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.
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.
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.
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.
Learn about your options for getting Social Security disability benefits based on depression
To qualify for disability benefits, an individual with depression must either meet certain specific disability criteria (found in Social Security’s impairment listing manual), or be granted a medical-vocational allowance based on the severity of their depression and a combination of other factors (such as other impairments, work history, age, and a level of education).
Social Security publishes a list of common, serious illnesses (“Listings”) that qualify for disability if they meet the specified criteria. The purpose of the list is to grant disability quickly for severe impairments. Depression is covered in impairment listing 12.04 Depressive, Bipolar and related disorders. To qualify for either Social Security disability or SSI disability benefits solely on the basis of depression, you must show you have severe depression by having at least five of the following symptoms:
Bipolar disorder must be characterized by three or more of these symptoms:
You will have to prove by treatment records from your therapist that these symptoms exist and that they cause serious functional limitations despite treatment for some period of time. If you regularly see a psychiatrist or psychologist, he or she should be recording your symptoms. If not, you may want to track your condition using a self-rated depression scale:
Social Security requires that your symptoms of depression cause you serious difficulties (one extreme or two marked) with:
Affleck & Gordon are experienced attorneys who represent individuals in Social Security disability appeals. We offer a free consultation and will be happy to answer any questions you may have.