Common Reasons Disability Claims Are Denied

Many applicants face disappointment when their disability claims are denied, often without fully understanding why. Data from the Social Security Office of Retirement and Disability Policy reveals that only 25% of initial disability claims are approved by the Social Security Administration (SSA). So while you might qualify for Social Security disability benefits, obtaining monthly benefits can be difficult. Denials often stem from technical errors during the application process or the claim not meeting the eligibility criteria. Knowing the signs that you will be denied for disability can help you navigate your initial claim and determine whether to appeal if your claim is rejected.

Signs That You Will Be Denied for Disability Claims

There are 10 key signs to look out for that may indicate a potential denial:

     1. Insufficient Medical Evidence

One of the most common reasons for denial is insufficient medical evidence to support the disability claim. The Social Security Administration requires detailed and comprehensive medical records to verify the severity and impact of your condition. Incomplete, outdated, or inconsistent medical documentation can lead to a denial.

It’s crucial to ensure that your medical records clearly outline your diagnosis, treatment history, and how your condition limits your ability to work.

     2. Incomplete or Inaccurate Application

The SSA requires extensive documentation to assess your claim so incorrect or missing information can lead to immediate rejection. This includes:

  • Failing to provide essential medical records
  • Misreporting personal information
  • Omitting details about your medical condition and how it impacts your ability to work

To prevent this, ensure that every section of the application is thoroughly completed and all necessary documents are submitted. Double-check your application for completeness and accuracy before submission.

     3. Failure to Follow Prescribed Treatment

The SSA expects applicants to follow their doctor’s advice and pursue recommended treatments unless there is a valid reason for not doing so. The only exceptions are, for example, instances that involve adverse side effects or lack of access to care.

     4. Lack of Cooperation With the SSA

Lack of cooperation with the SSA during the claims process can also result in a denial. This includes failing to attend scheduled medical exams, not providing requested information promptly, or not responding to communications from the SSA. If you fail to comply with these requests, the SSA may deny your claim due to insufficient information.

Ensuring timely and complete cooperation demonstrates your commitment to the process and helps the SSA gather all necessary information to make an informed decision about your eligibility for benefits.

     5. Earning Too Much Income

To qualify for disability benefits, you must show that you are unable to engage in substantial gainful activity (SGA). The SSA sets specific income limits that define what constitutes an SGA.

If your earnings exceed these limits, the SSA may determine that you are not sufficiently disabled to qualify for benefits.

Knowing these limits and ensuring that your earnings do not exceed them while your application is reviewed is essential. If you are working, consider speaking with an attorney to understand how your income might affect your claim.

     6. Previous Denials Without Significant Changes

Previously denied Social Security disability may be denied again if you have reapplied without significant changes in your condition or if there is new supporting evidence. The SSA looks for:

  • Substantial changes in your medical condition
  • New medical evidence
  • Additional documentation not previously considered

Simply resubmitting the same information is unlikely to result in a different outcome. Before reapplying, it’s crucial to gather new medical evidence, seek updated medical evaluations, and clearly articulate any changes in your condition that support your claim for disability benefits.

     7. Drug and Alcohol Abuse

If drug or alcohol abuse is a material factor contributing to your disability, the SSA may deny your claim. They need to determine whether your disability would persist if you stopped abusing substances. However, this process can be complex and requires thorough documentation and possibly legal assistance.

     8. Your Condition Does Not Qualify as a Medical Condition

Even if your condition is serious and limits your ability to work, the SSA may still find that you can perform other work and engage in substantial gainful activity.

The SSA has a list of medical conditions deemed serious enough to prevent a person from engaging in SGA. However, your condition might not fit neatly into any of these categories. In such cases, the SSA will decide if your condition is comparable to one on the list.

Often, the evaluator may conclude that your condition is not comparable and that you can perform other types of work, leading to SGA. If this determination is made, your claim will likely be denied.

You may need to appeal if you disagree with the SSA’s determination. Consult with one of our disability attorneys early to avoid any potential prejudice to your case.

Contact us today at 602.962.2818 and schedule your free consultation.

     9. Your Employment History Is Not Long or Recent Enough To Qualify for SSDI

Besides qualifying as disabled, as stated in the SSA guidelines, an applicant must have worked long enough and recently enough to be eligible for SSDI benefits. This requires earning a certain amount of “work credits” from reported yearly wages or self-employment income on which taxes were paid. Work credits are earned each quarter a person works, provided they earn a specific minimum income. The dollar amount required for one work credit varies yearly.

The number of work credits needed to qualify depends on the age at which the applicant became disabled. Generally, a person needs 40 credits, with 20 earned in the last 10 years.

However, younger applicants may require fewer credits.

If an applicant lacks enough work credits, their SSDI claim can be denied, even if they meet the disability criteria.

     10. Improper or Lack of Representation

Many denied disability claims happen because applicants are unaware of the detailed requirements and fail to provide adequate evidence. Having experienced legal representation, like the team at Pekas Smith: Arizona Disability Attorneys, can significantly increase your chances of a successful claim.

We can help ensure all necessary documentation is included, deadlines are met, and your case is presented effectively.

How Many Times Can You Apply for Disability When Denied?

There is no official limit to how many times you can apply for Social Security disability benefits.

You can file a new application if your initial and subsequent appeals are denied. However, it is crucial to understand that reapplying without knowing the common reasons for denial will be unlikely to lead to a different outcome.

Each new application should ideally be supported by additional evidence or corrected information to strengthen your claim.

Contact Our Experienced Disability Attorneys Today

Applying for disability benefits can be difficult, especially when facing the possibility of denial. At Pekas Smith: Arizona Disability Attorneys, we are dedicated to helping you every step of the way.

Our Arizona disability lawyers will work with you to ensure your application is complete, accurate, and well-supported by medical evidence. If you’ve been denied in the past, we can help you identify new evidence and significant changes to strengthen your case.

We have won millions of dollars in disability benefits for our clients and can help you, too.

Contact us today at 602.962.2818 to schedule a free consultation and take the first step toward the disability benefit you deserve.

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