Social Security Disability: Eight Reasons You May Be Denied Benefits

Unhappy family financial stress

In some cases, the reasons are beyond your control. In other circumstances, you may be able to avoid doing something that leads to denial.

1: You Earn Too Much Income from Working

For SSDI, the benefit program for workers who have paid into the Social Security system over multiple years, one of the most basic reasons you could be denied benefits is that, when you apply, your income is above the limit where it is considered “substantial gainful activity” (SGA). This means you earn too much money to be considered disabled. The SGA limit for non-blind people is $1,180 per month in 2018, and the figure is adjusted annually. Income from investments does not count toward the SGA — only earned income counts, as it shows your ability to work.

For SSI, which is the disability benefit for low-income people, when you apply for SSI, you can’t be making over the substantial gainful activity level. Also, the upper income limit for earned and unearned income combined is around $1,500 per month. Any time your income is over the federal benefit rate ($735 in 2017) your SSI payment will be reduced. If you make too much, your payment would be reduced to zero.

2: Your Disability Won’t Last Long Enough

To qualify for SSDI or SSI benefits, the Social Security Administration (SSA) must believe that your impairment is severe enough to last at least 12 months or result in your death. The only exception to this duration requirement is for blind SSI applicants. Remember that you can file for disability before 12 months has passed from the onset of your disability.

3: The SSA Cannot Find You

The SSA and the Disability Determination Service (DDS) — the agency that determines your medical eligibility for benefits — must be able to communicate with you regarding your application. If these agencies cannot reach you to schedule examinations or communicate with you about critical matters, your benefits may be denied. If you retain an attorney to handle your case, you may not need to get in touch with the SSA, but be sure to stay in touch with your attorney. If you move while your application is being considered, make sure the SSA and your attorney know how to contact you. Claimants (those who are applying for Social Security disability) get denied every day because the SSA cannot find them.

4: You Refuse to Cooperate

Your medical records are vital to granting your disability. If you refuse to release those records to the SSA, your claim could be denied. Similarly, the SSA may need additional information about your impairments, either because your treating doctor’s medical records are incomplete or because you have no treating doctor. In these instances, the SSA will request that you be examined by an SSA doctor in something called a consultative examination (CE), at government expense. In some cases, the SSA will require you to attend more than one CE. If you refuse to attend or request that the SSA make a determination based on the medical records already in your file, you may be denied disability because of inadequate medical information or failure to attend the CE. If you can’t make it to a scheduled CE because of the time or location, talk to your claim examiner so the DDS can schedule a CE at a time or place that is convenient for you. If you repeatedly fail to show up for a CE, your claim will most likely be denied.

5: You Fail to Follow Prescribed Therapy

If you are being treated by a doctor, but fail to follow the doctor’s prescribed therapy when you have the ability to do so, you can be denied disability benefits. The SSA recognizes certain legitimate excuses for failing to follow prescribed therapy, but generally you should make every effort to follow your doctor’s orders.

Acceptable medical excuses. Failure to follow prescribed therapy can be excused for reasons beyond your control. Some examples follow.

  • You have a mental illness so severe that you cannot comply with prescribed therapy.
  • You have a fear of surgery so intense that surgery would not be appropriate. Your treating doctor must confirm the severity of your fear.
  • You physically cannot follow prescribed therapy without assistance.

Acceptable nonmedical excuses. It is possible that you cannot follow a prescribed therapy for a reason that has nothing to do with your medical condition. Acceptable nonmedical excuses for failing to follow prescribed therapy follow.

  • You don’t have the money to pay for treatment.
  • Your religious beliefs prohibit you from receiving medical therapy.
  • Your doctor prescribes treatment that another doctor disagrees with.

For the SSA to deny your claim for failing to follow therapy, the therapy that you fail to follow must be one that is clearly expected to restore your ability to do substantial gainful activity. If your treating doctor tells the SSA that the prescribed therapy is not likely to result in your ability to work, the SSA won’t fault you if you don’t follow such therapy.

6: Your Disability Is Based on Drug Addiction or Alcoholism

The SSA will deny benefits to anyone whose drug addiction or alcoholism (DAA) is a contributing factor to his or her disability. The key factor is whether or not the SSA would still find you disabled if you stopped using drugs or alcohol. It is best to refrain from the use of drugs and alcohol when making a claim for disability benefits.

7: You Have Been Convicted of a Crime

Certain conditions related to conviction of a crime or imprisonment will prevent you from receiving Social Security benefits.

  • If you were injured while committing a felony and were convicted of the crime, the impairment suffered — or the worsening of an existing impairment — during the commission of a felony cannot be used as a basis for applying for disability benefits.
  • If you were injured while in prison, the impairment suffered — or the worsening of an existing impairment — while you are in prison cannot be used to obtain benefits. But you can generally receive benefits after being released from prison.

8: You Commit Fraud

If you obtain disability benefits by dishonest means, the SSA can terminate your benefits and prosecute you for fraud. Filing a tax return for self-employment in order to receive a refund is a common problem.

Leave a Reply

Your email address will not be published. Required fields are marked *