Top 5 Reasons Why Social Security Disability Claims Are Denied and How to Appeal

Social Security Disability benefits are vital financial support for individuals in Philadelphia who are unable to work due to a disability. Despite their importance, the process of applying for and receiving these benefits can be complex, with many claims ending in denial. 

It’s important to learn the top 5 reasons why Social Security Disability claims are denied to give you a better idea of how to appeal these denials if the worst comes to worst.

Top 5 Reasons for SSD Claim Denials

The reasons why SSD claims are denied are varied, but certain common mistakes and omissions lead to a large portion of refusals. Understanding these reasons can give you a leg up when appealing the decision or even when preparing your initial claim.

Lack of Sufficient Medical Evidence

Having full, detailed medical records is critical when applying for SSD benefits. The Social Security Administration (SSA) needs proof of your medical condition and the way it affects your ability to work. Without this information, it becomes difficult to evaluate the validity of your claim.

Some common missteps at this stage include neglecting to provide updated medical documentation or failing to demonstrate how the disability prevents you from working. Without comprehensive and accurately presented medical evidence, the chances of a denial increase.

Failure to Follow Treatment Plans

The SSA may deny your claim if they conclude that your condition could improve, and thereby allow you to return to work if you adhered to prescribed treatment plans. Consequently, they may label you ‘non-compliant,’ which sends a negative signal to the SSA about your commitment to recovery.

In appealing the denial, you’ll need to address these non-compliance issues effectively. This will most likely mean explaining the reasons behind your non-compliance – perhaps the side effects were too severe, or the cost of treatment was prohibitive.

Inconsistent Statements and Documentation

Inconsistencies between your claim form, medical evidence, and statements made during SSA interviews can significantly undermine your credibility, resulting in a denial of your application.

In your appeal, address and correct any inconsistencies identified in your initial application. You need to ensure your records, statements, and application responses align and present a coherent narrative about your disability.

Earning Capacity and Substantial Gainful Activity (SGA)

The ability to engage in ‘Substantial Gainful Activity’ (SGA) can result in denial. This means that if you’re still able to earn an income above a certain threshold, the SSA may see this as an indication that your disability does not prevent you from working.

In your appeal, you’ll have to demonstrate convincingly why your disability prevents you from engaging in Substantial Gainful Activity, despite any previous earning above the SGA level. It can be helpful to show your previous income levels versus your current, as a significant drop in the money you earn can be good evidence of why you require assistance.

Application Errors and Incomplete Information

A fairly common reason for SSD claim denials is application errors or incomplete information. Detailed, accurate information is vital to convey the nature and extent of your disability.

In the case of a denial, fully understanding and correcting the errors and omissions in your original application is the first step in a successful appeal. Ensuring complete and comprehensive information will help demonstrate your eligibility in the review stage.

How to Appeal SSD Claim Denials

Bureaucracy is one of the main barriers to appealing a denied SSD claim. While it’s a challenge, it’s far from impossible to do so successfully. Here are a few steps that can push your appeal toward a favorable outcome.

Legal Representation and Experience

While it’s possible to appeal a denied SSD claim by yourself, having seasoned legal help could be the difference between a successful appeal and another denial. A competent lawyer can help you understand the rules, process, and paperwork, and present your case professionally and convincingly.

Our firm, Larry Pitt Associates, is equipped with a team of dedicated lawyers who understand the nuances of SSD appeals. Our approach is to work closely with you in understanding your situation and constructing a compelling case that demonstrates your eligibility for SSD benefits.

Gathering Additional Evidence and Documentation

Often, a denial stems from insufficient medical evidence or incomplete documentation. Identifying these gaps and filling them with supporting evidence is a crucial part of the appeal process.

Medical experts and vocational specialists can provide additional documentation and testimonies that verify your disability and inability to work. Our team helps you coordinate with these professionals, ensuring that they provide the most compelling support for your claim.

Requesting a Reconsideration or Hearing

The appeal process includes several stages: reconsideration, a hearing by an Administrative Law Judge, a review by the Appeals Council, and a federal court review. You can request a reconsideration for a fresh, detailed review of your application by a person who wasn’t part of the initial decision.

Our team will prepare you for the hearing, help you understand the process, anticipate questions, and make your case assertively.

Larry Pitt Won’t Quit: Our Commitment to Your SSD Appeal

At Larry Pitt Associates, we believe that each case is unique and requires individualized attention. Our personalized approach means that we tailor our strategies to your specific needs and circumstances.

We encourage you to seek experienced legal guidance for your appeals. We are committed to representing you throughout the appeals process, providing you with robust legal support and advocacy.

Get Your SSD Claim Denial Appealed Today

Understanding the reasons why SSD claims are denied is the first step in making a successful appeal. Larry Pitt Associates is here to provide you with the legal guidance you need to successfully appeal a denied SSD claim. We can assist you in understanding the reason for denial and how to proceed to maximize your chances of a successful appeal. Contact us today for a free consultation on our website, or call us at 888-PITT-LAW.

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