An individual who suffers an injury or develops a medical condition that prevents them from working can seek financial assistance through the Social Security Administration’s disability benefits programs. Unfortunately, the agency denies a large volume of claims it receives, often for the same handful of reasons. Below are three of the most common reasons Social Security disability benefits claims are denied, and how to potentially avoid those mistakes.
Reason #1: Lack of Sufficient Medical Evidence
The Social Security Administration requires SSD benefits applicants to provide detailed medical documentation that demonstrates that:
- They have a medically determinable condition,
- The condition has lasted or will likely last for at least 12 months or will cause the applicant’s death, and
- The condition causes symptoms or limitations that prevent the applicant from working.
When the medical record submitted by an applicant to support their SSD benefits claim fails to demonstrate any of these elements, the SSA may deny an application due to the lack of sufficient medical evidence. A lack of medical evidence may involve:
- Incomplete medical records, such as when certain records refer to other documents not submitted by an applicant
- Inconsistent treatment history, including prolonged gaps in treatments or medical appointments
- Inconsistent diagnoses or descriptions of symptoms and limitations
- Missing specialist opinions when an applicant has a rare or complex disease
An applicant can secure adequate medical documentation by attending regular doctor’s appointments and gathering records of test results, treatments, and medications. Applicants can also work with their healthcare providers to ensure they have a complete medical record for their condition.
Reason #2: Earning Too Much Income
An applicant cannot qualify for Social Security disability benefits if they work enough to earn what the Social Security Administration considers a livable income. The eligibility requirements for SSD benefits preclude an applicant from earning more than the Substantial Gainful Activity threshold—an amount of monthly income that constitutes a living wage under SSA guidelines. Even when an applicant’s condition limits them from earning more money or makes it extremely difficult to work, having income above the SGA threshold will disqualify the applicant from disability benefits.
The Social Security Administration counts most types of income derived from work, including part-time or freelance work. Applicants should keep a careful track of their monthly income to ensure they do not exceed the SGA threshold, as monthly income over the threshold can result in the denial of a disability benefits claim or lead the SSA to terminate an individual’s benefits.
Reason #3: Failure to Follow Treatment or Cooperate with the SSA
Failure to follow treatment plans can lead the SSA to deny a disability benefits application, as a claimant’s decision not to seek treatment may indicate that their condition does not meet the required severity or that they have refused to treat their condition to improve their symptoms so they can return to work. Applicants should continuously pursue recommended treatment unless they have a sincere religious objection to a proposed treatment or if the treatment has severe side effects or risks of complications.
Furthermore, failing to respond to the SSA’s requests for additional documents or information, or to attend a consultative exam scheduled by the SSA, can also provide the administration with grounds to deny a disability benefits claim due to the lack of updated medical evidence.
Contact an SSD Lawyer Today
An experienced Social Security disability attorney can help you avoid the mistakes that can lead to one of these three common reasons for denial. Contact Crowe & Shanahan today for a free, no-obligation consultation with an attorney serving Metro St. Louis, including Illinois, and let us support your claim for Social Security benefits.