The process of applying for Social Security Disability Insurance (SSDI) can be daunting and complex. Many applicants face the frustration and disappointment of having their claims denied. Understanding the common reasons for SSDI denials can help you navigate this challenging process and increase your chances of a successful claim. This comprehensive guide delves into the various factors that may lead to a denial of your SSDI claim and offers insights into how to address these issues effectively.
One of the most common reasons for SSDI claim denials is insufficient medical evidence. The Social Security Administration (SSA) requires substantial and detailed medical documentation to establish that an applicant’s disability is severe enough to prevent them from engaging in substantial gainful activity. This means that your medical records must clearly demonstrate the nature, extent, and impact of your disability. In many cases, claims are denied because the medical evidence provided is either incomplete or does not adequately support the severity of the disability. It is crucial to work closely with your healthcare providers to ensure that all necessary medical records are collected and submitted. This includes detailed reports from doctors, diagnostic test results, treatment histories, and any other relevant medical documentation that can substantiate your claim.
Another significant factor that can lead to an SSDI denial is a failure to follow prescribed treatments. The SSA expects applicants to adhere to the treatment plans recommended by their healthcare providers unless there is a valid reason for not doing so, such as financial constraints, adverse side effects, or religious beliefs. If you fail to follow prescribed treatments without a legitimate reason, the SSA may conclude that your condition is not as severe as claimed or that it could be improved with proper treatment. Therefore, it is essential to follow your doctor’s recommendations and document any reasons for deviating from the prescribed treatment plan. This documentation can be vital in explaining your situation to the SSA and avoiding a denial based on non-compliance with treatment.
Attorney Attorney Attorney
Michael Phillips
Marcel McCrea
Natalie Andruczyk
The SSA uses a rigorous evaluation process to determine whether an applicant’s condition meets the criteria for a disability as defined in the Social Security Act. One of the key elements of this process is the listing of impairments, which outlines specific medical conditions and the criteria that must be met to qualify for SSDI benefits. If your condition does not match the criteria in the listing of impairments, your claim may be denied. However, even if your condition is not explicitly listed, you may still qualify for SSDI if you can demonstrate that your impairment is equivalent in severity to a listed condition. This requires providing comprehensive medical evidence and, often, a detailed explanation from your healthcare provider about how your condition limits your ability to function.
Work activity is another critical factor that the SSA considers when evaluating SSDI claims. To be eligible for SSDI benefits, you must be unable to engage in substantial gainful activity (SGA). The SSA defines SGA as the ability to earn a certain amount of income each month through work. If you are earning above this threshold, your claim will likely be denied. Additionally, the SSA may deny your claim if they determine that you are capable of performing other types of work, even if it is different from your previous occupation. This evaluation takes into account your age, education, work experience, and transferable skills. To strengthen your claim, it is important to provide detailed information about your work history and how your disability affects your ability to perform specific job tasks.
Michael was a pleasure to work with. He made sure all of my questions were answered in a timely manner. His compassion to help allowed me to receive excellence throughout my experience, i would highly recommend his expertise” - Anonymous Philips and McCrea Law firm provided excellent service to entire family and friends. There have been several situations that I/family /friends have depended on their legal service’s. On each occasion they have been professional, knowledgeable and dependable. Providing excellent representation and guidance under stressful situations. I would highly recommend their legal service." - Denise Simply great legal service. They were professional, easy to work with and thorough. I have been very pleased with their service and would highly recommend them to my friends and colleagues as exceptional Charlotte attorneys." - Logan Abrams 
Inconsistent or inaccurate information provided in your application can also lead to an SSDI denial. The SSA relies on the information you provide to make a determination about your eligibility for benefits. If there are discrepancies or inconsistencies in your application, medical records, or other supporting documentation, it can raise questions about the validity of your claim. It is crucial to review all information carefully before submitting your application to ensure that it is accurate and consistent. Additionally, promptly responding to any requests for additional information or clarification from the SSA can help prevent misunderstandings and potential denials.
