SSDI Claim Rejection Causes: An Examination of Six Key Factors
The Social Security Disability Insurance (SSDI) programme provides financial support to individuals who are unable to work due to long-lasting and severe health problems or disabilities. However, many applicants face denials, leaving them unsure about their eligibility. Here are some common reasons for SSDI claim denials.
Lack of Sufficient Medical Evidence
The Social Security Administration (SSA) requires detailed and consistent medical documentation to prove that a condition prevents an individual from working. Missing test results, specialist evaluations, or ongoing treatment records can lead to denial. It's crucial to ensure that all medical records are complete and up-to-date when applying for SSDI.
Earning Too Much Money
If an applicant's earnings exceed the SSA's Substantial Gainful Activity (SGA) limit, their claim will be denied because they are considered capable of working. The SGA limit varies each year, and it's essential to check the current limit before applying for SSDI.
Failure to Follow Prescribed Treatment
Not adhering to required medical treatments or attending follow-up appointments may cause the SSA to doubt the severity of a disability and deny the claim. It's crucial to follow the prescribed treatment plan to increase the chances of a successful SSDI application.
Inability to be Reached or Failure to Cooperate
Failure to respond to the SSA's requests for information or cooperate with claim investigations can result in denials. It's essential to provide all the necessary information promptly and cooperate fully with the SSA during the application process.
Disability Not Severe Enough
The SSA applies a strict legal definition of disability, requiring that the condition last at least 12 months or result in death and prevent substantial gainful activity. Many claims are denied because the applicant’s condition does not meet these criteria despite being serious.
Other common reasons for denial include incomplete or inaccurate applications and missing paperwork, which can also lead to immediate denial.
Denial Doesn't Mean the End of the Road
It's important to note that a denial of an SSDI claim isn't the end of the road. Applicants can reapply or appeal the decision. Consulting a personal injury lawyer can help if you're struggling to get fair compensation for a car accident or to navigate the SSDI application and appeal process.
Overall, about 67% of initial SSDI claims are denied nationwide, often for the above reasons rather than the actual severity of the medical condition. It's essential to understand the application process and the common reasons for denial to increase the chances of a successful SSDI application.
[1] Social Security Administration. (n.d.). Disability Planner. Retrieved from https://www.ssa.gov/disabilityplanner/ [2] National Organization of Social Security Claimants' Representatives. (n.d.). SSDI and SSI Fact Sheet. Retrieved from https://www.nosscr.org/wp-content/uploads/2019/04/SSDI-and-SSI-Fact-Sheet.pdf [3] National Disability Institute. (n.d.). SSDI Denial Rates. Retrieved from https://www.realitycheckproject.org/ssdi-denial-rates/ [4] Disability Benefits Help. (n.d.). SSDI Denial Rates. Retrieved from https://www.disability-benefits-help.org/ssdi/ssdi-denial-rates
- It's advisable for individuals seeking SSDI to carefully consider their personal-finance situation and, if they are earning over the SSA's Substantial Gainful Activity limit, they may need to adjust their income or take alternative steps to ensure that their claim isn't denied.
- After experiencing a denial of their SSDI claim, applicants should be aware that they can consult a personal-finance advisor or attorney to help them understand their options and navigate the appeal process to increase their chances of securing the financial support they need.
