Because filing for Social Security disability can be complicated, it’s not unusual for a claim to be denied at first; however, many of those who are denied initially go on to be successfully approved for benefits. To increase your odds of approval, it’s helpful to understand why disability claims may be denied.
Although a disability claim may be denied for many reasons, five common problems result are at the root of many denials:
- Top 5 Reasons Why Disability Claims Are Denied
- What Happens if Your Claim Is Denied?
- The Importance of Medical Insurance
Top 5 Reasons Why Disability Claims Are Denied
1. Incorrectly Filled-Out Forms
Your disability claim can be denied for something as simple as a clerical error. Because of the sheer volume of claims that DDS reviewers must assess, forms that are incomplete, illegible, or improperly filled out are often denied simply because employees don’t have the time to scrutinize each one.
To give yourself the best chance of approval, make sure all your paperwork is, completely, and legibly filled out. If you aren’t sure about how to fill out something on the form, seek help directly from the Social Security Administration or reach out to a legal professional who specializes in Social Security disability.
2. Lack of Medical Substantiation
To be approved for disability benefits, you must provide documentation that supports the validity of your claim. Lack of compelling supporting evidence is one of the main reasons disability claims get denied.
For the best chance of approval, your claim should include clear, medically documented evidence of your condition. This may include, but is not limited to, these documents:
- Diagnosis and prognosis
- Physician reports
- Imaging and laboratory results
- Treatment plans and history
- Records of hospital stays or visits to the ER
- Physician statements that describe your limitations
- Statements from family members, friends, or colleagues
- Any other information that may be pertinent to your case
All of the medical information you provide should come from approved sources, including physicians (including psychiatrists and other specialists) and licensed therapists.
3. Treatment Noncompliance
It isn’t enough to prove the existence of a medical condition. Failure to seek adequate medical care and follow a physician- or therapist-prescribed treatment plan can cause a disability claim denial. If you don’t comply with your treatment plan, claim reviewers have no way of knowing what the outcome might have been or whether you may have been able to return to full-time work had the treatment been successful.
Some claimants may have legitimate reasons for failing to follow a treatment plan. If this is true in your case, you or your lawyer should bring it up and provide any supporting documentation when it comes time to appeal.
4. Lack of Cooperation with the Social Security Administration
To get approved for disability benefits, you’ll need to cooperate with any requirements set forth by the Social Security Administration, and failure to do so is one of the main reasons claims get denied. The SSA may require access to your medical records and may even request that you submit to a consultative exam carried out by an SSA-approved medical provider. Although the examination may seem redundant, it’s important to cooperate.
To optimize your chances of approval, you should supply any information that’s requested, respond to all questions and concerns, and show up on time for scheduled appointments, including SSA-ordered medical exams. Failure to do so almost always results in the denial of a claim.
5. You Have Prior Denials
Disability claims are often denied simply because the claimant has a record of prior denials. That’s because you shouldn’t simply refile a claim if you’ve been denied. Instead, appeal your denial through the formal process set up by the Social Security Administration.
What Happens if Your Claim Is Denied?
If your disability claim was denied by the Social Security Administration, you’ll receive a notice of denial, which explains why you weren’t approved. Some letters also include a technical rationale, which offers deeper insight into the reasons for the denial. If your letter doesn’t include the technical rationale, you may request it by calling your local Social Security field office. This can be particularly helpful if you plan to file an appeal.
Preparing Your Appeal
Because so many disability claims are denied initially, filing an appeal may ultimately offer you the best chance for benefits approval, so it’s important to prepare. When getting ready for your appeal hearing, it’s helpful to review your case file, which can be requested directly through your local SSA field office. Your complete file should contain these items:
- An exhibit list that shows everything your file contains
- Copies of all previously filed applications and appeals
- Copies of any additional forms or correspondence
- Any relevant medical evidence, including reports gathered by disability examiners and testimonials from relevant parties
- Transcripts of prior hearings
- Your Social Security earnings record
When reviewing your file, make sure it contains all relevant documentation, including medical records, statements, and transcripts. Verify the accuracy of all forms and supporting documentation so that your appeal can’t be denied for missing or inaccurate information.
Filing an Appeal
Once you’ve received the notice of denial, the Social Security Administration gives you 60 days to request an appeal. You can file an appeal online by visiting your local SSA field office or by calling 1-800-772-1213.
The process for appealing a disability claim takes on different forms depending on the type of denial you received and whether you’ve appealed before. There are four levels of appeals, and your denial letter should contain guidance about which type of appeal to choose:
• Reconsideration: With this type of appeal, your claim receives a complete review by an SSA representative who didn’t participate in the initial assessment. Reconsiderations take into account any new evidence that’s available.
• Hearing by an administrative law judge: This type of appeal involves a formal hearing, either live or via video, in front of an administrative law judge who wasn’t involved in the original decision or reconsideration.
• Appeals Council review: Appeals Council reviews typically examine cases that have already been heard and dismissed by an administrative law judge.
• Federal court review: A federal court review is the highest level of appeal and is typically requested when all other channels have been exhausted. A federal court review is essentially a civil lawsuit that’s heard in a federal district court.
Claimants may also have additional options for recourse, including the right to file an Unfair Treatment Complaint if they feel they’ve been treated unfairly by the administrative law judge that heard their case.
Where to Get Help
The disability claims process can be difficult to navigate, but it’s important to file if a medical condition has left you unable to work and you don’t have private disability insurance to cover your expenses. Thankfully, if you’re feeling overwhelmed, there are places to go for help with filing a claim.
• Friends and family: If you’re unable to file a claim on your own, you can have a friend or family member file online on your behalf. Once the SSA receives the paperwork, they’ll contact you to sign the documents.
• Social Services staff: Social services offices in many states employ social workers and disability advocates, who can help with disability applications.
• SSA representatives: Representatives are available at local field offices to help you navigate the disability claims process. If you’re unable to attend an appointment in person, you can send an advocate on your behalf.
• Your physician: Many physicians are familiar with the disability claims process and can help you complete any necessary forms and gather relevant documentation.
• Disability attorneys: A lawyer who specializes in Social Security disability can help you with everything from the initial application to the appeals process, and can represent your interests when necessary.
The Importance of Medical Insurance
If you’ve been disabled by an illness or accident, it’s more important than ever to have comprehensive health insurance benefits, so make sure you’re covered. Reach out to our dedicated team of licensed insurance agents at TrueCoverage to find affordable medical coverage that suits your unique health care needs.