Your work history and Social Security earnings record play a significant role in determining your eligibility for SSDI benefits. To qualify for SSDI, you must have earned sufficient work credits through paying Social Security taxes. The number of work credits required depends on your age at the time you became disabled. If your work history does not meet the SSA’s requirements, your claim will be denied. It is important to review your earnings record to ensure that it accurately reflects your work history and contributions to Social Security. If there are any discrepancies, you should address them with the SSA as soon as possible to avoid potential issues with your claim.
In some cases, SSDI claims are denied due to procedural issues, such as missing deadlines or failing to provide requested information. The SSDI application process involves strict deadlines and requirements for submitting documentation and responding to SSA inquiries. Missing a deadline or failing to provide requested information can result in a denial of your claim. To avoid these procedural pitfalls, it is essential to stay organized and keep track of all deadlines and requirements. Working with an experienced attorney can help ensure that you meet all necessary deadlines and provide the required information in a timely manner.
Understanding the appeals process is crucial if your SSDI claim is denied. The SSA provides several levels of appeal, including reconsideration, a hearing before an administrative law judge, a review by the Appeals Council, and, if necessary, a federal court review. Each level of appeal offers an opportunity to present additional evidence and arguments to support your claim. If your initial claim is denied, it is important not to become discouraged. Many claims are ultimately approved on appeal. Working with an attorney who is knowledgeable about the SSDI appeals process can significantly improve your chances of a successful outcome. They can help you gather additional evidence, prepare for hearings, and present a strong case to the SSA.
Choosing an Attorney What happens if my appeal is denied?Related Videos
The impact of an SSDI denial can be significant, both emotionally and financially. The uncertainty and stress of navigating the appeals process can take a toll on your well-being. However, understanding the common reasons for denial and taking proactive steps to address these issues can increase your chances of success. It is important to remember that you have the right to appeal a denial and that many applicants are eventually approved after presenting additional evidence and arguments.
A Glossary of Essential Social Security Disability Terms
Those who want to qualify for Social Security Disability benefits have to first understand the different language and terms used in a disability claim in order to get approved. However, these words and phrases can be confusing to anyone who hasn’t undergone the Social Security disability application process.
To help you understand the terms, acronyms, and phrases used in a disability claim, the attorneys at Phillips and McCrea have created this handy reference guide on social security disability terms. Here you’ll find valuable information allowing you to comprehend and communicate your social security disability needs.
Substantial Gainful Activity (SGA).
“Substantial” work activity involves doing significant physical and/or mental activities. “Gainful” activity is determined by looking at the earnings of the claimant to determine if they meet a designated dollar amount.
Past Relevant Work.
When someone applies for Social Security Disability Benefits, the Social Security Administration usually considers work that has been performed in the last fifteen years or fifteen years prior to the date last insured. However, the work must be at the SGA level and must last long enough for the claimant to develop the skills to perform the job.
Date Last Insured (DLI).
DLI refers to the last date you are eligible to receive Social Security Disability Insurance (SSDI). In order to receive SSDI, you must pass the “recent work test.” This means that you need to have worked for at least five out of ten years prior to the date on which you applied for Social Security Disability benefits. More specifically, you must have worked twenty of the last forty quarters.
Residual Functional Capacity (RFC).
RFC determines the level of exertion that you are capable of doing and the restrictions that limit your job as a result of your disabling condition(s).
Alleged Onset Date (AOD).
AOD represents the day that you became disabled or the date at which you stopped working as a result of your disability. This implies more than just not working because the job ended, or the company laid off employees. This date indicates that you could not work any longer because of your disabling condition.
Unsuccessful Work Attempt (UWA).
UWA refers to work that lasted up to six months, which was stopped by the claimant as a result of the disabling condition or impairment.
Impairment Related Work Expenses (IRWE).
