Applying for Social Security Disability can be challenging, and unfortunately, many first-time applicants are denied. The Social Security Administration (SSA) enforces strict eligibility standards and has specific requirements for documentation, so understanding common reasons for denial can help you prepare a more effective application. Here’s an overview of typical pitfalls and how to avoid them.
1. Insufficient Medical Evidence
- Why It Leads to Denial: Social Security Disability in California applications require comprehensive medical documentation to support claims of severe, long-lasting disability. Many denials occur because applicants fail to provide adequate evidence proving their condition meets SSA’s disability criteria. Missing records, outdated information, or lack of specific details on how the disability affects work capabilities can result in an unfavorable decision.
- How to Avoid It: Regularly visit your healthcare provider, keep your medical records updated, and ensure detailed documentation of your symptoms and limitations. Include test results, treatment histories, and statements from your doctor describing how the condition limits your ability to work. Additionally, asking your doctor to complete a Residual Functional Capacity (RFC) form can clarify the extent of your limitations and strengthen your case.
2. Failure to Follow Prescribed Treatment
- Why It Leads to Denial: If an applicant does not follow the recommended treatment plan or fails to take prescribed medication, the SSA may conclude that the disability isn’t as severe as claimed or that the condition could improve with treatment.
- How to Avoid It: Adhere closely to your doctor’s treatment plan and attend all follow-up appointments. If there are valid reasons for not following a particular treatment, such as adverse side effects, financial limitations, or religious beliefs, communicate these to the SSA. In some cases, exceptions can be made, but clear explanations are essential.
3. Earning Over the Substantial Gainful Activity (SGA) Limit
- Why It Leads to Denial: SSDI is designed for people who are unable to work at a substantial level. If an applicant is earning above the SSA’s defined SGA threshold ($1,470 per month for most applicants in 2024), the application will likely be denied, as this income level suggests they can perform substantial work.
- How to Avoid It: Ensure your monthly earnings remain below the SGA limit when you apply. Additionally, if you attempt to work while applying, keep careful records and inform the SSA. In some cases, limited work attempts are allowed under the “trial work period” without disqualifying you.
4. Lack of a Severe, Long-Lasting Disability
- Why It Leads to Denial: SSA only grants SSDI for severe conditions that are expected to last at least 12 months or result in death. Short-term or partial disabilities typically do not qualify, even if they prevent you from working temporarily.
- How to Avoid It: Before applying, ensure your condition aligns with SSA’s duration requirements. If your condition worsens or you receive a new diagnosis after applying, update the SSA immediately to provide current information.
5. Incomplete or Inaccurate Application
- Why It Leads to Denial: Errors, omissions, or inconsistencies in an SSDI application can lead to automatic denial. This includes missing information on medical history, gaps in work history, and failure to fully explain how the disability limits employment.
- How to Avoid It: Carefully review your application and make sure all details are accurate and complete. Consider seeking help from a disability attorney or advocate who can guide you through the application, double-check your paperwork, and address any gaps.
Receiving an SSDI denial can be frustrating, but understanding common reasons for denial can help you avoid them from the start. Thorough medical documentation, consistent treatment adherence, and an accurate, complete application are all critical steps in building a successful claim. If your claim is denied, remember that you have the option to appeal, and many applicants ultimately succeed in getting benefits through the appeals process.