Not every social security benefits application will be honored, and sometimes they can be rejected for reasons that the applicant did not expect. Therefore, individuals may find reviewing the most common reasons for denial useful so they can anticipate a denial and respond accordingly. This information can help greatly when attempting to secure benefits with the help of an experienced disability benefits lawyer.
1. You Do Not Provide the Requested Documentation
One of the most common reasons for denial lies in the applicant’s failure to provide all of the requested medical documentation.
If the documents provided are deemed incomplete or if you visited several physicians contributing conflicting reports, then the Social Security Administration (SSA) may request a consultative examination (CE) by a doctor within their care network. A CE visit is paid for by the government, not the applicant.
Should you refuse to attend your CE or repeatedly fail to attend one without proper notice, your claim could be denied.
2. You Did Not Respond in Time
Those without a permanent address face difficulty when trying to correspond with the SSA, but they should nevertheless reply promptly and take heed of all notices and deadlines. Otherwise, their inability to file the needed paperwork in a timely fashion could result in a denial.
If you are concerned about receiving notices on time, you can assign a representative like a disability benefits lawyer to handle correspondence for you. Just make sure to check in and reply to the representative’s requests, or they could be put in the same situation as the SSA.
3. You Make Too Much Money
Social Security benefits like Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are limited to those who cannot earn above the Substantial Gainful Activity (SGA) income limit.
For SSDI, the 2016 SGA limit for work-related income is $1,130 per month. This income does not include returns on investment or other non-employment-related contributions from others.
For SSI, all earned and unearned income cannot exceed $1,500 per month, total. Any income over $740-$800 could cause a reduction in payment, as well.
4. Your Disability Won’t Last Long Enough
Generally speaking, the SSA expects all covered disabilities to either last at least 12 months or lead to the death of the recipient within that period.
Certain claims like bone fractures are typically denied, but can be contested if the condition is severe enough and has not progressed satisfactorily after six months.
5. You Did Not Participate in the Prescribed Therapy
Part of your disability application includes your physician’s treatment recommendations, which can include a prescribed therapy regimen. If the purposes of the therapy are to improve or lessen your disability, then failure to abide by the regimen could mean the cancellation of your disability benefits.
Exceptions can exist for certain mental illnesses, diagnosed phobias of surgery, the need for assistance, inadequate finances for treatment, religious beliefs or conflicting doctor recommendations.
6. Your Disability Is Caused or Worsened by an Addiction to Drugs or Alcohol
Simply put, if the SSA feels that your disability could be rectified if you stopped using drugs or alcohol, they will not cover the condition.
7. You Have Been Convicted of a Felony
Those convicted of a felony are typically ineligible for SSA disability benefits while they are incarcerated. Those injured during commission of a felony they were later convicted for and those injured while in prison are also typically ineligible.
Even still, those with ineligible claims due to a felony records can register for a benefit-free disability period, which “freezes” their earnings record during the relevant period.
8. You Have Been Accused of Fraud
If the SSA suspects that your documentation or disability claim is based on fraudulent behaviors in part or in whole, they could terminate your benefits and prosecute you for fraud.
Defending Against SSA Denials with a Disability Benefits Lawyer
All of the above reasons for denying a claim can involve exceptions and complex nuances. Additionally, the SSA may hold facts as true that can be legitimately disputed by a skilled attorney.
We’ve been helping disabled individuals in the Greater Los Angeles area, the Inland Empire, and Orange County get the disability benefits they need for years. Call Dr. Bill LaTour and his team today at 800-803-5090 or fill out our online form to schedule a free consultation.