IRWE are out of pocket medical expenses that are used to treat the disabling impairments. These may be deducted from a claimant’s monthly earnings after determining that the work is SGA.
Reconsideration.
When the Social Security Administration denies your initial claim for Social Security Disability, you have the option to file an appeal. The first step to this appeal process is known as reconsideration.
Vocational Expert (VE).
A vocational expert is a person who is present during an appeal to the Administrative Law Judge or the hearing. He or she provides the Administrative Law Judge (ALJ) with information regarding the jobs that a claimant can qualify for, if any exist in the national economy. He or she provides this information after listening to the testimony of the claimant during the hearing in conjunction with the Residual Functional Capacity (RFC) retained by the claimant.
Social Security Disability Insurance Benefits (SSDIB).
These are benefits that are paid much like an insurance plan to workers that have contributed to the program (Social Security Taxes) over a long period. This allows them to be fully insured and recently enough to have disability insured status.
Supplemental Security Income (SSI).
SSI is a federal welfare program for the disabled, blind as well as for those over sixty-five years of age who do not otherwise qualify for Social Security Disability benefits as a result of lacking work credits.
Continuing Disability Review (CDR).
This is a review of the claimant’s disability status to determine whether or not the claimant receiving Social Security Disability (SSD) and Supplemental Security Income (SSI) disability benefits continue to meet the SSA definition of disability and are still entitled to those benefits.
Re-entitlement.
If entitlement to childhood disability benefits ends because the child’s disability has ceased, a child may be re-entitled to benefits on the same earnings record, if the child becomes disabled again eight-four months before the benefits ended.
Light Work.
Light work is defined as lifting no more than twenty pounds at a time with frequent lifting or carrying of objects that weigh up to ten pounds.
Sedentary Work.
This involves lifting no more than ten pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools.
How to Prove Disability for Social Security Benefits in North Carolina
What Does the SSA Look for When Determining Disability?
When applying for Social Security disability benefits, it is essential to understand what the SSA is looking for. There are a few key factors that the SSA will consider when determining whether you qualify for benefits.
The first thing the SSA will examine is whether your disability is severe. This means that your condition must be serious enough that it prevents you from doing any substantial work for at least a year or is expected to result in death. The SSA uses a five-step process to determine whether you meet this requirement.
They will look at your medical records to see if your condition is severe enough to limit your ability to perform work tasks. You will need to provide as much medical evidence as possible to support your claim. This can include doctor’s notes, test results, hospital records, and statements from medical professionals who can speak to the impact your disability has on your life.
Next, the SSA will evaluate whether your disability matches or is similar to one of the conditions listed in their “Blue Book.” The Blue Book is a document that outlines the specific conditions that qualify for disability benefits. While not every condition is listed, if your condition closely matches one of those outlined, it can be easier to prove your disability. However, even if your condition is not listed, it does not mean that you will automatically be denied. It simply means that you will need to provide additional medical evidence to show that your disability is just as severe as one that is listed.
Another important aspect the SSA will consider is whether you are capable of doing your previous work. If you are still able to perform tasks similar to the work you did before your disability, your application may be denied. This is where providing detailed medical evidence that shows how your condition prevents you from performing even basic tasks is crucial.
Finally, the SSA will look at whether there are other types of work that you could do given your condition. This is known as the “transferable skills” test. If your medical condition limits your ability to do your previous job but does not prevent you from doing other types of work, the SSA may decide that you do not qualify for benefits. Again, presenting thorough medical evidence that demonstrates your condition’s severity is essential to ensuring that the SSA understands how your disability affects your ability to work in any capacity.
How to Gather the Right Evidence for Your Case
To prove that you meet the SSA’s definition of disability, you will need to gather medical records, supporting documentation, and detailed information about how your condition impacts your ability to work and live your daily life. This is often one of the most challenging parts of the process, as it requires detailed documentation that can sometimes feel overwhelming.
