My Social Security Disability Claim Was Denied -Now What?

March 15, 2016

First, you must not believe the idea that all claims are denied the first time in order to dissuade people from continuing to seek disability benefits. In reality, a little over 20% of all claims filed are approved the first time. On the average the percentage increases to about 30% for those who appeal to the reconsideration level and on the average a little of 40% of all claims that are appealed to the hearing level are eventually approved.

That being said, it probably doesn't help you comprehend why in the world you would be denied when you are unable to work.

However, let's take a look at some reasons why a person would be denied and try to find a solution to keep the claim alive and headed in the right direction.

First, there are the technical denials:

If you were denied because you were working and making over the allowable income limit to qualify for Social Security disability, then your claim is going to be denied immediately. If you see in your denial letter that you are engaging in "substantial gainful activity," then you are working and earning too much to qualify.

Solution: Drop your income below the limit or reduce your hours working, etc. I understand this may not be the best answer, but it is the only one that will allow you to refile your claim.

The other reason for a technical denial could also be for Supplemetal Security Income (SSI) benefits in which you may have too many assets to qualify. Since qualifying does not depend on work credits to earn benefits, a person must not have a certain amount of cash on hand and other nonexempt assets. If this is the case, then you will receive a denial even if you qualify medically and are determined to be disabled.

Solution: First check what are exempt and nonexempt assets for SSI. After determining what assets are keeping you from qualifying, spend down those assets (wisely) and then reapply.

There is also the issue with Social Security Disability Insurance (SSDI) benefits and work credits. Depending upon a person's age, he or she will have had to have worked long enough in order to qualify.

Solution: You may either have to stay working until you earn the required number of credits or turn back to the asset limits for SSI and qualify that way.

What happens many times is that a person may have not worked enough or not worked in such a long time that they no longer qualify for SSDI and they have too many assets to qualify for SSI. If that is the case, that person will be unable to qualify at all for any type of disability benefit.

Solution: Determine how close you can qualify for either SSDI or SSI and make a game plan to resolve those issues and then reapply for a medical determination.

Second, another reason why you may have been denied is because you do not have strong medical evidence.

The Social Security Administration has stated time and time again it will not issue benefits to a person who cannot show medically his or her impairment that keeps them from working. Many people attempt to file for disability without seeing a doctor or going to a hospital on a regular basis. If that is the case, many times there is a denial because the impairment(s) cannot be substantiated.

Solution: Keep the case going and appeal the denial. However, even if you are going to have to go to your county hospital through the emergency room, it may be just what you have to do. If this is the case, when you are finally allowed to see a doctor after waiting 8 hours, be sure and tell him or her that you are applying for disability and can he or she document your medical records showing what is keeping you from being able to work. It's a long shot going through a county emergency room, but it never hurts to ask. This way, you can continue to accumulate medical records while you are waiting for your next decision. On the average, it takes a disability case over 2 years to adjudicate if it goes to the hearing level. By this time, you should have pretty strong medical records.

Third, you over-exaggerated your limitations in relation to your medical records. Believe it or not, the doctors reviewing your medical records know whether you can or cannot perform certain daily activities. If your medical records show mild or moderate limitations and you state in your Function Report that you are unable to even get out of bed in the morning, you are going to be denied because your restrictions in your daily activities and medical records do not align.

Solution: Be honest with yourself. Just because you have certain physical or mental limitations does not automatically mean you are unable to work. Assess your situation and make the right decision. If you truly cannot work, then appeal the denial and keep your case moving forward. If you can work, attempt to do so and if your impairments become worse, then refile. At least you will continue to earn work credits which may help your case further down the line.

Finally, one must understand that in the end it is an actual person that makes a determination of whether or not you are disabled. In fact, it is a real person during this entire process who uses his or her judgment to make a determination. We're all prone to mistakes and that is why sometimes you will be denied the first time you apply and approved on the reconsideration.

Solution: The point here is to keep pushing forward and keep appealing your case. Many people are denied multiple times before being approved. A lot of this has to do with the length of time it takes to adjudicate a claim. Many conditions tend to become worse over time. When filing for disability benefits, many times the fact that it takes so long actually helps a person qualify.

The other really big reason why many people are approved at the hearing level is because they are allowed to speak with the judge face to face and explain how they are unable to work due to their physical and mental limitations. During the first two phases of a claim the claims examiner cannot see you and is likely not to take the time to speak with you directly. Therefore, even though you may have to eventually go to a hearing, many times this is just the break a person needs in order to receive benefits.

 

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