Common Reasons for Denial of SSDI Benefits in Massachusetts and Nationwide

By Tdmalone at en.wikipedia [CC BY-SA 2.5 (https://creativecommons.org/licenses/by-sa/2.5)], from Wikimedia CommonsAnyone who has worked for a long enough period of time, and contributed enough in payroll taxes, could be eligible for benefits through the Social Security Disability Insurance (SSDI) program. This is a federal program that offers support to people who are unable to work because of a disability (or what is categorized by the Social Security Administration (SSA) as a medical diagnosed severe medical impairment). Applying for SSDI benefits is a lengthy and complicated process, but a knowledgeable Social Security attorney can help you prepare your application in order to present your claim in the best way possible.

An SSDI application requires a substantial amount of information about your medical conditions, ongoing medical treatment, work background, financial circumstances and daily activities.  The number of reasons the SSA might deny a claim is nearly infinite, but some reasons are quite common for workers in Massachusetts and around the country.

Lack of Medical Evidence

In order to be eligible for SSDI benefits, you must convince the SSA that your severe medical conditions (physical and/or mental ) prevent you from working gainfully (which is defined as the ability to undertake substantial gainful activity on a regular and continuing basis: simply what is deemed to be the ability to earn $1090 per month at any job for which one is reasonably suited by age, education or experience).  The best way to do this is with detailed medical records from your health care providers (and, if possible, with supportive medical reports from your physicians, that address the nature and severity of your medical conditions and how they impact you from working).  One of the most common reasons for denial of an SSDI claim is a failure to provide sufficient medical evidence that adequately addresses Social Security’s complex regulations.

The Social Security Administration (SSA) will not take your word for it that you cannot work. Ideally, you can provide medical evidence that shows how your condition has developed or progressed, or that demonstrates a distinct point in time when you became disabled. However, SSA does not want to see conclusions drawn from your medical providers that you remain unable to work or see that your doctor is drawing a conclusion that you should qualify for benefits: they simply want to see appropriate objective medical documentation based on examinations and testing that evidence the severity of your condition, and a indication from your doctors as to how the medical conditions impact your ability to perform various basic activities that would be necessary in a work setting (for example, the ability to sit for a length of time, stand for a length of time, walk for a period of time, lift, carry, push, pull, maintain attention and concentration, deal with work stress, and the list of activities is much more extensive than this).  Having an aggressive attorney who specializes in Social Security disability matters assist you with obtaining such evidence can make all of the difference in satisfying Social Security’s need to see proper medical documentation of one’s disabling condition.

Income-Related Reasons

You may be approved for SSDI benefits even if you are still working, but only if your income does not evidence to SSA your ability to earn substantial gainful wages (again, defined as the ability to earn up to $1090.00 per month).  Even assuming one is earning only $500, $600 or  700 per month may still form the basis for the SSA to determine that one remains capable of earning more (and earning SGA level wages).  Thus, having an experienced attorney advise you as to how the Social Security Administration may review your earnings in light of the schedule you keep, the type of work you’re performing, your age, education and experience, etc. will help you determine whether an application for Social Security disability benefits even makes sense.   Assuming one is earning $1090 per month on a regular basis will serve as the basis for a technical denial at step 1 of Social Security’s sequential evaluation process as they will determine that one is indeed earning substantial gainful wages and is not “disabled from substantial gainful activity” as is required under the law.  Assuming one is earning under $1090 per month, however, may still cause a denial from the standpoint of a decision by the SSA that one still remains capable of SGA level earnings (which is a separate basis for a denial).

Duration or Severity of Your Medical Condition

An injury, illness, or other disability must be a severe medical impairment that hinders one’s ability to work (that is, earn SGA level earnings) for at least 12 months, or must be a condition that is expected to result in death, in order for one to meet the medical requirements of the Social Security Act. Many acute injuries, such as a fractured bone resulting from a car accident, result in denials because they are not likely to remain a disabling severe impairment for the required 12-month period. SSA investigators make these determinations on a case-by-case basis, however, and many times simply having a certain medical condition may not answer the question as to whether the condition will remain disabling such that one would not be able to perform either 1) one’s past work or 2) other work,  for which one is reasonably suited by age, education and experience, and for which there are significant jobs in the regional or national economy) at which the individual could earn $1090 per month (substantial gainful wages).  These decisions are determined on a case-by-case basis, and the decision could take into account factors such as your age, the physical or mental demands of your field of work, your past education and your past work experience.

Failing to Follow Medical Treatment

The SSA can deny your SSDI claim if your medical records indicate a failure to follow the treatments or therapies prescribed by your doctor, such as medications, physical therapy, and checkup appointments. If you are unable to afford treatment, are physically or mentally unable to participate in treatment, or have a bona fide religious objection to the treatment, the SSA may excuse this requirement.  Continuing to smoke cigarettes or drink alcohol when doctors point out in the records that these activities may be causing one’s medical difficulties to worsen likewise can be the basis for a denial based on one’s failure to follow prescribed treatment.

Failing to Cooperate or Communicate with the SSA

You must agree to release your medical records to the SSA so they can review your claim, and you must be available to provide additional information if requested (including the forms that are requested of you) or attend appointments with Social Security’s doctor(s) if requested to do so.   If you do not cooperate with providing the requested form or attending the scheduled examinations, or if  the SSA cannot reach you or your lawyer for follow-up questions/issues, your claim may be denied.

Drug or Alcohol Abuse

The Federal law was changed in the mid 1990’s such that if alcohol and/or druges are deemed to substantially contribute to one’s disabling condition then benefits are not payable.  Consequently, if one is actively using drugs (other than those lawfully prescribed) and/or alcohol and it is evident that such use is contributing to the severity of one’s disabling condition, one may very well face a denial.

Criminal Convictions

The SSA may deny your claim for benefits if you sustained the injuries resulting in your disability in prison, your injury occurred during the commission of a felony for which you were convicted, or you are in prison for a felony conviction at the time of your application.

Fraud

If the SSA concludes that you made false or misleading statements, used dishonest means, or engaged in other forms of fraud in an attempt to obtain SSDI benefits, it will deny your claim.  One may also face criminal prosecution for acts of fraud associated with any application for benefits.

Contact the Law Offices of Russell J. Goldsmith today at 1-800-773-8622 to schedule a free consultation and obtain the advice and assistance you need in order to get your Social Security claim started.