Why Benefits Are Denied

Dec 09, 2015
Tagged with: Why Benefits Are Denied

Being diagnosed with a disability can be stressful and frightening as well. There are many health and life issues to deal with, it can be  multiplied by the financial worries that often accompany people with a disability especially if it prevents you from continuing your job.Disability benefits like Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) can lessen these worries to some extent, but they can be denied as well. But before getting into the details of what to do if your SSDI/SSI benefits are denied, let’s take a look at the reasons behind such denials.

Why SSA Denies SSDI/SSI Benefits?

Most people usually focus on the points why they must be granted SSDI/SSI benefits when applying. But understanding the reasons why the federal body often denies them is equally important. This will help you to avoid things that can result in a denial.

  1. Your Income is Too High

SSDI is a benefit program for American workers who pay for Social Security benefits. Those working at the substantial gainful activity (SGA) level are ineligible for such benefits. So if the government thinks you are earning too much money to deserve the disability benefits, your application will be denied.

SSI, on the other hand is a disability benefit designed for low-income people. Here again your monthly income cannot exceed the SGA level when you are applying for this benefit. But there is a limit on your earned and unearned income and your SSI payment can be reduced even after approval, should your monthly income exceed the said limit.

  1. The Impairment isn’t Long-Term or Severe Enough

To qualify for SSDI or SSI you need to convince the Social Security Administration (SSA) that your disability is severe enough to last at least 12 months or result in your death. However, this rule doesn’t apply to blind SSI applicants.

  1. The Disability is Caused By Alcoholism or Drug Addiction

Applicants with a history of alcoholism or drug addiction, which contributed towards the disability are also denied the benefits of SSDI. However, there is a chance of being approved if you have recently stopped using alcohol or drugs.

The SSA can also deny application if you are convicted of a crime. Again, this clause won’t stop you from getting SSI disability benefits, although you cannot collect them.

  1. You Don’t Follow the Prescribed Therapy

Disability benefits can be denied if you fail to follow your doctor’s prescribed therapy, despite having the ability to do so. The SSA, however, recognizes legitimate medical excuses, especially those beyond your control.

As said earlier, you can avoid a few of these reasons with due diligence. But if you have still faced an unfavorable decision, the first thing you should do is talk to your personal injury lawyer to appeal for reconsideration.

Your Application is Denied

If your SSDI/SSI application has been denied, appeal for a reconsideration immediately. There is a 60-day deadline to appeal your claim. Although you must have a lawyer representing your case to the SSA, you should always request your appeal personally.

Reconsideration Request

Most applicants commit two mistakes – they appeal too late or file a new claim. And both lead to a loss of appeal rights and therefore you need to start once again with a new SSDI/SSI application.

The disability appeal process requires you to file an appeal request within 60 days of the denial with the SSA. After you make a request for reconsideration, the SSA will review your application for a second time and it may take as much as three to five months to get the results.

Request for Hearing

The second step includes a hearing, which you can appeal for if your reconsideration request has also been denied. Again, you have 60 days’ time to request for a hearing to the SSA.

Appeal with the Appeals Council

You can even contest the judge’s decision and appeal it with the Appeals Council. The review process can take a long time, ranging from six months to a year, before the Appeals Council gives its verdict.

File a Claim at the Federal District Court

If the Appeals Council also denies your application, you can still ask for a review in the Federal District Court. Your SSDI/SSI application can be approved or denied by the Federal District Court or send it back to the SSA for further review. A significant number of appeals get approval at this stage.

Conclusion

As you can see you have the best chance of winning an approval for your SSDI/SSI application during the disability appeals process. Filing a brand new application, on the other hand, is just a waste of time. Talk to your Social Security Disability lawyer immediately to get details about the reconsideration request process if your initial application has been denied by the SSA.

 

 

Author: Rachel Oliver