9 Common Reasons Why A Claim May Be Denied
Only one-third of initial Social Security disability claims are approved at the application level. Understanding the reasons why so many claims are denied can help increase the chances of a successful disability application.
Lack of Medical Evidence
- An applicant may assert any number of medical impairments. A claim will not succeed, however, without objective medical evidence showing a clear diagnosis of the alleged impairments.
- The medical evidence must demonstrate how these impairments would interfere with an applicant’s ability to work.
Lack of Severity
- SSA must believe the condition is so severe as to last at least 12 months or result in death.
- Surprisingly many cancer claims are denied due to lack of severity because the cancer is treatable within a 12 month period. The same considerations apply to stroke victims.
Duration Not Met
- Claims may be denied because the impairments are not likely to cause disability for 12 months.
- Claims based on bone fractures resulting from trauma or accidents are a common example.
Applicant’s Income Exceed Substantial Gainful Activity Allowance
Failure to Follow Treatment
- If an applicant is unwilling to cooperate with prescribed medical treatment, the claim will be denied. This is referred to as medical noncompliance.
- IMPORTANT – this is different from an applicant being unable to follow treatment due to lack of insurance, financial constraints, or religious beliefs.
Failure to Cooperate
- If an applicant fails to provide requested information or fails to show up for scheduled medical exams, the claim will be denied.
- Benefits will not be paid to those confined to a jail, prison, or state hospital – for either a misdemeanor or a felony – because food, shelter and medical needs are provided during incarceration.
Impairment Caused During a Crime
- Impairments, or worsening of an existing impairment, that are incurred during the commission of a felony cannot be used as the basis for applying for disability benefits.
- An injury suffered while an applicant is in prison cannot be used to obtain disability benefits.
Disability Caused by Drugs/Alcohol
- Benefits will be denied if drug addiction and/or alcoholism is a contributing factor to his or her disability.
- SSA considers whether the impairment would exist if applicant stopped using drugs or alcohol.
For more information on disability approval ratings, see http://www.disabilitysecrets.com/disability-approval-rate.html.