Denial of Benefits

Social Security Disability Insurance (SSDI) benefits are available to those individuals who remain unable to work due to long-term or permanent disability and who are covered by Social Security based on sufficient Social Security taxed earnings. It may be surprising to discover that most initial claims are denied. However, understanding the application and appeals process with the help of an experienced attorney may be advantageous in pursuing your benefits. Social Security lawyer Russell J. Goldsmith has over 34 years of experience assisting people with seeking SSDI. He provides personalized legal services to each of his clients.

In considering an SSDI claim, the Social Security Administration (SSA) will first determine whether some non-medical requirements have been met. Basically, it considers whether the applicant has worked long enough and recently enough under a job covered by Social Security. This requires a detailed and accurate listing of prior work history. If the applicant cannot prove eligibility at this step, the claim will be denied.

Once SSA determines that the applicant has satisfied the non-medical requirements, the claim is sent to Disability Determination Services (DDS) to determine whether the applicant has remained “disabled” under Social Security’s rules. The Social Security Act defines “disabled” as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that has lasted or can be expected to last for a continuous period of one year or longer, or that can be expected to result in death.

All disability claims, therefore, are determined on the basis of the medical evidence. DDS seeks to determine, through medical documentation and tests, whether and how severely the applicant’s medical condition affects his or her ability to perform basic work activities. Consequently, a common reason for denial is insufficient medical evidence. If DDS does not have the medical evidence to establish that the disability is severe and that it is directly preventing the applicant from working, the claim will be denied. In this regard, individuals who do not seek regular treatment from a doctor, or have not done so recently, are at a particular disadvantage to prove how their condition has affected their job, simply due to a lack of treatment records. In addition, applicants who do not follow treatment prescribed by their doctors may be denied SSDI benefits, if failing to follow treatment is making their condition worse. A claim may also be denied if the disability is not expected to last longer than 12 months, as determined from the medical evidence. In cases of insufficient medical evidence or for other reasons, DDS may request that the applicant attend a consultative examination. The claim can be denied if the applicant fails to attend a scheduled consultative evaluation.

In addition, the disability must prevent the applicant not only from engaging in his or her prior work but also from engaging in any substantial gainful activity, considering the applicant’s disability, background, education, experience, and other factors. Therefore, consideration must be given ahead of time by any potential claimant as to whether they might be capable of returning to a job that is different from the type of work they have performed in the past (assuming it is something for which they would be qualified and capable of undertaking based on their age, education and experienced: including unskilled, sedentary type positions). Moreover, applicants who are currently working and earning substantial gainful wages or are deemed capable of undertaking such work will be denied. For non-blind workers, the cap for 2015 is $1,090 (net of disability-related work expenses). Even if an applicant is making less than that amount, however, it is important to remember that one may be considered capable of undertaking substantial gainful wages even if they are not technically undertaking work that would amount to $1090.00 per month. Thus, someone earning $700.00, $800.00 or $900.00 per month may still be denied benefits if the Social Securtiy Administration determines that they may be capable of undertaking additional work hours or a different manner of work that would indeed add up to $1090.00 per month.

SSDI claims can also be denied for failure to cooperate, or essentially a failure to respond or provide information or forms necessary for SSA and DDS to process a claim. This can happen at any stage of the initial claim, and so it is important to provide accurate and current contact information in a timely manner when requested to do so. Other various reasons for denial may include drug or alcohol abuse if it exacerbates the applicant’s condition, disabilities occurring in prison, or injuries occurring during the applicant’s commission of a felony.

Since each claim is unique, the circumstances of an applicant’s denial may vary greatly. However, you can minimize the chance of an initial denial by seeking guidance from an experienced attorney, who can submit the appropriate documentation on your behalf and present your claim to the SSA and DDS in the most persuasive way possible.

After being denied SSDI benefits, the best option is to obtain the advice of your attorney (or if you have yet to obtain a lawyer, it is advisable to seek one out at that time) as to the potential reasons for such a denial and to discuss the viability of pursuing an appeal of the decision within the required deadline. The Social Security letter of determination will explain the decision and provide instructions for a request for reconsideration or hearing. If you are represented by an attorney, notice should also be sent to your attorney. Your attorney will be able to initiate the appeal process on your behalf and submit any required documentation.

If your claim has been denied, you may have options to continue pursuing a claim for benefits. At the Law Offices of Russell J. Goldsmith, we can guide you through the entire process, assisting you with your initial application and handling any subsequent appeals. To discuss your SSDI claim with a knowledgeable attorney at a free consultation, contact our office by phone at (800) 773-8622 or online.