When pursuing Social Security Disability Insurance or Supplemental Security Income benefits, individuals often focus on the factors that make them eligible for approval.
Nevertheless, it can be equally valuable to consider the factors that might lead to a denial of benefits. While some of these reasons may be beyond your control, understanding them can help you proactively address potential pitfalls and avoid actions that could result in a denial.
1. Earning Above Income Limits:
When applying for Social Security Disability Insurance (SSDI), which is designed for individuals who have paid into the Social Security system over an extended period, a common reason for denial is earning an income exceeding the threshold defined as “substantial gainful activity” (SGA).
This means your earnings are considered too high to qualify as disabled. You can work a limited amount while applying for and receiving SSDI, but it must not exceed the SGA limit of $1,470 per month in 2023 for non-blind individuals. Income from investments does not factor into SGA calculations; only work income is considered, as it reflects your ability to work.
Similarly, for Supplemental Security Income, a disability benefit aimed at low-income individuals, you must not exceed the substantial gainful activity level both during the application process and while receiving benefits. There is a cap on all earned and unearned income for SSI, which is approximately $1,600 per month.
Additionally, any income over $85 per month reduces your SSI payment through a somewhat complex formula. You will no longer qualify for SSI if your income surpasses approximately $1,650.
2. Duration and Severity of Disability:
To be eligible for SSDI or SSI benefits, the Social Security Administration (SSA) must determine that your disability is severe and expected to last at least 12 months or result in your death. This duration requirement typically applies to all applicants except for blind SSI applicants, who may have different criteria.
3. The SSA Cannot Find You
Maintaining open lines of communication with the Social Security Administration (SSA) and Disability Determination Services (DDS) is crucial during the application process. It’s imperative that these agencies can reach you to schedule necessary examinations or convey important information about your benefits.
If you have designated a representative, such as an attorney, to handle your paperwork, you may rely on them for communication with the SSA, but it remains vital to stay connected with your representative or attorney.
If you change your residence while your application is under review, promptly updating the SSA with your current contact information is essential. Failure to do so can result in benefits denials, as applicants are frequently denied when the SSA cannot locate them.
4. You Refuse to Cooperate
Cooperation with the Social Security Administration (SSA) is pivotal in the disability claims process. Providing access to your medical records is essential for a successful claim. If you decline to release these records to the SSA, your claim will likely face denial. Additionally, there may be instances where the SSA needs further details about your impairments, especially if your treating doctor’s records are incomplete or you lack a regular treating physician.
In such cases, the SSA may request a consultative examination (CE) at government expense. Refusing to attend the CE or asking the SSA to base their decision solely on existing medical records can lead to a denial due to insufficient medical information. If attending a scheduled CE is inconvenient due to timing or location, discussing the matter with your claim examiner can help reschedule it at a more suitable time or place. Consistent failure to attend CE’s, however, may result in a denial of your claim.
5. Your Disability Is Based on Drug Addiction or Alcoholism
Benefits from the Social Security Administration (SSA) may be denied if your disability is primarily a result of drug addiction or alcoholism (DAA). In such cases, a critical factor for DDS (Disability Determination Services) medical consultants is whether your disability would persist if you were to cease using drugs or alcohol. If it is determined that your disability is largely contingent on substance abuse, you may not qualify for benefits.
6. You Have Been Convicted of a Crime
There are specific circumstances related to criminal convictions or imprisonment that can impact your eligibility for Social Security Disability Insurance (SSDI) benefits:
- If you are incarcerated due to a felony conviction, you generally won’t receive SSDI benefits unless you participate in a court-approved rehabilitation program expected to lead to employment upon release within a reasonable timeframe.
- In cases where you sustained an injury while committing a felony and were subsequently convicted, the resulting impairment or worsening of an existing impairment cannot be the basis for applying for disability benefits. If you have been involved in domestic violence and injured, it will be a felony.
- If you incurred an injury while in prison, any impairment or worsening of an existing impairment during your incarceration cannot be used to qualify for benefits. However, you typically become eligible for benefits after your release from prison.
Nevertheless, applying for SSDI benefits is advisable even if you fall into one of these categories. Applying may lead to a period of benefit-free disability that can protect your earnings record, retirement, or dependents benefits.
7. You Commit Fraud
Receiving disability benefits through fraudulent methods can result in severe consequences. The Social Security Administration (SSA) has the authority to terminate your benefits and pursue legal action against you for fraudulent claims. Additionally, if it is discovered that someone within the SSA facilitated the fraud, your benefits can still be terminated.
How can a disability lawyer help you?
A Social Security disability lawyer can assist by navigating complex regulations, gathering necessary medical evidence, and presenting a strong case to the Social Security Administration (SSA). They also provide invaluable expertise in appeals if your initial application is denied, improving the likelihood of a successful claim.