Making mistakes when filing for Social Security Disability can result in benefit denials. More than 70% of claims get rejected during the initial application stage. Many of these denials happen because of mistakes made during the application process. When disability claims are denied, applicants must reapply or file appeals. Often times, hiring a social security lawyer to make the initial claim will avoid these problems. Currently, over 800,000 people are awaiting decisions on their appeals.
Why are Disability Claims Denied?
First-time application denials may not mean that those seeking benefits do not qualify. Rather, the issues that cause rejections are often minor and procedural in nature; leading many to receive benefits through the appellate process. Understanding and adhering to the program’s eligibility and application requirements may help people improve their chances for initial approval. These are some of the most common mistakes people make when filing for disability.
1. Providing Incomplete or Incorrect Information
Failing to provide the Social Security Administration with full, accurate information can result in rejections. The SSA requires detailed information to make eligibility determinations. People applying for disability benefits must include:
- Birth certificate or other proof of birth
- Medical evidence of the condition
- Work history for 15 years prior to the disability
- W-2 forms or self-employment tax returns for the previous year
In addition to providing all the required information and documentation, it is important for people to make sure any statements or information they provide are accurate and do not conflict with any other facts of their claims. A mistake as simple as a misspelled physician name could result in a costly and time-consuming denial of benefits.
2. Applying for Benefits with a Non-Qualifying Condition
The SSA rejects benefits claims for conditions that do not qualify as disabling under the program’s definition. To be eligible, people’s conditions must prevent them from performing any type of substantial gainful activity, not just their current job duties. Conditions must also be long-term or terminal. The types of medical conditions that may qualify include cardiovascular problems, respiratory illnesses, neurological disorders, mental disorders, immune system disorders, and cancer.
Some conditions that are considered disabling by employers or disability insurance companies are not eligible for benefits through the SSD program. The SSA considers applicants’ work histories for the 15 years before their filings to determine if there is some other type of work they could reasonably be expected to perform.
3. Failing to Attempt Appropriate Treatment
People must seek medical treatment and make an effort to overcome their disabilities or their claims for SSD benefits may be denied. In addition to attending follow up appointments as ordered by their treating physicians, people must follow their medical providers’ recommended treatment plans. Exceptions may be granted to applicants in cases when they underwent numerous treatments that did not work before deciding against other treatment suggestions.
Applicants must also attend consultative exams requested by the SSA. To gather more information, the SSA may ask people to undergo examinations by a third-party medical expert. Refusing such exams or neglecting to show up for scheduled appointments may result in rejection of people’s applications.
4. Applying Too Soon or Waiting Too Long
Filing for SSD benefits too early may lead to application denials. In anticipation of lengthy processing times, some may initiate the SSD benefits process as soon as they are diagnosed with a disabling medical condition. However, they must prove that their condition will keep them out of work for at least 12 months and will prevent them from performing any type of work they have previously done. Should they apply too soon, applicants may not have adequate documentation regarding their conditions and how long they are expected to last.
Waiting too long to apply for SSD benefits can also cost people an initial approval. The SSA uses the most current medical records to make eligibility determinations. Filing delays may cause medical information to become outdated. This may result in a rejection or requests for additional exams and documentation to support people’s claims. Additionally, back pay on benefit claims is limited to the 12 months before the application filing date. Waiting beyond that time frame may cost people back pay that could be helpful in providing for themselves and their families.
5. Applying While Working or Receiving Unemployment
Suffering from a disability alone is not enough to entitle people to SSD benefits; their conditions must also prevent them from working. Therefore, people who are working when they apply for benefits may have their claims denied on the basis that their conditions are not fully disabling.
Receiving unemployment benefits when filing for disability may also result in rejections of claims. Qualification guidelines for these two programs contradict each other. To be eligible for unemployment benefits, people must be willing and able to work. In some states, they must also be actively looking for a job. Filing for disability indicates that the claimant is unable to work.