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What Are The Primary Reasons Social Security Disability Benefits Are Denied?

The following post is part of our Law Student Blog Writing Project, and is authored by Jessie Smith, a law student from the University of Kentucky.

Many people suffer from debilitating injuries or conditions that prevent them from working at all. Others’ conditions so severely limit the amount of time that they can devote to work each month that they, effectively, are prevented from earning a livable wage. Oftentimes, the only place for people in these positions to turn is the Social Security Administration in an attempt to obtain Social Security Disability benefits. Unfortunately, requests for these benefits are often denied. This blog post will explore the primary reasons that such requests are denied.

1. Lack of Adequate Medical Documentation to Support One’s Claim

When one applies for Social Security Disability benefits, his or her request will be solely decided upon the proffered medical documentation. What this means for someone who has applied, or is going to apply, for disability benefits is that the more medical records one has to demonstrate that they suffer from the condition claimed, the more likely it is that their request will be granted. Practically speaking, of course, one would have to make regular visits to a physician to obtain treatment for their medical condition. Such frequent visits will result in the accumulation of medical evidence to support one’s claim, which will, in effect, make it more likely that the Social Security Administration will approve a request for disability benefits.

The problem many people face, however, is that frequent visits to a treating physician can be cost-prohibitive and time-consuming. Medical treatment, for any condition, rarely comes cheap. Even if one has medical insurance, deductibles for many plans are high – too high for some to take advantage of frequent medical treatment. Those who do not have insurance at all are in a worse condition; paying for medical treatment, relying solely upon out-of-pocket resources, is an option few can afford.

For those who find themselves in such a position, it is wise to pursue low-cost or free medical treatment options that are available in their community. Many communities have cheap or low-cost medical clinics where they can obtain treatment, and thus amass medical records. Others can seek out treatment from physicians that offer low, monthly payment plans, or offer services based on a sliding scale fee basis (a “sliding scale fee basis” is a plan under which a physician bases the costs of his or her services on the patient’s ability to pay). Finally, few communities are without a hospital, and therefore an emergency room. Therefore, if no other option exists, visits to the local ER are another way to build a portfolio of medical evidence that can later be used in making one’s Social Security benefits determination.

Ultimately, if an applicant has not sought and obtained medical treatment for their condition recently, the Social Security Administration will require said applicant to have a “consultative medical exam” performed. These exams are performed by physicians hired by the Social Security Administration; they are performed so that Social Security disability examiners can have recent medical records at their disposal when making disability determinations. The problem with these “consultative medical exams” is that they are often performed hastily, are oftentimes not thorough, and rarely reveal many of the symptoms that a disability applicant is claiming. In other words, they are a poor substitute for obtaining medical records via one of the aforementioned means, i.e., private physicians, local clinics, and emergency rooms.

2. Once One’s Claim is Denied, They Fail to Fully Pursue the Appeals Process

The vast majority of disability claimants are denied benefits upon initial application. In fact, one source provides that nearly 70% of all Social Security Disability claims are denied under the first application. Many people do not realize that an appeals process exists under which they can continue to pursue receipt of disability benefits.

The first step in the appeals process is to file a “request for reconsideration.” Such a request must be filed within sixty days of the date one receives their letter denying disability benefits. For those who pursue this option, close to 15% are ultimately approved for benefits.

If a request for reconsideration fails, the second step in the appeals process is to file a request for a hearing before an administrative law judge (ALJ). This hearing typically involves a review of existing evidence, but new evidence may be considered, as well. At these hearings, a disability claimant, as well as witnesses, including medical experts, may be questioned by the ALJ. For those who pursue this second step in the appeals process, around 60% are ultimately approved for the receipt of disability benefits.

The third step in the appeals process is to request a review by a Social Security Appeals Council. If an Appeals Council reviews one’s case, it may decide the outcome of one’s case on it’s own, or, alternatively, may return the case to the ALJ for further consideration. It is important to note that an Appeals Council may deny one’s request for review; however, if this occurs, or if the Appeals Council decides the case on it’s own, and denies one disability benefits, a lawsuit may be filed in a federal district court. This suit represents the last step of the appeals process.

Ultimately, based upon the aforementioned numbers, the more one appeals their decision, the more likely it is that they will ultimately be approved for receipt of disability benefits. Statistically speaking, if one is initially denied benefits, the appeals process is likely to reverse this negative outcome. However, failing to pursue any of these options, whether due to lack of knowledge of the process, or an unwillingness to engage in these often lengthy processes, would result in never receiving disability benefits.

3. One’s Disability is Not Included in the “Social Security Impairment Manual”

The Social Security Impairment Manual provides a list of many conditions that the Social Security Administration considers to be disabilities. It also provides a list of the specifications that must be met to constitute being afflicted by these disabilities in the eyes of the Social Security Administration. Many people whose disabilities are not listed in this manual are often denied Social Security Disability benefits. However, the simple fact that one’s disability is not included in the manual does not mean that they are not eligible for disability benefits. In fact, most disability claimants that are provided benefits do not suffer from any of the conditions listed in the Impairment Manual.

Ultimately, suffering from a disability listed in the Impairment Manual is typically sufficient, but is, by no means, necessary, to obtain disability benefits. If one suffers from a disability not included in the Impairment Manual, the Social Security disability adjudicator is required to apply other rules to determine whether an applicant is, in fact, disabled.

An Attorney May Be Able to Help You for No Out of Pocket Charge

In sum, the three primary reasons Social Security Disability benefits are quite often denied stems from a lack of medical documentation to support one’s claim of disability, failure to fully pursue the entirety of the appeals process, and, to a lesser extent, suffering from a disability not included in the Social Security Impairment Manual. Ultimately, however, each of these problems stems from the lack of medical evidence to support a claim of disability. The more medical evidence one accumulates, the less likely it is they will be denied their initial application, the less likely it is they will lose during the appeals process, and the less likely it is that they will be denied benefits simply because their condition is not listed in the Social Security Impairment Manual.

A good social security attorney is trained to prove your disability for you whenever possible. Further, social security attorneys do not charge a fee out of pocket to you, so you never have to worry about paying one. Rather, the attorney’s fee is a percentage of your back due award, if any. If you think you may be able to claim disability, call Lawrence & Associates today and ask for a free consultation. We’re Working Hard for the Working Class, and we want to help you!