Top 6 Reasons Social Security Denies Disability Claims

Section I – Financial Assets

One of the first things that the Social Security Administration (SSA) evaluates when examining an application for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI) is not, in many cases, the disabling condition itself. Instead, the SSA will evaluate the applicant’s financial situation to determine if he or she is functionally disabled. The SSA will deny disability benefits on the grounds of financial concerns if:

• The applicant is still engaged in what the SSA calls “substantial gainful work,” or, rather, work that pays more than a certain amount per month. This amount can vary from year to year, check with the ssa.gov website or an expert to learn the current limits for your area.
• In cases involving SSI if the applicant possesses countable assets in excess of a specific amount (usually 2,000 or 3,000 dollars, depending on marital status). The SSA excludes certain assets from this evaluation, such as the primary residence of the applicant, and one vehicle necessary for transportation. It is usually a good idea to consult with an expert to see which assets are excluded from consideration and evaluate the total value of all assets that are not excluded.

If, after a thorough evaluation of your assets is concluded, you find that you would be in excess of the maximum allowed assets for SSI consideration, you may need to consult with a financial expert to find ways to minimize or disburse your assets.

Section II – Work History

This is another qualification that causes applicants to be denied benefits that they could have otherwise claimed. When the SSA considers an application for Social Security benefits, they consider how much the applicant has become, as the ssa.gov bluebook puts it, “insured under the [Social Security] Act by virtue of their contributions to the Social Security trust fund through the Social Security tax on their earnings.” The SSA will break this evaluation into two different work tests to determine if an applicant meets the minimum required Social Security contributions:

1. A “recent work test” which evaluates how much work the applicant has performed during the last three to ten years based on age. The younger the applicant is, the fewer total number of years that need evaluation. Generally speaking, the SSA requires applicants to have worked at least half of the time before becoming disabled. For example, if you are over the age of 31 when you become disabled, the SSA will evaluate your work history for the ten years prior to the occurrence of the disability, and you would need to have had regular employment for at least five years to be considered for SSDI.
2. A “duration of work test” which evaluates your total number of years worked based on your age. As with the other test, the older the applicant is, the more work that applicant needs to have on file in order to qualify. For example, in order to pass the duration of work test, a 34-year-old applicant would need a minimum of 3 years of total work experience, while a 54-year-old applicant would need a minimum of 8 years of total work experience to be considered for SSDI benefits.

The SSA requires that both “work tests” be passed before an applicant may be considered eligible for SSDI benefits (there is an exception for certain blind applicants, who may only need to pass the “duration of work” test). It is important to note, however, that the “recent work” test is based upon the date in which the applicant became disabled, not the date of application for SSDI benefits, while the “duration of work” test is based on the applicants’ current age. The sooner you can file for benefits, the better, as the “duration of work” test may cost a younger applicant if he or she delays filing for benefits for too long.

Section III – Criminal Convictions

While a previous criminal conviction does not necessarily exclude one from being considered for SSDI benefit payment, an extensive criminal history can complicate matters. No matter the situation of the applicant, the SSA will not pay benefits if:

• The applicant is incarcerated for a violation of the law
• The applicant has an outstanding arrest warrant and is evading custody
• The applicant is in an institution at the cost of the state (Disqualifies an applicant for SSI but not SSDI)

Of course, while not being paid benefits while serving time in any institution is an obvious way that a criminal conviction can deny an applicant SSDI benefits, there is another way that time in prison can affect an applicant’s ability to qualify for benefits.

Applicants are required to pass two different work tests to determine if they have put enough into the Social Security trust to be considered “insured” under Social Security. Time spent in prison is time that the applicant is not paying into Social Security, and may be counted against them in qualifying for SSDI benefits.

