What are the most common reasons that SSD claims are denied?

An SSD claim may be denied if a person does not meet basic criteria, provide enough evidence, or comply with prescribed treatments and claim requirements.

Each year, thousands of Michigan residents who can no longer work due to disability apply for Social Security Disability benefits. Unfortunately, the majority of these SSD claims end in denial. According to the Social Security Administration, nationally, only 34.8 percent of the SSD claims filed in 2010 – the last year with data available – were approved without further appeal. Unfortunately, claim denial may occur for many reasons, from errors during the application process to failure to meet fundamental requirements of the SSD program.

Financial factors

SSD benefits are only awarded to people who meet specific financial criteria. People who are engaged in substantial gainful activity – which is defined in 2017 as work with monthly income of at least $1,950 – are ineligible for SSD benefits. The only exceptions are for claimants who suffer from low vision or blindness. Furthermore, SSD benefits are awarded based on a person’s work history. To qualify for benefits, a person must have accrued a set amount of credits, which is calculated based on the person’s prior earnings and age of disablement.

A denial made on the basis of these financial criteria is termed a “technical denial.” Of the SSD claims filed in 2010, more than 875,000 – or over three out of ten – ended in a technical denial.

Medical reasons

Many other applicants may be denied SSD benefits because they do not meet Social Security’s strict medical requirements. Social Security uses the following distinctive definition of disability:

• The disabling condition must be anticipated to last for more than one year or result in death.
• The condition must prevent the person from performing any work that he or she previously did.
• The condition must preclude the person from taking up a new form of work.
• Drug or alcohol dependence cannot be a substantial cause of the condition.

These provisions preclude severe but short-term disabilities, along with conditions that cause partial rather than total disablement.

Inadequate evidence

Even when a person qualifies financially for SSD benefits and suffers from a disabling medical condition that meets Social Security’s requirements, a claim may be denied if sufficient medical evidence is not supplied. It is critical that claimants provide evidence of the disabling condition – such as medical imaging and diagnostic tests – and document how it impacts their ability to work. Statements from physicians, former employers, family members and other personal sources can help supplement objective medical evidence.

Failure to meet the necessary medical requirements or prove that these criteria are met is another common cause of claim denial. Upwards of 680,000 of the SSD claims filed in 2010 were declined for medical reasons.

Compliance issues

Finally, many SSD claims may be denied because claimants fail to cooperate with their doctors or with the Social Security Administration. If a person does not follow prescribed treatments that have potential to restore her or his ability to work, a claim may be denied. A person’s case also can be closed if she or he declines to provide necessary information in the application or respond to requests from a claims examiner.

Considering the many errors that can result in SSD claim denial, people who are seeking these benefits may want to consider securing the assistance of an attorney. An attorney may be able to help a person avoid common errors and document his or her case more effectively to improve the odds of a favorable decision.