Updated: May 20
As many know, Social Security Disability claims can take years to resolve. Often these people have medical doctors telling them to file for disability and even documenting in the medical files that people are not able to work. So why do these people get denied? Below are the top five reasons claims, that will ultimately be approved, are denied at the initial level and the reconsideration level.
1) The Number 1 reason people get denied is medical doctors not understanding what Social Security needs. I see a lot of really great and compassionate doctors who genuinely want to help. These doctors are used to dealing with work comp claims and short term or long term disability claims. In those matters, the doctor can simply state that someone needs to be off work and the claims proceed accordingly. However, the issue of someone's permanent disability under the SSA guidelines is entirely up to the person adjudicating the claim. These people must follow very strict and specific guidelines to determine if someone meets the definition of disability. It is crucial to ask the medical doctor the right type of questions to get a statement of someone's abilities rather than a blanket statement of inability to work. Only then can the doctor's statement be used to determine one's disability.
2) Lack of sufficient objective medical documentation is the next big culprit in a denial of a claim. If someone has had 3 surgeries 10 years ago and their pain suddenly becomes so bad they have to stop working, the SSA cannot rely solely on 10 year old testing. Likewise, it is rare that the first levels of review are going to put much weight on an individuals complaints of pain without clear diagnostic testing or other objective results substantiating the complaints. It is essential to obtain any potential diagnostic evidence to support a claim for disability. Medical statements of restrictions from your doctor, without some type of objective evidence to back it up, will not carry enough weight to convince the SSA that you are disabled.
3) The wrong Onset Date is another frequent culprit. The guidelines the SSA uses to determine your disability use your age as one of the main factors. Sometimes a claimant's results will change based on whether they are 49 or 50, 54 or 55, or 59 or 60. Often the medical records start slow with only minimal reports of symptoms. Perhaps someone was misdiagnosed for a long period of time or no diagnostic testing was performed. Claimants may misunderstand the date of onset and put the date they started having medical issues or the date they were formally diagnosed even if they worked well after that date. It is essential to look at the big picture to determine the onset date that will give the most benefits while offering the most substantial proof of disability.
4) Emphasizing one disability where there are several contributing factors. Some claimants will focus on one issue that may present the most pain or that they take the most medications for, but that does not mean that condition contributes the most to their disability. Often disability is a combination of several conditions that, when considered together, result in the person's disability. It is important to prove each limitation from each condition.
5) Failure to complete paperwork is the other major issue often associated with denials. From the moment you complete your application there will be a series of forms for you to complete either online or by mail. Failure to return the appropriate and fully completed paperwork results in a failure to obtain all of your records. The Social Security Administration only goes back so far and tries to focus on the time period you allege your disability began. Sometimes they need to go back a little further. The paperwork is essential to complete the claim.
There are many other pitfalls in handling these claims. Often the representative acts as a translator for you so that you and Social Security are speaking the same language. A representative can help you get the paperwork completed, obtain the information necessary to be successful from your physicians, and analyze your claim to give you the best possible chance for success. Most representatives work on contingency fees meaning we do not get paid unless we are able to get you approved for benefits. You don't have to be afraid, and you don't have to do it alone. Schedule an appointment today to discuss the specific details of your case.