Top 10 Reasons Disability Claims Are Denied And How To Avoid Them

Denied Social Security Disability

Insufficient treatment. If you are applying for disability benefits, you need to treat enough to establish your diagnoses and the severity of your conditions. Your medical records are what Social Security uses to determine whether you are disabled, so it is a good idea to make sure your doctors are documenting what you deal with on a day to day basis.

Poor medical care. Poor medical treatment will typically repeat the same phrases for each appointment and lack corroborating examination detail. Your providers should be completing full examinations, to prove the extent of your medical conditions. At times, you may need to investigate better care if you feel that your providers are not listening to you or providing you with the best care.

Lack of medical testing. A classic cause for denials is a lack of MRI’s, with x-rays revealing limited findings. Depending on the conditions, objective medical testing can make or break a claim. Certain tests may prove certain medical conditions to satisfy Social Security’s standards, such as an EMG for neuropathy. You can inquire whether such tests are appropriate at your medical appointments.

Uncomplaining claimant. Some people simply do not complain, neither to their loved ones nor their doctors. While this stoic approach may seem brave, it can significantly hamper medical treatment and strip the medical record of subjective symptoms. You should cooperate with your providers to allow them to do their jobs. Then, the medical treatment notes may better prove the extent of your limitations.

Overthinking claimant. Some claimants engage in a strategy of proving their disabilities rather than letting their providers do the doctoring. This classically occurs for some conditions that have strong subjective bases and require extensive testing to prove, such as fibromyalgia, connective tissue disorders, and somatoform disorders. If you are forcing treatment decisions on your providers, your providers may believe you are exaggerating. You should do research but learn to trust your treatment providers’ decisions about care.

Drug-abuse. Drug and/or alcohol abuse tends to make Social Security ignore mental health issues due to “materiality.” If you have an issue with this, you should get help to get and remain clean and sober if you wish to have a better chance at an approval for benefits. Attorneys may condition their continued representation on this factor. For example, if you cannot get or remain clean and sober, an attorney may choose to withdraw their representation.

Remote DLI. The date last insured, or the date by which we must prove you are disabled, will dictate what evidence can be used to prove your disability. For clients with a DLI in the remote past (over three or so years ago), we must take great care to get any and all records that document medical conditions, including one-time ER visits, ambulance notes, letters from neighbors, prescriptions for canes, etc. If you have a remote date by which we must prove you are disabled, we will try to help you think of significant events on or before this date to jog your memories as to your limitations near that time period.

Missing client. A major obstacle to winning a hearing can be that a client moves without letting us know how to contact them. Social Security’s long timelines cause people to lose their homes and move while they await hearings. Make sure you always keep your attorney informed as to how to get in touch with you. Most judges will not allow hearings to occur without a client present, and even if they do, they will not be able to pay you benefits without knowing your whereabouts.
Work. If you want to work or plan to work while you apply for disability benefits, there is a limit as to how much you can earn and still receive benefits. This amount changes from year to year. You should also clear any work activity with your physicians and/or other providers. You should also inform your attorney and the social security administration of any earnings that you have.

Duration/Medical improvement. In these cases, disability must last a continuous 12 months or more. If you improve medically and can return to substantial gainful work, make sure, again, that you are discussing your return to work with your providers. That way, the medical records document the medical improvement that allows the return to work. If a return to SGA work occurs under 12 months from the AOD (alleged onset of disability), a withdrawal may be in order before a hearing is held.

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