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  • Christopher Le

Top 5 Reasons Why Social Security Disability Cases are Denied

Several millions of people apply for Social Security Disability each year. but did you know only 30% are approved at the initial claim level? Ever wonder why so many Social Security Disability claims are being denied?

Although there can be many reasons why a claim is denied, below are the top 5 most common reasons for a claim to be denied.

#1: Lack of STRONG Medical Evidence

Several Social Security Disability claims are denied due to a lack of strong convincing medical evidence. If you expect to be approved for disability benefits you will need to prove that you are unable to work due to your disabling condition. Medical records are extremely important as they show your disability has interfered with your ability to perform work. If you are seeking treatment with a doctor regularly, you should ask your doctor to provide a medical opinion within their visit note stating why they believe you are disabled and can no longer work. They can also notate in the visit note what limitations and restrictions you have as a result of your impairments. This information will help the social security administration (SSA) have a better understanding as to your limitations. Simply going to the doctor for routine medication refills every few months wont provide strong enough evidence to get you approved.

There's also an assumption that Social Security will send you to their doctors who will gather the evidence needed to approve their claim. This is not the case. Although you may be sent out for a medical exam by social security, that doctors medical opinion will not be in of itself enough to prove your disability. Medical records provided by your primary care physicians are most important in determining the success of your claim. In addition any referral doctors like specialist, neurologist, pain doctors also boost your chances of success. Since your own doctors medical records play a significant role in you being approved for disability benefits, its important that you discuss how your disability is impacting your ability to work.

If you can provide doctors notes or doctors excuses, this would also help to show that you did have difficulty maintaining a full time job due to constant medical visits. Also if you have records of missed time from work prior to filing for social security disability, like a work log of all the days you missed work due to your condition, this should also be provided to SSA.

#2: Previous Denials

Many people think that filing a new application for disability benefits is better than appealing a denied one. This is not true. The more denials you have had in the past, the more likely SSA is to deny again. This is because the disability examiner reviewing your claim is more likely to deny your claim again if they see that you've already had previous denials. The best route is to appeal every denial and take your case to the next stage. Do not give up just because you were denied. You have appeal rights and its always best to appeal.

#3: Your Still Earning Income

If you are still working, even part time, and earning income, this could cause your claim to be denied. The maximum amount you can earn per month gross is $1310 for an individual. Any months where you earn more than that amount you are not eligible and will likely be denied social security disability benefits. If you have no other choice but to work in order to survive, and you also want to be eligible for disability benefits, you should work part time hours and your total monthly gross income should be no more than $1310. The Social Security Administration will only approve Social Security Disability claims for people who are unable to work FULL TIME (meaning 40 hours per week) due to their disability. If you are working part time, you can still be eligible for benefits.

#4: Failure to Follow Treatment

If you do not follow doctors orders or fail to adhere to the treatment plan provided by your doctor, this will likely lead to a denial. This is because the disability examiner who reviews your claim needs to see that you adhered to recommended treatment and that treatment still failed at providing you any relief. If you do not follow the recommended treatment, the disability examiner wont be able to determine if the treatment would have helped or not. If there is valid reason for not following through with recommended treatment such as religion, you can bring this up during the appeals process. Its best to hire an attorney to help you with your appeal.

#5: Failure to Comply with SSA

Its very important to stay on top of your own claim. Its best to fill out any forms that is required by the social security administration, to keep them informed of any changes, and to update them on any and all medical visits. Its also important to check your mail frequently and to notify SSA of any address changes so that you dont miss any correspondence being sent to you. If there is any requested form that need to be filled out, fill them out and send them in immediately. If there are any scheduled medical exams with a social security appointed doctor, please be sure to attend that exam on the scheduled date. If you fail to fill out necessary forms or attend the scheduled exam, this could lead to a denial.

Approval Rates For Denials

Social Security disability applications face an overwhelming 70-80% denial rate upon initial application. Luckily, the Social Security disability program offers an appeals process that offers a better chance of success.

After you appeal a denial, it is best that you review why you were denied to make sure that SSA was provided with all relevant documentation needed to make a fully informed decision on your claim. You do not want them to deny your claim because they were missing relevant records. This unfortunately happens a lot.

In some cases, new medical information became available after you were initially denied. Maybe you were initially denied and two weeks after the denial you underwent surgery. Since this surgical report is now in existence, it should be provided on appeal as this could lead to an approval of your claim. The reality, though, is that your request for reconsideration, goes back to the SSA so this appeal level only has an average success rate of about 15%. Although the success is low on appeal, the best chance of success comes at a disability hearing before an administrative law judge.

At your disability hearing before an actual live administrative law judge, you will have the chance to speak to a neutral impartial judge about your medical problems. Although you were denied previously, the Judge is not bound by any previous denials and will listen to the testimony and review the evidence and make their own independent decision. You are able to bring witnesses to testify on your behalf. There is an average success rate of 62% at this the hearing stage.

If you do not prevail at the hearing stage, the next two appeal levels are the Appeals Council stage and federal court. The likelihood of prevailing at either of these stages is slim. Its the hearing level where you have your best shot at being approved.

Given the complexity of the appeals process, it is advised to hire an experienced lawyer to help you navigate the process and ensure that you have everything you need to give you the best chance of prevailing.

How an Attorney Can Help

The whole process of applying for Social Security disability benefits is long and complex. There are deadlines and many forms that need to be correctly filled out. An experienced attorney can help guide you through every step of the process so that you can be assured you are doing everything the correct way. Although there is no guarantee that you will automatically win your case just because you have an attorney, it will greatly improve your chances of success.

Keep in mind you can hire a disability lawyer at any step of the process. You can hire one at the very beginning, or hire one as you await for a hearing before a Judge. Its always best to hire an attorney at the beginning though so the attorney has plenty of time to familiarize themselves with your case. Your attorney will know what information should be included in your initial application, as well as what should be added to boost your chances of being approved. They will also know when the deadlines are to appeal any denials.

Wondering if you can afford an attorney? Our office works on a contingency fee basis, so YOU DO NOT PAY ANYTHING UNLESS WE GET YOU APPROVED! Our fee is 25% of your back award or $6000, whichever is less. Since you do not have to pay any money up front and you only pay an attorney if they win your case, there are major benefits with working with a lawyer through the process.

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