Social Security Disability Insurance (SSDI) applications can be denied for several reasons. We've outlined some factors below.
Remember: our Memphis SSDI attorneys can help you with your initial disability application, or with your appeal. The attorney's fee is limited to a relatively small percentage of your past due benefits, and only if the lawyer is successful. Nothing can be charged from your ongoing benefits.
Lack of Medical Records
To have the best SSDI application possible, you should always include accurate and complete medical records. Here are some tips on how to do so:
- 1) Obtain your own copies
- Get your hands on all of your medical records for at least a year before the injury or condition in question.
- Don't forget hospital stays, specialists, therapists, etc.
- Make 2 full copies of the records (1 for you, 1 for the application). The Social Security Administration (SSA) won't always make full copies on their own.
- If you aren't able to get a copy yourself, make sure to include a detailed medical history, all of the treatments you've received, and the full and accurate contact information for each health care provider who treated you.
- 2) Keep in touch with your disability determination specialist
- The SSA will provide you with a disability determination specialist
- Mail or fax your records in to your disability determination specialist. If you already have a case open, you can call your specialist to find out which records are missing.
- Highlight or mark your name and Social Security # on each record.
- If you get more treatment or tests, update your specialist.
- 3) Let your doctor speak for you
Your doctor can write a letter for you on your behalf, but the letter needs to be extremely specific. Rather than saying "this person is disabled," the letter should say exactly how your injury would affect a certain work-related activity like lifting or bending your arms.
Failure to Follow Doctor’s Orders
You may have seen numerous doctors in the SSDI application process.
When you receive second and third opinions or meet with specialists, some medical advice may differ. In your case, perhaps you decided not to follow one of the doctor's treatment plans in order to do what another doctor said. Or perhaps you changed your plan after a certain treatment didn't work or caused pain.
Such decisions are certainly understandable; however, you may be denied if your choice not to follow certain treatment plans shows up in your records.
If you've chosen one treatment plan over another, the best way to handle it with your claims adjuster is to submit:
- Complete and accurate medical documentation (see: "Lack of Medical Records" above)
- A statement from your current doctor about how the medical advice or treatment plan you followed was the best choice for your condition or injury
If you've submitted an SSDI claim already and were denied (something that happens all the time), there's a specific process to appeal. Re-applying over and over isn't the best way to make your case, and your claim may be denied over and over again as a result.
Here's how the appeal process typically works:
- The first step in the appeal process is submitting a Request for Reconsideration, which usually results in an affirmation of the original denial.
- The next stage is the appeal, in which the claimant requests a hearing before a judge.
- At the hearing, the judge's decision is either fully favorable, partially favorable or unfavorable.
- If you receive an unfavorable decision, the next step is to request that the decision be reviewed by the appeals council.
- If the appeals council affirms the judge’s unfavorable decision, the next step is to file a lawsuit against the Commissioner of Social Security.
- To prevail, you must establish that the judge’s decision was not supported by substantive evidence and/or the judge committed errors of law.
As you can tell, the appeals process is different from the initial application, and because it's so complicated, you'll likely need an attorney's help to be successful. We're available to discuss your situation at 901-327-1212.
You Make Too Much Money
Strange as it may seem, you can be denied Social Security Disability Insurance (SSDI) if you make too much money.
The Social Security Administration (SSA) uses a number called Substantial Gainful Activity (SGA), which is the amount of money you can make each month while still being eligible for benefits. The SSA assumes that if you make more than this amount, you are capable of competing for full employment and don't need any benefits.
The SGA can change annually, but if it appears you exceed it, you'll likely be denied SSDI.
Failure to Cooperate with the SSA
Throughout the SSDI application process, you'll need to cooperate with the SSA. To stay on top of your case while they consider your application:
- Stay in regular contact with your administrator to know what they need from you.
- Show up on time to scheduled appointments and exams.
- Provide requested documents.
- Present materials to the SSA on time.
- Keep a cordial attitude toward your administrator.
The Social Security system, and with that Social Security Disability, is ultimately an insurance plan you pay into as you work. So the years you've worked and the amount you've made show how much you've paid into the system, or how insured you are.
In order to receive SSDI, you need to have worked long enough and/or paid enough based on your income to be considered currently and fully insured. Fortunately, that doesn't have to mean you've been employed in an ongoing fashion or made a large sum of money. It does mean you will need to prove some work experience so the SSA knows you qualify.