Why Are SSD Claims Often Denied?

Social Security Disability (SSD) benefits provide a crucial financial safety net for individuals who are unable to work due to long-term disabilities. These benefits ensure that disabled persons can maintain a basic standard of living despite their inability to earn an income. Social Security Disability (SSD) claims are often denied for various reasons, ranging from insufficient medical evidence to technical errors in the application process. Here are some common reasons why SSD claims are denied:

1. Lack of Sufficient Medical Evidence 

Securing Social Security benefits for diabetes under SSD claims hinges on providing substantial medical evidence to affirm the presence and gravity of the individual’s condition. This crucial evidence comprises a comprehensive compilation of medical records, results from diagnostic tests, an extensive history of treatments, and explicit statements from attending physicians. 

2. Failure to Meet Listing Criteria

The SSA maintains a comprehensive list of impairments, known as the “Blue Book,” with specific medical criteria that qualify individuals for SSD benefits. If an applicant’s condition does not match the criteria outlined in the Blue Book or the medical evidence provided does not sufficiently demonstrate the severity of the impairment, the claim may be denied. Applicants must understand the specific requirements of the Blue Book and ensure that their medical evidence aligns with these criteria.

3. Engagement in Substantial Gainful Activity (SGA)

SSD benefits are intended for individuals who are unable to engage in substantial gainful activity (SGA) due to a disabling impairment. If the SSA determines that the applicant can perform work that earns income above a certain threshold, they may be deemed ineligible for SSD benefits. The SSA assesses an applicant’s work activity, earnings, and ability to perform substantial work-related activities when evaluating their eligibility for benefits.

4. Failure to Follow Treatment Plans

Applicants must follow prescribed treatment plans and comply with medical recommendations to manage their disabilities effectively. If the SSA determines that the applicant has failed to seek appropriate medical treatment or follow recommended therapies without valid reasons, the claim may be denied. Non-compliance with treatment can raise doubts about the severity and legitimacy of the applicant’s disability.

5. Insufficient Work Credits

SSDI benefits are based on an individual’s work history and payment of Social Security taxes. To qualify for SSDI benefits, applicants must have accumulated sufficient work credits through their past employment. If an applicant does not meet the work credit requirements, they may be ineligible for SSDI benefits, resulting in a claim denial. Work credits are essential for establishing eligibility for SSDI benefits and are based on an individual’s earnings and employment history.

6. Exceeding Limits

SSDI benefits are subject to financial eligibility requirements besides the medical eligibility criteria. If an applicant’s income or financial resources exceed the limits set by the SSA, they may be deemed ineligible for benefits. Income from sources such as employment, pensions, or other government benefits can impact eligibility for SSDI benefits. The SSA evaluates an applicant’s financial situation to determine their eligibility for benefits.

7. Failure to Cooperate with the SSA

Applicants must cooperate with the SSA throughout the application process, including providing requested documentation, attending medical evaluations or hearings, and responding to inquiries promptly. In particular, when dealing with complex medical claims such as neurological disorder cases, the importance of engaging with the SSA and finding the right attorney for neurological disorder cases must be balanced, as their expertise can significantly influence the outcome of the claim. Failure to cooperate or provide requested information can result in the denial of the claim. 

8. Improvement in Medical Condition

If the SSA determines that an applicant’s medical condition has improved to the extent that they are no longer considered disabled according to the SSA’s definition, the claim may be denied. The SSA conducts periodic reviews, known as Continuing Disability Reviews (CDRs), to assess whether individuals receiving SSD benefits still meet the eligibility criteria for disability. If an applicant’s condition has improved significantly, they may no longer qualify for SSD benefits, leading to a claim denial.

9. Technical Errors or Incomplete Applications

Simple technical errors or incomplete information on the application can lead to claim denials. Errors such as missing signatures, incorrect dates, or incomplete forms can result in delays or denials of benefits. It’s essential to ensure that all required information is accurately provided and the application is submitted to avoid unnecessary denials. Attention to detail and thorough completion of the application are crucial for avoiding technical errors that could result in a denial of benefits.

10. Disability Does Not Meet Duration Requirement

To qualify for SSD benefits, the disability must be expected to last for at least 12 months or result in death. If the SSA determines that the impairment, such as cancer disability, is not severe enough or is expected to resolve within a shorter timeframe, the claim may be denied. The SSA evaluates the duration and expected course of the applicant’s cancer disability when assessing eligibility for benefits. 

Wrapping Up

SSD claims are often denied for reasons such as lack of sufficient medical evidence, failure to meet listing criteria, engagement in substantial gainful activity, non-compliance with treatment, insufficient work credits, financial ineligibility, failure to cooperate with the SSA, improvement in medical condition, technical errors, or incomplete applications. Overcoming these obstacles requires careful preparation, comprehensive documentation, and adherence to SSA guidelines throughout the application process.