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Why Was I Denied Benefits?

When denied benefits, applicants naturally question the underlying reasons for the denial. These reasons may be within the control of the applicant and therefore avoided to prevent denial. This is one of the main reasons why the representation of an experienced disability attorney is vital to the initial application process. So what are some of the typical reasons applicants are denied benefits?

Consider someone who is working part-time while applying for disability. Applicants may have too much earned income and kill their case on that point alone. Applicants with earned income (from work activity) above a certain limit have what is considered “substantial gainful activity” (SGA) and therefore earn too much income to qualify for Social Security Disability Insurance (SSDI) benefits. Again, there is a distinction between earned and unearned income, and the thresholds are different for blind versus non-blind persons.  For a non-blind person who is working for wages, the SGA threshold for 2017 is $1170.00 per month in gross earnings.   There are several tricks and qualifications here, and Regulations and Rulings on point.  IT gets much worse with self-employed persons.  I once had a claimant with a borderline IQ who filed a tax return for her work cutting hair in her apartment.  She was above SGA for the year as reported on her return.  She was self-employed and did not deduct her business expenses, and had subsidized housing as well. With the subsidized housing as her place of work (home based business), she was not paying rent on a salon space. I was able to show that had she paid a reasonable rent for salon space, her income would have been well below SGA.   So in effect, her work was in fact subsidized.   She was a sympathetic plaintiff as well.  We won that case!  Remember,  SGA topics are a minefield,  a single months’ earnings above the SGA threshold amount does not always spell doom. Talk to an experienced attorney.

Applicants may not have an impairment that is severe enough to qualify for benefits. In order to qualify for SSDI or SSI benefits, the impairment must be severe and expected to last at least 12 months or result in death. That the medical condition causes a limitation that adversely affects the applicant’s ability to perform basic work activity is the hallmark of a severe impairment.  IF you have a knee replacement and have a great result, and are released to work after 5 months, that might kill a disability case because of the 12-month rule.

The SSA will deny disability benefits if there is inadequate medical evidence to prove that the impairment hinders or impedes an applicant’s ability to perform the past work, or in some cases, any other suitable work that exists in significant numbers.  This is really a way of saying, know your burden of proof (what you have to do to win), and find the medical proof to get you there.   The SSA requires medical proof of disability in typically the form of objective proof of an underlying medical condition. Examples of objective proof include X-rays, EMG’s, Echocardiogram, MRIs, and CT scans.

Refusing to do any of the following may constitute a failure to cooperate, and therefore cause the denial of benefits:

  • release medical records,
  • provide requested necessary information,
  • complete SSA forms,
  • attend consultative examinations, or
  • miss medical appointments.

While there may be times when there is good cause for a failure to cooperate, it is good sense to apply for benefits with the clear goal of fully cooperating with the SSA and all other involved parties.

An applicant’s failure to follow “prescribed medical therapy” is a wholly separate category and may be grounds for a denial of benefits. Such a refusal may be excused if reasons exist beyond the applicant’s control, such as a severe mental illness that limits or prevents compliance with the prescribed treatment. Basically, any reasonable refusal to submit to proposed medical treatment will suffice and likely prevent the denial of benefits.

Consider also that any denial based on a refusal to accept treatment presupposes that the treatment would, in fact, restore the applicant’s ability to work.  Otherwise the treatment has no real meaning for this disability case.  If the refusal to submit to medical treatment is in fact unreasonable (say a refusal to quit smoking. With the surgeon ordering this to maximize the chances of success of a surgery), you can always attack a denial with the approach that the treatment would not restore the ability to work.   Just ask a surgeon to guarantee that a spine surgery will restore your ability to do your work!

One of the best ways to make sure you understand all of your options associated with applying for disability benefits is to retain the services of an experienced, knowledgeable and qualified Kentucky Social Security Disability attorney. Contact Sullivan Law Office today. We offer free consultations, so there is absolutely nothing to lose! We look forward to hearing from you. We look forward to hearing from you. Call 888-587-0228 or visit us online.Why Was I Denied Benefits?

2017-03-16T19:51:09+00:00