You can be denied disability a total of 5 times. The first time will be on your initial application and can be for a variety of reasons. If your initial SSDI or SSI claim has been denied, the system allows you to enter an appeals process that has 4 steps. Similar to the court system, each denial requires you to appeal at a higher level for redress. If all 4 of your available appeals are denied, there are no options left to you. This makes it important that you make every effort to provide the correct information in the proper format during the initial application.

Applying for Social Security benefits, whether it’s SSDI or SSI, can be a confusing and frustrating process. There will be a lot of information that you have to provide, including access to your medical records for the doctor treating the condition that’s causing you to apply. You’ll also need to provide proof of earnings in order to demonstrate that you don’t already exceed the earnings requirement of the program being applied for. Ask a disability attorney for advice before you submit your application for the best chance at approval, assuming you qualify.

Can You Get Denied for Disability?

There are quite a few reasons why you can be denied for SSDI or SSI benefits. How can a Chicago disability lawyer help you get benefits? A disability lawyer has spent time working within the Social Security system, learning precisely what the SSA is looking for, and the best way to present the information to them in order to ensure you receive any benefits you’re entitled to.

Your disability attorney will educate you in advance of your application so that you know exactly what information and documentation will be required of you for the process. In some cases, he or she may even be able to help you acquire records and documents that will be required for your disability application.

Having a disability lawyer in your corner at the beginning of the process could help to minimize the chances that your initial application will be denied. There is an appeal process, but it is always preferable to not need to use it for your disability application. Having the correct information, presented in the proper format, and making every appointment required of you will go a long way toward maximizing your chances of approval for your SSDI or SSI claim.

How Many Times Can You Appeal a Disability Claim Denial?

If your SSDI or SSI claim has been denied, you may appeal the decision up to 4 times in increasing levels of appeals. You must appeal the decision in writing within 60 days of receiving the denial, so time is of the essence. If you’ve had your disability claim denied, and you decide to hire a disability lawyer for SSDI benefits, he or she can help you determine what can be done to win an appeal for benefits.

Each disability claim appeal can take between 4 and 22 months to complete, so the process is certainly not going to be swift. A dedicated advocate on your part can be a useful tool in ensuring that you get any Social Security disability benefits that you’re eligible for.

Reasons Disability Claims Are Denied

Generally speaking, unless you are currently in prison, or attempted to claim your disability fraudulently, there are six primary reasons why your claim may be denied. These reasons are:

  • Your earned income is too high
  • The length or severity of your disability is insufficient
  • The SSA can’t contact you
  • Refusal to cooperate with the SSA’s requests
  • Failure to follow prescribed therapies or treatment plans
  • Your disability is due to drug or alcohol addiction

Earned Income

If you’re applying for SSDI, you must earn less than $1470 per month. Earnings from investments do not count for this calculation, but if you earn more than this amount, your disability application will be denied due to earned income.

If it’s SSI that you’re applying for, you can make up to around $1600 per month without losing all benefit availability. Your SSI payment will begin being reduced if you make $85 per month, and by the time you get to $1650 per month, you will no longer qualify for SSI at all.

Length or Severity of Disability

In order to qualify for both SSDI and SSI payments, the Social Security Administration must believe your disability will either last more than 12 months, or result in your death. If you have injuries causing a disability that will be healed in less than 12 months, you will likely be denied disability payments through either program. 

Most disability applications denied under this category are denied because of a lack of perceived severity of your condition or limitations. If you will be able to heal and go back to work without serious limitations inside a year, they are likely to deny your application.

SSA Can’t Find You

If you’ve changed addresses, or have failed to respond to phone calls or letters from the SSA, they are likely to deny your application. If you’ve hired a Social Security disability attorney, he or she can be named as your representative to the agency and all communication will go to your lawyer. However, you will still need to keep in contact with the attorney’s office to ensure they have the information they need to keep your claim progressing.

Refusal to Cooperate

The SSA is going to need access to your medical records as part of the claims process. If you refuse to release your medical records, your claim is probably going to be denied. If you’ve released your medical records, but they are incomplete or do not meet the needs of the claims process, the SSA will schedule an appointment for you to meet with one of their doctors for a consultative exam.

The CE exams are offered to you free of charge, the government will pay for them. In some cases, you may be required to see multiple doctors for consultative exams. If you refuse to see their doctors or ask that a determination be made with only the records you’ve provided, your claim may end up being denied.

If the consultative examination is scheduled in a time or place where you cannot be there, ask the claim examiner to reschedule to a time and place that is convenient for you. Repeatedly missing CE appointments will likely result in your claim being denied.

Failure to Follow Prescribed Therapy

With some notable exceptions, both medical and nonmedical, you must follow the therapy prescribed by your doctor so long as that therapy is for the condition you’re applying for. If you have a severe mental illness, a noted and verifiable phobia about surgery, religious restrictions preventing treatment, or cannot afford the therapy prescribed, you may still be able to receive disability.

Disability Due to Drug or Alcohol Addiction

If your disability is primarily due to drug or alcohol addiction, your claim may be denied. If the SSA determines that your disability would remain in the absence of the addiction, they may choose to approve the disability application.

What to Do When Your Disability Claim Is Denied

If your disability claim is denied, and you don’t already have a disability lawyer, it might be the time to consider hiring one. You have only 60 days to file an appeal in writing from the time your claim is denied.

The first thing your disability attorney is going to need is the reason for denial. Make sure you bring the denial letter with you to your initial consultation, so your lawyer will know what they will need to help you win on appeal, if possible.

Once you and the attorney you’ve chosen have determined the reason for the initial denial, it will be time to determine if you simply don’t qualify for benefits, or if the information provided to the SSA was incomplete or presented in a less than favorable way. During the appeals process, your attorney will help guide you in providing the proper information to the SSA. 

Perhaps you simply require more medical information than the original treating doctor provided in your records. It could also be a matter of scheduling new CE appointments if you were unable to attend due to timing or location. In the event of an accident that has caused multiple fractures, for example, the SSA will likely deny your claim as those types of injuries tend to be healed in less than 12 months. If your fractures haven’t healed yet, and it’s been more than 6 months, this might be grounds for a successful appeal.

As long as you meet all the qualifying conditions for the SSDI or SSI benefit you’ve applied for, your attorney will take you through the appeals process to help ensure that you receive what you’re entitled to.