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Applying for Social Security Disability Insurance (SSDI) can be complex and often overwhelming. Unfortunately, many claims are denied on the first attempt. Understanding the most common reasons for claim denials and learning to avoid these pitfalls can improve your chances of securing benefits. Below, we’ll explore why claims are commonly denied and provide practical steps to help strengthen your application.
1. Lack of Sufficient Medical Evidence
The Social Security Administration (SSA) relies on medical documentation to evaluate disability claims. If the evidence provided does not demonstrate that your condition prevents you from working, your claim may be denied.
How to Avoid This
Ensure your medical records are thorough and up-to-date, including physician notes, diagnostic test results, and any imaging (like MRIs or X-rays) that supports your condition. It is also important to regularly see your doctor and keep detailed records of each visit. This consistent medical history demonstrates the ongoing severity of your condition. Finally, ask for medical support letters–a letter from your doctor explicitly stating how your condition impacts your ability to work can add weight to your claim.
2. Failure to Follow Prescribed Treatment
In some cases, applicants fail to follow the treatment plan recommended by their doctors. The SSA may interpret this as a sign that your disability is not as limiting as claimed.
How to Avoid This
If a treatment plan is difficult to follow due to side effects or other reasons, discuss alternative options with your doctor rather than discontinuing treatment on your own. In some situations, financial constraints or lack of access to healthcare may prevent you from following prescribed treatments. If this is the case, provide a clear explanation to the SSA.
3. Working Above the Substantial Gainful Activity (SGA) Limit
Your claim may be denied if you work and earn more than a specific amount set by the SSA. This earnings limit, known as Substantial Gainful Activity (SGA), changes annually and assesses whether an applicant is truly unable to work.
How to Avoid This
Before applying, familiarize yourself with the current SGA limit to ensure your earnings are below this threshold. Also, avoid working more than part-time or earning close to the SGA limit until your claim is approved, as this can reduce the likelihood of a denial.
4. Incomplete or Incorrect Application Information
An SSDI application with missing or incorrect information, including incomplete or inaccurately filled-out forms, is likely to be denied.
How to Avoid This:
Review your application thoroughly to ensure all sections are complete and accurate. If you have a complex work history or medical situation, include additional notes or explanations to give the SSA a clearer picture of your condition. Consulting a disability attorney can help ensure your application is complete and accurately represents your situation.
5. Disability Not Expected to Last 12 Months
To qualify for SSDI, the SSA requires that your disability is expected to last at least 12 months or result in death. Temporary disabilities, even if severe, typically do not qualify.
How to Avoid This
Confirm with your healthcare provider that your disability is likely to persist beyond 12 months, and provide documentation from your doctor explaining the expected duration of your condition and its impact on your ability to work.
6. Previous Denial and Refiling Without Changes
Many applicants assume that simply reapplying after a denial will improve their chances, but the SSA may deny claims that do not present any new or additional information.
How to Avoid This
If your initial claim is denied, consider appealing the decision rather than starting a new application. Appeals allow you to present additional information and address the reasons for denial. If you appeal, work with your attorney and medical provider to gather more robust evidence for your condition.
Increasing Your Chances of Approval for SSDI Benefits
Obtaining SSDI benefits can be challenging, given the high rate of denials. You can achieve a positive outcome by ensuring your application is thorough, accurate, and well-documented. If you’re struggling with the SSDI process, Grech Law Firm is here to help. We can guide you through all aspects of the process, from submitting your claim to the appeal. Contact us today to get started with a seasoned disability attorney.