The Difference Between Technical Denials and Informal Denials in a Disability Case

Submitted by CM on

There are two types of denials in a disability benefit claim application. These are technical denials and informal denials. They are similar because both types of denial result in your disability claim being denied prior to a medical determination.

Apart from that, the two denials are in fact quite different. A technical denial requires an actual determination by the Social Security Administration (SSA) and there are also appeal rights.

This means an individual has certain amount of time to disagree with a decision by asking that the denial be reconsidered. Only after meeting the non-medical requirements can a disability claim be forwarded for a medical determination.

Informal Denials

Informal denials involve Supplemental Security Income (SSI) disability benefits which are income and assets tested before a decision is made. If a Social Security representative determines that an individual's income is too high or it is determined that an individual has too many resources such as assets then the denial is called an informal denial.

Income could include wages, workers compensation or money from other public disability programs. Assets could include owning more than one vehicle, land, owning more than one home, stocks, bonds and trust funds, etc. to qualify for disability in the program then the social security representative may issue an informal denial. The case never gets to the medical determination stage.

An informal denial basically saves interview time for the disability applicant, because they will not be required to provide all the information such as medical records involved in a full claim.

Technical denials

These are more related to Social Security Disability Insurance (SSDI) benefits. A technical denial may be based on the applicant’s financial position which would be calculated before requesting a medical determination. This could include the following:

  • 1. Lack of insured status. This means you have not earned enough work credits to be covered for SSDI or you have not worked enough time in the last 10 years to be sufficiently insured for eligibility for disability benefits.
  • 2. Unable to prove a relationship in the case of adult disabled children or disabled widow/ widower disability claims.
  • 3. Failing to cooperate with the claims representative or disability examiner when asked to provide necessary information needed in order to forward their disability claim to the state disability agency for a decision to be made.
  • 4. Taking part in too much substantial gainful activity to be eligible for disability benefits. The monthly amount is set each year by the SSA so any disability claim which is over the threshold will be given a technical denial and the case will not be forwarded to the state disability agency for a medical determination.

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