Start by obtaining a complete copy of your medical records. You will need documentation from all doctors, specialists, and other healthcare providers who have treated you for your condition. The SSA wants to see that you have been receiving consistent medical care for your disability, and they will review all your treatment history.
Choosing an Attorney What happens if my appeal is denied?Related Videos
Additionally, be sure to gather any test results, imaging reports, and diagnostic records that provide more information about the extent of your disability. This includes lab tests, X-rays, MRIs, and any other relevant tests that show the severity of your condition.
One crucial piece of evidence that can strengthen your case is a detailed letter from your treating physician or medical professional. This letter should explain the nature of your disability, how it limits your ability to work, and how long you have been dealing with the condition. A statement from your doctor can be incredibly helpful in supporting your claim, especially if your doctor can provide insight into how your condition affects your day-to-day life.
In some cases, the SSA may require additional evaluations from medical specialists to further assess your condition. These medical evaluations, known as Consultative Examinations (CEs), can help clarify the extent of your disability. If the SSA requests a CE, it is important to attend the examination and follow the instructions provided.
Huge Mistakes People Make in Social Security Disability Cases
Have you ever got in trouble or hurt because of the absentmindedness or negligence of someone else? It can be devastating especially if the damage caused has repercussions on your work or family life. Instead of trying to resolve such situations yourself, firms are willing to help you get the justice you deserve.
If you’re reaching out to an injury law firm, ensure that the firm has some experience in the field and know what they are dealing with. Although you are not in the wrong, by working with experienced professionals, you will be better equipped to fight a case. You will also be prepped before the case to say precisely what you are supposed to because getting carried away and giving away too much information doesn’t always work in your favor.
To help you avoid many of the fundamental errors people make that prevent them from getting justice, Phillips and McCrea, PLLC, has put together a list of the most common mistakes people make in Social Security Disability cases.
1. Pro Se representation.
Beginning any process uneducated or uninformed is bad news. Some people believe it’s just a matter of filling out a few forms, sending them in, and waiting for a cheque. They are later surprised to find out just how complicated the Social Security Disability (SSDI) process really is. No matter how solid you think your claim may be, there’s no such thing as a “slam dunk” case. Navigating the law can be tricky, and continually telling the judge that you deserve Social Security Disability benefits doesn’t mean you will get them. Even if you provide stacks of medical records proving your disability claim but don’t know how the law applies to your case, you might not win the appeal. That’s where a Social Security Disability attorney comes in. I am an experienced disability attorney and can help prepare and professionally present your case.
2. Missing filing deadlines.
If you have already applied for Social Security Disability benefits and have been denied, you most likely received a letter notifying you about this. Make sure you meet all deadlines for filing your request for reconsideration or a hearing. The Social Security Administration (SSA) usually gives you sixty days to file from the time you receive a denial notice. If you missed a deadline, you will have to show “good cause” for why it was missed. If the SSA decides there wasn’t “good cause” you will have to start the process all over again.
3. Incomplete medical history.
I represent clients that included medical sources for specialists (such as orthopedists, gastroenterologists, rheumatologists) but did not include information for their primary care provider or the emergency room that they went to when initially injured. We do all that we can to fix this at the office but need the client’s input and cooperation.
A medical disability is proven by medical documentation. It is just as important to list the information for the emergency room visit you had when you were initially injured, as it is to list the orthopedic surgeon who performed your surgery. In the same aspect, it is equally important to list your primary care provider, to whom you may have reported symptoms of back pain before receiving any specialized treatment. The medical providers who treated you should give the medical records to you upon your request, but you may have to sign a release.
It is obvious to list the most disabling of your conditions, severe back pain, PTSD, fibromyalgia, cancer, arthritis, schizophrenia, etc., however, I find it to be equally important to list all of the conditions you suffer from. Often, before being represented by me, clients do not list things like asthma, high blood pressure, obesity, and depression, which should be included, along with medical records concerning these conditions, which need to be provided to the Social Security Administration (SSA).
