Applying for Social Security Disability (SSD) benefits can feel overwhelming, especially if you receive a denial letter after your initial application. The truth is that most first-time SSD claims are denied. We are here to share and help you understand why it happens, so you can work to avoid making these mistakes.
BUT FIRST: Let us share that obtaining legal representation is the best first step in applying for disability benefits. By obtaining legal counsel, you can increase your chances of approval by up to 33%. Another benefit of having legal representation is that there are no upfront fees. Typically, disability attorneys or advocates work on a contingency basis, which means they do not get paid unless you receive your benefits.
Here are five reasons disability claims are denied the first time—and how to avoid them.
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Lack of Sufficient MEDICAL EVIDENCE
The most common reason for denial is simply not having enough medical documentation to prove your disability. The Social Security Administration (SSA) relies heavily on medical records. Your medical records must clearly show the diagnosed condition, what you are doing for ongoing treatment, and how the condition limits your ability to work.
How to avoid this:
Make sure you provide complete medical records from all healthcare providers, including test results, treatment history, and provider notes. Also, if you have legal representation, their support team should be able to assist and guide in this process.
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Earning Over SUBSTANTIAL GAINFUL ACTIVITY (SGA)
SSD benefits are designed for individuals who cannot engage in SGA. Even if you have a serious condition, if you’re earning above the SSA’s income threshold, your claim may be denied.
How to avoid this:
Understand the current SGA limit, and when you are applying for SSD, be sure your earnings are below it. Even if you’re working part-time, be aware of how much you’re making.
At Parmele Disability Advocates, we respect your time. One way we do this is by reviewing your income at the very beginning of the process. If you earn above SGA, we will discuss that with you and help determine what your next steps should be.
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Failure to Follow Prescribed Treatment
If you do not follow your doctor’s prescribed treatment plan, the SSA will more than likely assume your condition could improve if you did. Not following your doctor’s treatment plan could include skipping medications, missing provider or therapy appointments, or refusing recommended procedures without a valid reason.
How to avoid this:
(insert treatment plan) When your provider gives you a treatment plan, follow it as closely as possible. Valid reasons for not following it may include financial limitations or experiencing severe side effects. If this is the case, be sure to document the reasons clearly and explain them to your legal counsel as well as the provider.
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Application Errors or Missing Information
SSD applications are detailed, can be confusing, and require a significant amount of information. Filling them out on your own may lead to missing forms, incomplete answers or information, as well as inconsistencies between documents. All of these can lead to automatic denial.
Some common mistakes include leaving sections blank, incorrect dates or work history, as well as failing to list all medical providers.
How to avoid this:
Double-check your application before submitting it. Better yet, allow your legal representative to complete the paperwork for you. Our attorneys have over 150 years of combined disability experience, which allows us to provide you with top-shelf service, which includes completing your paperwork for you, carefully and accurately. Let us do this for you to ensure every I is dotted and T is crossed, then all you need to do is sign your name.
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Condition Is Not Considered Severe Enough
To qualify for SSD, your condition must significantly limit your ability to perform basic work activities for at least 12 months, or sadly, be expected to result in death. If the SSA believes you can still work at your previous job or perform other types of work, your claim may be denied.
How to avoid this:
Clearly explain how your condition impacts your daily life and ability to work. Detailed statements from your doctor about your functional limitations can strengthen your case. Also, keep detailed records of how your conditions affect your inability to work. For example, if you are unable to stand for extended periods of time due to leg pain or numbness in your extremities, be sure to write that down. Also, your legal counsel must be aware of all this information and any changes to your situation as soon as they occur. They can offer input to help strengthen your claim and answer any questions you may have about this situation.
A disability denial isn’t the end of the road—many times it is part of the process. Many people who are denied initially go on to win benefits through the appeals process. The key to winning your benefits is by understanding what went wrong and how you can strengthen your claim moving forward.
The legal team at Parmele Disability Advocates has a combined 150+ years of disability representation experience—who wouldn’t want that level of competency representing them? Call Parmele’s experienced team today at 866-815-5244 to schedule a no-cost consultation where we will review your claim, answer any questions, and help determine your next best steps.
Parmele Disability Advocates. Helping you get the benefits you deserve.