Why Was My Disability Claim Denied?

You apply for Social Security Disability and a few months later SSA sends you a Notice of Disapproved Claim. The reason SSA denied you is listed under, "How We Made the Decision." However, it usually says something vague like, "your condition is not severe enough to keep you from working and we determined you are able to adjust to other work." These are the top reasons why disability claims are denied,

  • You are still working. If you are currently working and earning over substantial gainful activity(SGA), then you do not qualify for disability benefits. SGA for 2018 is $1,180 gross per month for nonblind individuals. Even if you are working under SGA, it still shows that you are capable of some form of work. Therefore, you must prove with written doctor support what medical conditions, symptoms, and functional limitations prevent you from working over SGA.
  • You do not have enough work quarters for disability. Social Security Disability is based on your past work earnings record and disability. That is why it is so important to apply for disability as soon as you stop working. If you have gaps in your work history, worked on and off, worked "under the table," are a housewife, only worked part time, etc., then you might not have enough work quarters to qualify for disability benefits. If you do not have a sufficient earnings record for disability, then you should look for other benefit programs like Supplemental Security Income (SSI).
  • You are not disabled before your date last insured (DLI) for disability. As above, Social Security Disability is based on your earnings record. You must pay into Social Security by working continuously and filing taxes in order to get benefits out. If there is a long gap in your work history, then your DLI for disability benefits might be a date in the past. You must prove the onset of disability before your DLI. It is difficult to do that because the medical records in the past are what they are and evidence after the DLI are almost irrelevant.
  • You are over the countable resource limit for SSI. Supplemental Security Income (SSI) is basically welfare disability. It is for disabled people in "low-income households" who have resources valued under $2,000. Your spouse's income and other countable resources could financially disqualify you for SSI.
  • Insufficient medical evidence. When you apply, you can sign an SSA-827 Authorization to Disclose Information to SSA (medical release), so SSA can request and obtain your medical records at no cost to you. If you do not have regular medical care, then SSA probably will not have enough medical records to review to make a favorable decision on your claim. If you do not have health insurance, there are some of programs for the uninsured. VCU has Virginia Coordinated Care (VCC) for uninsured individuals living in the Greater Richmond Metro and Tri-Cities areas at 804-554-3168. The Daily Planet has a mission to provide accessible health services to anyone regardless of housing, financial, or insurance status. The Bon Secours Financial Assistance Program provides financial assistance to eligible patients who receive emergency or medically necessary care in any BSHS facility at 804-554-3168. Try your local Community Services Board.
  • You did not complete and return forms to SSA promptly. SSA might mail you a function report, pain questionnaire, or other forms to fill out.
  • Your condition is not severe enough to keep you from working. This is a very common reason SSA gives for denying disability claims. The best way to be successful in a disability claim is to prove with written doctor support that your medical conditions cause functional limitations so severe that you cannot sustain gainful employment doing any type of job in the entire national economy. Doctors rarely comment on functional limitations (sitting, standing, walking, climbing stairs, climbing ladders, lifting, carrying, reaching, pushing, pulling, typing, bending, breaks, being "off task," etc.) or date of disability onset in the medical records. You should appeal this denial within the 60-day deadline and contact my firm immediately for Residual Functional Capacity (RFC) questionnaires for your doctors to complete. I can cater the questionnaire to your specific diagnoses, symptoms, treatment, and restrictions.
  • Your condition is expected to improve within 12 months. In order to be successful for disability, you must prove with written doctor support that your medical impairment has prevented (or will prevent) you from sustaining gainful employment in any capacity for at least 12 straight months without improvement despite compliance with regular medical care. If you are not expected to improve within a year, then you should appeal this denial within the 60-day deadline and contact my award-winning firm immediately.
  • You are capable of doing your past relevant work. Claimants under age 50 must rule out any type of job. Claimants over age 50 must prove with written doctor support that you cannot sustain gainful employment doing your past relevant work as normally performed in the national economy according to the Dictionary of Occupational Titles and that you cannot adjust to another work with transferrable skills.
  • Unfavorable consultative exam by a Social Security doctor. Sometimes (and especially when there is not much medical evidence in your file) SSA will schedule you an appointment with one of their doctors. The exam is usually very brief and not very thorough. Furthermore, the physical consultative exam is almost always by a general practitioner, not a specialist (orthopedist, rheumatologist, neurologist, etc.) The SSA doctor will probably examine you for a few minutes, ask you some questions, and write a report.

Free Consultations Are Available Now

If you get denied Social Security Disability, don't get discouraged. Most claims are denied after the initial application. The good news is you have 60 days to appeal. Call my Richmond-based firm immediately for a free case evaluation.

I don't get paid unless you win your case, nor do I ask you to pay me for my services. Instead, SSA pays me directly from a portion of the back benefits. I get involved throughout many stages of the disability denial and appeal process:

  • Notice of Disapproved Claim (First denial)
  • Request for Reconsideration (First appeal)
  • Notice of Reconsideration (Second denial)
  • Request for Hearing (Second appeal)
  • Notice of Decision - Unfavorable (Hearing appeal)
  • Request for Review of ALJ Decision (appeal to Appeals Council)

If you are in need of help with your disability claim, call me today at 804-554-3168 or send me an email to get started for free.