combined face value of $1,500 or less
- Burial plots and up to $1,500 in burial funds
- Property used by the applicant in their trade or business
The Social Security Administration will independently verify an applicant’s financial information, which can result in the denial of an SSI claim if the applicant has undisclosed assets or receives substantial gifts from family or friends. SSI applicants can take steps to manage their finances to qualify under the asset/income limits.
Incomplete Applications
The Social Security Administration may sometimes deny SSDI or SSI applications due to insufficient information or supporting documentation. Common examples of deficiencies in SSDI/SSI applications include:
- Missing supporting documentation, such as medical records or financial documentation
- Incomplete application forms missing specific pieces of information
- Scrivener’s errors that result in incorrect names or addresses
- Contradictory information on application forms or between the application and supporting documentation
Fortunately, an applicant who has their application denied due to incompleteness can remedy the issue by requesting reconsideration and submitting the missing information or documents.
Failure to Cooperate with the Application Process
Finally, the Social Security Administration may deny an SSDI/SSI application due to an applicant’s failure to communicate or cooperate. The Social Security Administration may follow up with an application to request additional documentation or information or to ask the applicant to submit to a medical exam to provide the agency with updated medical information. Ignoring the agency’s requests for additional information or missing scheduled medical exams may lead the Social Security Administration to reject a disability benefits application. Applicants can avoid seeming uncooperative by keeping their contact information updated with the Social Security Administration and keeping a calendar of any exams or meetings for the application process.
Contact a Social Security Disability Attorney Today
If the Social Security Administration has denied your initial SSI or SSDI claim, you need an experienced Social Security disability lawyer to guide you through the next steps and help you seek the disability benefits you need. Contact Disability Advocates Group today for a free, confidential consultation to discuss your legal options after a denial of your Social Security disability benefits claim.