4. Not understanding when you became disabled.
Once you, through consultation with your doctor(s), have determined that you may be unable to work for a period of twelve months or more, you should file for benefits immediately. You could risk losing benefits to which you are legally entitled by waiting longer than necessary to apply.
If you are eligible to receive Disability Insurance Benefits, you can only recover retroactive benefits for the twelve month period prior to submitting your application. Therefore, if you wait more than a year from the date you stop working to apply for benefits, you risk losing more benefits with each month that passes.
Depending on how much you have paid into Social Security over the years, this could result in a loss of thousands of dollars per month.
5. Not having worked long enough to qualify.
You have to work a minimum amount of time to qualify for Social Security Disability benefits. The SSA calculates your credits based on your age, the number of years you’ve worked (and therefore paid into the SS system), and when you became disabled.
6. Temporary disability.
The Social Security Administration requires that your disability is expected to last twelve months or more and or result in death. Before you receive disability benefits, show that you have been disabled for at least an entire year. Additionally, you need to prove that you have not been able to obtain sufficient employment during that time because of your disability.
To avoid these and other mistakes, reach out to the experts at Phillips and McCrea, PLLC. We are an injury and family law firm located in Charlotte, North Carolina, and we pledge diligence, excellence, and integrity in all matters that we handle. Our primary practice areas are social security disability, personal injury, workers’ compensation, and family law. We believe in fostering relationships and work closely with our clients and friends.
Appealing a Denied SSDI Claim: Understanding the Process
If you’ve applied for Social Security Disability Insurance (SSDI) benefits and your claim has been denied, you’re not alone. Many deserving applicants find themselves in this situation, feeling frustrated and unsure of what to do next. However, it’s important to know that a denial doesn’t mean the end of the road. There is a process in place to appeal this decision, and understanding how to navigate it can significantly increase your chances of success.
Initial Steps After a Denial
When your SSDI claim is denied, the first step is to carefully review the denial letter from the Social Security Administration (SSA). This letter will outline the reasons for the denial and provide important information regarding your next steps. It’s crucial to pay attention to the deadlines for appealing the decision, as missing these deadlines could jeopardize your ability to appeal.
After reviewing the denial letter, consider seeking legal assistance from experienced SSDI attorneys like those at Phillips & McCrea, PLLC. Navigating the appeals process can be complex, and having knowledgeable legal representation can make a significant difference in the outcome of your case.
Understanding the Appeals Process
The SSDI appeals process consists of several stages, each with its own requirements and deadlines. The process typically begins with a Request for Reconsideration, where your case will be reviewed by a different examiner at the SSA. If your claim is denied again at this stage, you have the right to request a hearing before an administrative law judge.
Preparing for an administrative hearing is crucial. This stage allows you and your attorney to present evidence, call witnesses, and argue your case before a judge. The judge will consider all the evidence presented, including medical records, testimony, and your own testimony regarding your disability and its impact on your ability to work.
Appeals Council and Federal Court
If your appeal is unsuccessful at the administrative hearing stage, you have the option to request a review by the SSA’s Appeals Council. The Appeals Council will review the administrative law judge’s decision to ensure it was made correctly based on the evidence presented.
If the Appeals Council denies your request for review or decides not to review your case, your final option is to file a lawsuit in federal court. This step involves presenting your case before a federal judge who will review the SSA’s decision and determine if it was lawful and supported by substantial evidence.
Frequently Asked Questions About Social Security Disability Legal Services
It can be challenging if you’re unable to provide for your family due to a disability. Therefore it’s essential to seek benefits from the Social Security Administration promptly. However, the rules and process for claiming social security disability may not be easy for everyone to comprehend.
