1. Health

Social Security Disability Denials

Reasons Why a Claim May be Denied


Updated November 26, 2011

Social Security Disability Denials

Tessa Walker, founder and President of CH Consulting

Probably the number one myth about Social Security Disability is that all claims are denied at the initial level. Most claims are denied at the initial level, but not all claims. There are a percentage of claims that are denied due to reasons other than the mechanical components of the program. There are medical denials in which claims are denied according to the program guidelines and there are technical denials in which claims are denied due to non-medical issues.

Reasons why your Social Security Disability claim may be denied:

  • Failure to sign and return the Authorization to Release Information form to the local social security field office or to the Disability Determination Services (DDS) office. This form needs to be signed and dated by you in order for DDS to request medical records, school records, and any other pertinent information from other medical or non medical sources for your disability claim.

  • You must meet the income requirements for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). In order to qualify for SSDI you must have worked and earned enough wages for each quarter. If you are applying for SSI your income and resources cannot exceed the income requirements for the program.

  • If you file a SSDI claim only, with a date last insured in the past, you should provide medical sources and evidence prior to your date last insured. For example, your alleged onset date is 01/01/1995 and your date last insured is 09/30/2003, DDS needs medical evidence prior to your date last insured to determine if you are eligible for disability benefits. If you have no medical evidence prior to the date last insured, your claim may be denied for insufficient evidence prior to your date last insured. If you only file a SSDI claim with a date last insured in the past, a consultative examination may not be scheduled because your insured status for disability benefits has expired. However, if you have a subsequent SSI claim, a consultative examination (if needed) may be scheduled.

  • If you do not attend a consultative examination, your claim may be denied if you do not have a reasonable cause for not attending the examination. Failure to complete and return the activities of daily living and work history forms after social security has made reasonable effort to contact you may result in a denial of your claim.

  • Res judicata is an administrative policy that can be utilized at all levels of the claims process to avoid deciding an issue that was previously decided based on the same facts, same issues, same parties, and same adjudicative period. If a new application is filed with the same issue by the same party and no new facts or evidence, the application may be denied on the basis of res judicata. The purpose is to protect the SSA from having to consider the same claim (on which it has already issued a determination) repeatedly.

  • Benefits will not be awarded while you are incarcerated. If you have an outstanding warrant or have been convicted of a felony crime, your benefits will be terminated. In the case of the felony, your disability benefits could be terminated indefinitely.

  • If you file for Social Security Disability and you are working and earning substantial gainful activity (SGA) at 40 hours a week and earning more than *$1000 per month (*$1640 per month for statutorily blind individuals), your claim will be denied. If you decide to return to work, while your claim is pending, your claim will be denied if you are working at the SGA levels stated earlier. (*SGA income quote for 2011; for 2012, SGA income projected at $1010 per month and $1690 for statutorily blind individuals*).

  • If it is found that you have filed a fraudulent claim, your claim will be denied and you could face felony charges.

  • Inappropriate use of funds may result in termination of disability benefits.

  • If your condition improves when Social Security decides to do a redetermination on your claim, there is a possibility that your disability benefits may be ceased due to improvement in your medical condition.

  • If your medical evidence indicate that there has been failure to follow prescribed treatment for your disability (e.g. Epilepsy) the claim may be denied for failure to follow prescribed treatment.

A denial based on failure to cooperate can be avoided if you comply with the specifications of the program. If you need assistance in understanding the disability process, seek the help of a social security disability attorney, disability advocate, a relative, or friend.

Tessa Walker is the founder and President of CH Consulting. CH Consulting provides free resources, services and guidance to individuals with disabilities and disability advocates. She earned a Master of Science in Human Services Administration from The University of Baltimore and a bachelor’s in psychology from Towson University. Her passion is helping to spread disability awareness to the public. Where there is a will, there is a way. Ms. Walker’s passion to help others is the “will.” Sharing knowledge is the “way” to educate the public.

Follow Tessa Walker on Twitter: @chconsultingllc

Website: CH Consulting LLC

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