Section IV – Severity of Disability

After the non-medical qualifications have been processed, the SSA then determines if your condition is severe enough to warrant SSDI and/or SSI benefits. In order to medically qualify for benefits, an applicant must have a condition that is severe enough to:

• Prevent or severely inhibit the applicant’s ability to perform basic work functions (cognitive recollection, physical ability to manipulate objects to perform necessary tasks, etc.)
• Last for at least one year according to the medical diagnosis
• Meet or exceed a medical condition on the SSA’s List of Impairments

For example, if a laborer has an accident at work and breaks his or her leg, but is expected to recover within six months, he or she would not qualify for SSDI benefits. While a broken leg does prevent the laborer from performing critical tasks such as lifting objects, the duration of the condition is far too short to be considered for SSDI benefits. Even if the condition somehow lasted for over a year, the initial prognosis of six months would have forced the SSA to refuse the initial claim (a better avenue of reclaiming lost income would be worker’s compensation in this case, as the injury occurred on the job).

The SSA makes the judgment of whether or not an applicant’s condition meets this severity requirement based on the findings of both the applicant’s medical records and a special examination by SSA medical experts.

Section V – Failure to Supply ALL of the Necessary Records

When applying for SSDI benefits, it is of the utmost importance to provide as much documentation as humanly possible to the SSA while they consider your case. Information required by the SSA listed on the ssa.gov website includes but may not be limited to:

• Your Social Security number
• Contact information of the doctors, caseworkers, hospitals, and/or clinics that supplied care to you and the dates of treatment/visits
• A list of all medications you are on and their dosages
• Medical records from all doctors, therapists, hospitals, clinics, and caseworkers that have supplied care to you
• All laboratory and test results concerning your condition
• A summary of your work history, where, when, and what tasks you performed
• Your most recent W-2 or federal tax return form

Failure to provide any of these records can prevent the SSA from approving your claim. Falsifying a record can result in charges of fraud. Be sure to confirm that you have all necessary records when you apply for disability. Having an expert to assist in the compiling of documents for a disability application can prevent a misunderstanding and save time and effort. If you cannot find all of the necessary documents, however, the SSA can help you find the necessary information if you tell them what you are missing.

Section VI – Age/Education and the Ability to Change Occupations

One of the major factors that the SSA will examine when determining an applicant’s eligibility is their age at the time of disability. Generally speaking, the older an applicant is, the more readily the SSA will grant an application for disability benefits. The reason for this is that older applicants who become disabled generally have a more difficult time changing occupations in response to a disabling condition.

For example, say a lifelong fisherman in his late fifties has an accident at sea and suffers a cranial injury that destroys his ability to stand upright and maintain balance. Such a major motor disability would prevent the seaman from working on a ship ever again, and would severely inhibit his ability to perform any other physical labor for which he might otherwise have been qualified. Also, the age of this applicant would diminish his ability to learn a new trade by returning to school. In this case, the SSA would be more willing to approve the application because of the difficulty this applicant would have in finding new employment in other fields (such as office work) that his disability would not prevent, but his lack of experience or education does.

A young 22-year-old college graduate in a similar situation would have a harder time being approved for benefits because he would be more able to find new work that would be compatible with his physical limitations. The SSA would attempt to help this applicant find new work through the use of disabled worker’s programs and return-to-work incentives. Failure to comply with rehabilitation efforts could cost the applicant his benefits.

Why would a college education make it harder for the younger man to qualify for SSDI benefits? Simply put, the SSA evaluates an applicant’s ability to return to work as part of the application process. An applicant who has spent decades doing one kind of labor-intensive work has a difficult time changing occupations. On the other hand, an applicant who has training for less labor-intensive work has options that the older man does not possess when it comes to finding new employment. The younger man would have an easier time finding employment in an office setting where he would not be forced to perform intense physical labor, so he may not be found to be disabled by the SSA.

Final Advice

The above factors are some of the most common causes for the denial of an application for SSDI benefits, but they are not the only ones. When applying for Social Security benefits, it is important to have an expert opinion so that you can know all of your options. Having an expert assist you in the application process can mean the difference between a quick, favorable decision from the SSA and a long, drawn out battle for the benefits you are owed.

Know all of your options.