Therefore, Phillips and McCrea, PLLC, wants to arm you with the most accurate information available to help you resolve your social security disability case. To do this, we’ve answered some of the most frequently asked questions about social security disability legal services.
1. What does “Disability” mean to the Social Security Administration?
The Social Security Administration defines disability as the inability “to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months.”
As a result, any person suffering from a mental or physical condition and those conditions prevent them from doing their previous work for more than twelve months will be considered disabled by the Social Security Administration. The person’s age, education, and prior work experience will also get considered.
2. What happens if I’m denied benefits, and I do not appeal within sixty days?
You’ll have to start over with a new application, and it may mean that you’ll lose some back benefits, so it’s vital to appeal to all denials within sixty days. It’s advisable to appeal right away so that you get through the bureaucratic denial system faster. The quicker you can get to the hearing stage, the better.
3. How do I appeal?
Your denial letter will tell you about appealing. The first appeal is called a “reconsideration.” You must request reconsideration, and then, after the reconsideration is denied, you must request a hearing within the sixty-day time limit.
You can appeal in one of three ways. (1) Telephone the Social Security Administration and make arrangements for your appeal to be handled by phone and mail. (2) Go to the Social Security office to submit your appeal. If you go to the Social Security office, be sure to carry a copy of your denial letter, and be sure that the Social Security representative gives you a signed copy of your appeal paper showing that you appealed on time. (3) appeal online at
https://secure.ssa.gov/apps6z/iAppeals/ap001.jsp.
Be sure to print and retain the receipt for your appeal so that you can prove you appealed on time.
4. Since medical evidence is crucial, should I have my doctor write a letter to the SSA, and should I gather medical records and send them to the SSA?
SSA will gather the medical records, so you don’t have to do that. Whether you should ask your doctor to write a letter is a tough question. A few people win their cases by having their doctors write letters, so you can consider trying this approach. The problem is that the medical-legal issues are so complicated in most disability cases that a doctor may inadvertently give the wrong impression. Therefore, obtaining medical reports may be something best left for a lawyer to handle.
5. When is the best time for a lawyer to get involved in my case?
Many people wait until it’s time to request a hearing before contacting a lawyer to represent them. While everyone agrees that a lawyer’s help is essential at the hearing and the great majority of people who have lawyers win their cases at a hearing, the decision to seek a lawyer at the early stages is a subject with merits on both sides.
Keep in mind that more than one-third of the people who apply will be found disabled after filing the initial application without a lawyer’s help. Also, about fifteen percent of those who request reconsideration are found disabled at this stage, without a lawyer’s help. If you successfully handle the case yourself at the initial or reconsideration steps, you will save having to pay attorney’s fees. It’s challenging to predict which cases may benefit from a lawyer’s help at the start.
6. How much do you charge?
Almost all of our clients prefer a “contingent fee,” where the money needs to get paid, only if they win. The usual fee is twenty-five percent (one-quarter) of back benefits up to a maximum amount set by SSA, currently $6,000.00. The price is one-fourth of those benefits built-up by the time you are found disabled, and benefits are paid. Keep in mind that no cost comes out of your current monthly benefits.
While the usual fee will not typically exceed $6,000.00, if we have to appeal after the first administrative law judge hearing, our contract drops the $6,000.00 limit on fees. Even in this circumstance, though, our cost will not be greater than twenty-five percent of back benefits.
Sometimes at the request of a client, we charge a non-contingent hourly or per case fee. There is also the rare case where a twenty-five percent fee arrangement is insufficient to allow for an acceptable price. In such a case, we use a different method of calculating the cost.
At Phillips & McCrea, PLLC, we understand the challenges and complexities of the SSDI application and appeals process. Our dedicated team is committed to helping you navigate this process and obtain the benefits you deserve. If your SSDI claim has been denied, we are here to provide the guidance and support you need to appeal the decision and strengthen your case. Contact us today for a consultation and let us help you secure the benefits that can make a meaningful difference in your life.