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.

Incarceration

  • 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.