Top 5 Reasons Why Disability Claims are Denied

Submitted by Kyle on Tue, 02/18/2020 - 14:38

Each year the Social Security Administration denies approximately 60 to 70 percent of the initial disability claims that it receives each year. The applicants who receive such a denial of benefits must pursue the disability benefits appeal process in order to obtain the Social Security Disability benefits that they need.

Unfortunately, the pursuit of such a denial may take two years or more to complete. If you want to avoid having your initial disability claim denied, it’s important to understand why so many claims are denied in the first place.

To increase your chances of having your initial claim for benefits approved, make sure you don’t make one of the following mistakes.

Most disability claims are denied during the initial review, and many claims are denied more than once. While there are many reasons for claims to be denied, there are some reasons that are more prevalent than others. Here are some of the main reasons that disability claims are denied and what you can do to avoid such pitfalls.

1. Lack of Sufficient Medical Evidence

Oftentimes when a Social Security Disability applicant submits a claim for Social Security Disability benefits, they fail to provide the SSA with sufficient objective medical evidence in order to prove their disability claim.

Without this vital evidence, the SSA is forced to deny the applicant’s disability application. If you want to increase your chances of a favorable outcome of your disability claim, it is important that you provide the SSA with as much objective medical evidence as possible.

Remember, it is better to err on the side of caution and that there is no such thing as too much evidence when it comes to a claim for Social Security Disability benefits. Review the Blue Book with your doctor to make sure you have all tests and documents required in the listing for the condition you are experiencing.

Disability Determination Services (DDS) needs to have hard medical evidence to support your claim. This includes medical test results and records that indicate the severity of your condition as well as the restrictions and limitations that you suffer because of the problems.

If you don’t have the records to provide the details, then you should talk with your physician. Additional medical testing may be ordered, or your doctor may need to provide more detailed notes. If you don’t have the medical evidence, your claim will be denied. Medical evidence is essential to the success of your disability claim and its outcome.

2. Improperly Completed Claim Forms

There are many forms that must be filled out when submitting a claim for Social Security Disability benefits and these claim forms must be filled out properly if you are going to be awarded the Social Security Disability benefits that you are applying for.

Make sure every “i” is dotted and every “t” is crossed when filling out your Social Security Disability application paperwork and provide detailed answers to each and every question.

The claims process is complex, so you need to make sure that all paperwork is completed in detail and that you provide the supporting evidence that you need to show that your condition is disabling. Don’t skip questions. Be sure that all questions are answered truthfully and in detail.
You will need to make sure any requests for additional information or evidence are responded to in a prompt and efficient manner and that you meet any deadlines. Just skipping a single question or failing to answer one question in detail can be detrimental to your disability claim.

For all the answers, you should make sure that you provide supporting documentation. As an example, if you say that you cannot stand for long periods, you will need to specify how long you can stand and why you cannot stand any longer. You will need to provide medical evidence to support this claim.

Top 5 Reasons Why Disability Claims are Denied

3. Failure to Comply with a Consultative Exam

Sometimes the Social Security Administration will request that an applicant attend a consultative exam performed by a third-party medical expert.

If you refuse to attend this exam or fail to show up for your appointment, your claim for Social Security Disability benefits is likely to be denied. If the SSA requests that you attend a consultative exam, it is in your best interests to comply with their request.

If the SSA feels that they need more information, or if they question the information provided by your medical provider, they may ask for a consultative exam to be performed by a third-party medical expert that they hire. It is imperative that you attend this appointment.

They will send you notification about this appointment, and include the date, time and location of the exam. You need to make arrangements to attend this appointment at the date and time it is scheduled. If you need to, make transportation arrangements well enough in advance to get there for the evaluation.

When you go to the exam, respond to the prompts of the healthcare provider and truthfully answer any questions. Let the healthcare provider know about the severity of your symptoms and how you are limited from performing any work duties. Also, indicate any restrictions or limitations for performing routine tasks and daily activities. You need to let them see the overall picture of your health and how you are affected by the severity of your medical problems.

4. A Case That Just Isn’t Strong Enough

Even though your disability prevents you from performing the work you’ve performed in the past, that does not necessarily mean that the SSA will rule that you are unable to perform any type of work at all.

If the SSA determines that there are other types of work that you can perform, you will be denied Social Security Disability benefits. This is why it is so important that your medical evidence and residual functional capacity forms detail exactly how impairing your disability is in your everyday activities – not just those that are required of your current or most recent job.

Sometimes the medical records don’t accurately portray the severity of your condition, or the disability examiner cannot fully comprehend your limitations and restrictions because of the medical issues that you suffer. When medical records aren’t strong enough to paint the picture for the disability examiner, then a residual functional capacity (RFC) form can help you.

The RFC is a detailed form that explains what you can and what you cannot do. It paints a vivid picture of how your medical problems affect your ability to perform daily activities as well as work and earn a living. If your physician – who is most familiar with your medical conditions and restrictions – fills out the RFC, it can be a significant boost for your case.

The RFC will indicate everything – such as how far you can walk, how much you can lift, if you can reach or bend, how long you can stand, how often you must be repositioned, and if you cannot work around certain materials, such as inhalants or dust. When the RFC is reviewed, it should show the disability examiner what kinds of jobs – if any – you can do.

5. Failing to Seek Out Legal Help

Many of the Social Security Disability claims that are denied would have been approved had the applicant sought out the services of a qualified disability attorney prior to filing their Social Security Disability paperwork.

These professionals can help an applicant prepare their paperwork properly and will help ensure that the SSA is provided with the medical evidence that will be needed to support the claim for benefits from the Social Security Administration.

While it is true that initial disability claims are denied more often than they are approved, keep the above five facts in mind and your chances of being approved during the initial claim process can increase significantly.

Disability claimants represented by an attorney are three times more likely to have your claim for disability benefits approved. If you try to handle the claims process on your own, you are more likely to fall through the cracks, miss some important information, fail to complete the paperwork accurately and completely, and even miss deadlines.

A disability lawyer understands the claims process and will be able to determine the best way to proceed with your disability claim. Your lawyer will gather the pertinent evidence and medical records then carefully review them to make sure that everything is in order and that you have a claim that meets the criteria to be approved for disability benefits.

If you don’t enlist an attorney’s help, you may find yourself in a situation where you don’t know how to respond or you may not know exactly what evidence is needed to convince the disability examiner that your condition is severe enough to warrant disability benefits. You need to be able to show that you are legally disabled and will not be able to work for a year or longer.

There isn’t an excuse for delaying getting the legal representation that you need for a successful disability claim. Disability lawyers take cases on a contingency basis, which means that your lawyer will not be paid until you win your claim and are approved for disability benefits. At that point, your lawyer will receive a percentage of your backpay.

You should have an initial consultation with a disability lawyer to determine the best way to get your claim underway and to determine if you need additional documentation and evidence to get your claim on track and get the disability benefits that you need.

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