When your SSDI or SSI claim is refused, it’s confusing, scary and frustrating. Unfortunately, it happens far more often than acceptance. In fact, roughly 70% of all claims to the SSA are denied upon initial application. Explore the many reasons why the SSA denies social security claims, what you can do if it happens to you, and how the right social security lawyer can help.
Types of Social Security Benefits
When you’re injured, there are two types of social security benefits you can apply to receive. The First is SSDI or Social Security Disability Insurance. This benefit pays benefits to those who have paid into social security through your regular paycheck FICA deductions, and to those whose disability is also expected to last for at least a year, or until their death.
SSDI has a five-month wait between becoming disabled and getting your payments. Those who are disabled for two years can, after those two years pass, become eligible for Medicare coverage.
The second type of benefit is SSI or Supplemental Security Income. This is a type of benefit that applies to those who don’t qualify for SSDI and is based entirely on need. It’s generally only available to those who have very low income, or who are at least 65 years of age. There’s no waiting period for SSI, and Medicaid is available as soon as you’re approved.
Reasons for Denial
There are a wide variety of reasons why SSDI claims are denied. These include criminal convictions, lack of medical evidence, prior denials, drug and alcohol use, the ability to do other work, failure to complete paperwork, poor cooperation, and failure to meet basic requirements.
If you’re currently incarcerated or your condition is the result of a criminal conviction or was made worse by your crime, you can’t receive benefits. Likewise, if you’re on parole or probation and you violate the terms of your parole, you won’t be eligible for benefits for that month.
Not Enough Evidence
One of the most common reasons claims are denied is that the SSA decides there’s not enough evidence that your injury is truly disabling. They feel that your condition isn’t bad enough to prevent you from working. You need to clearly document the debilitating nature of your injuries with as much detail as possible.
Previous Denials of Benefits
Many people who have been denied benefits decide, rather than challenging or appealing the denial, to just try re-filing. This is a bad way to go, and almost always results in another denial. A new filing after a refusal is a red flag; it’s far better to file an appeal than a new claim.
Alcohol and Drug Use
If alcohol or drug abuse is what’s causing you to be unable to work you won’t be able to get benefits from SSDI. You can get benefits for conditions that were the result of alcohol or drug use, so long as the alcohol and drugs weren’t the main contributing factor.
If, for example, going into a treatment program and getting your addiction under control would enable you to keep working, you can’t get benefits. If, on the other hand, you developed cirrhosis, seizures and mental health disorders from permanent damage to your body, you may be able to collect benefits.
You Can Work a Different Job
SSDI requires that you be unable to work any job due to your disability. If you can still work a different job based on your experience and training, you may not be eligible to receive SSDI benefits.
Failure to Complete Paperwork
If you don’t complete your paperwork correctly, your claim will be denied. SSDI is a request for government financial assistance. This means a lot of bureaucracy and red tape. It’s essential to be sure you do it right, and that the SSA can get hold of you for follow up questions.
Failure to Cooperate
If you refuse to give them permission to gather medical records, you don’t show up for exams, you don’t follow your doctor’s treatment prescriptions, or otherwise cooperate, your claim will be denied. Make sure you cooperate with all that is required of you.
You Don’t Meet Basic Requirements
If you earn too much money, you have too much in the bank, you don’t have enough work credits, or your condition isn’t severe or long-term enough, your application will likely be denied. This is among the most common reasons for refusal.
Call a Social Security Lawyer