Reasons for SSDI Claims Being Rejected: An Overview of Six Key Factors
The Social Security Disability Insurance (SSDI) programme, managed by the Social Security Administration (SSA), offers financial assistance to individuals who are unable to work due to a severe and long-term disability. However, many applicants face denials, and understanding the reasons behind these denials can help improve the chances of a successful claim.
Lack of Sufficient Medical Evidence
One of the leading causes of denial is lack of sufficient medical evidence. The SSA requires detailed and consistent medical records that clearly demonstrate the severity of your condition and how it impairs your ability to work. Missing documents, gaps in medical care, or lack of specialist evaluations can result in denial.
Earning Too Much Money
Earning too much money can disqualify applicants since SSDI has income limits related to "substantial gainful activity." If claimants earn above this threshold, their claim may be denied as they are considered able to work.
Failure to Follow Prescribed Treatment
Failure to follow prescribed treatment can lead to denial if the SSA believes the claimant is not complying with medical advice without a valid reason, as this might indicate that the disability is not as limiting as claimed.
Inability to Be Reached
Inability to be reached by the SSA during the application process can cause denial, as failure to respond to requests for information or attend required examinations may prevent claim processing.
Disability Not Being Serious Enough
The SSA requires that a disability must be severe enough to prevent any substantial gainful activity and last at least 12 months or result in death. Claims are denied if the condition does not meet this standard.
Uncooperative Behavior
Uncooperative behavior, such as not attending consultative exams or refusing to provide necessary information, can also cause denial due to insufficient evidence or perceived non-compliance.
These reasons, among others like incomplete applications or missing information, are common initial denial causes. Many denials can be appealed by addressing these specific issues, such as submitting additional medical evidence or clarifying inconsistencies.
It's crucial for applicants to understand the criteria for SSDI eligibility and to provide complete and accurate information to increase their chances of approval. If a claim is denied, it's important not to lose hope and to seek advice on how to strengthen the application for the appeal process.
[1] Social Security Administration. (2020). Disability Benefits: What You Need to Know. Retrieved from https://www.ssa.gov/pubs/EN-05-10028.pdf
[2] National Organization of Social Security Claimants' Representatives. (2020). Frequently Asked Questions. Retrieved from https://noscr.org/faq
[3] SSA.gov. (2019). SSA's disability programs: what's the difference? Retrieved from https://www.ssa.gov/disability/disability_ssdi_ssi.htm
[4] Social Security Administration. (2020). Disability Evaluation Under Social Security. Retrieved from https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm
[5] National Academy of Social Insurance. (2019). Disability Insurance: Protecting Workers and Families. Retrieved from https://www.nasi.org/resource/disability-insurance-protecting-workers-and-families/
- Maintaining good health and wellness and mental health before applying for Social Security Disability Insurance (SSDI) can help provide the necessary medical evidence, as clear records demonstrating the extent of a long-term and severe disability can improve an applicant's chances of approval.
- Balancing workplace-wellness and complying with treatment recommendations is crucial for SSDI applicants, as failure to follow prescribed treatments may give the impression that the claimant can perform substantial gainful activity and lead to claim denial.
- By understanding the importance of proper finances and effective personal-finance management, applicants can ensure they remain below the income limits for SSDI, avoiding disqualification due to earning too much money that may be considered as substantial gainful activity.
