Disability benefits are financial assistance provided to people who are unable to work due to health conditions. In this instance, health problems can be either physical or psychological. Disability benefits aim to help cover necessities such as shelter, food, and health care. Often, these benefits last as long as you cannot work. Applying for disability benefits in California can feel stressful. Many people with serious health conditions expect the SSA to approve the benefits right away.
However, the government denies disability benefits applications in some instances. Common reasons for the denial of your claim include insufficient evidence or work history issues. Sometimes, you can be denied if you make an error during the application process. In California, disability benefits are provided through Social Security Disability Insurance (SSDI). Before approving benefits, the Social Security Administration (SSA) carefully reviews each claim.
If your application does not meet the standards, the SSA can deny your benefits even when you are struggling with your health. The following are some of the reasons why the government can deny your application for disability benefits:
Lack of Strong Medical Evidence
You must have sufficient evidence to support your disability claim. The medical evidence will help show the illness you have and how they impact your ability to work. The SSA will not have your disability benefits based on your statement of illness. For this reason, insufficient evidence is a common ground for claim denial. Medical evidence in this case may include:
- Doctor treatment notes. These notes explain the diagnosis, symptoms, pain levels, and treatment plan. Also, they can outline the duration during which your condition is expected to last.
- Hospital records.Hospital documents can show any serious complications you may be facing. These records help prove the severity of the condition.
- Blood test results. Should you suffer from disorders such as diabetes, autoimmune diseases, or any infections, they will be identified in the lab report. Your health issues for the SSA will prove that you cannot work.
- Psychological health reports. Usually, psychological health reports contain diagnoses such as depression, anxiety, post-traumatic stress disorder, or bipolar disorder. This will explain how your psychological health affects your behavior.
- Physical therapy reports. The reports from physical therapy detail your mobility and chronic pain problems.
The SSA may decide there is not enough proof of disability if the records you present are incomplete or insufficient. Many applicants also fail to provide records from specialists who treated their condition. Missing records can weaken the entire case. The SSA also wants to see consistent treatment. The agency may think the condition is not severe if there are long gaps between medical visits.
The Condition Does Not Meet Social Security Administration (SSA) Rules
Not all diseases or ailments would necessarily qualify an individual to receive disability payments. The Social Security Administration (SSA) has a set procedure for determining whether an individual qualifies. The individual could be suffering from chronic pain, tiredness, mental disorders, and physical difficulties daily. But the SSA might still rule out the possibility that the individual can perform any kind of work. The considerations in making the ruling include:
- The severity of the condition. The SSA reviews your medical records, symptoms, and treatment history to assess the seriousness of your condition. If the condition does not meet the necessary parameters, your claim will be denied.
- The ability to return to your prior job. SSA checks whether you have the capacity to return to your former job. If you are capable of doing the same work tasks, then you will not be entitled to the disability benefits.
- Ability to adjust to another type of job. Even if you cannot return to your previous position, the SSA expects you to try to find another job. The SSA can decide that you can still handle lighter or less physical work before denying your claim.
- The duration of your condition. For you to receive disability benefits, your condition must last at least 12 months.
Temporary conditions do not qualify for SSDI or SSI benefits. The SSA denies most claims because it believes that the applicant can still perform some form of work, even if it pays less or requires fewer physical demands.
Earning Too Much Income
Disability benefits help people who have difficulty performing certain job functions. However, if you earn more than the stipulated amount, your request will not be approved by the Social Security Administration. Meanwhile, you can continue working while you wait for feedback on your request. Some people work part-time because of various obligations. Individuals who may be affected by a denial based on too many earnings include:
- Self-employed workers. Business owners may earn income even when their condition limits daily work. Such an incident can occur if the business does not require the owners' constant presence.
- Freelancers. Self-employed people usually have fluctuating income. Nevertheless, the SSA will consider their total income.
- Part-time employees. Sometimes, part-time work can exceed the allowed monthly limit.
Before arriving at its conclusion, the SSA will look into your payroll, taxes, and employment history. When your earnings are higher than the level of SGA, the SSA can conclude that you can support yourself by working. Even if you are struggling with your health, you can still be disqualified for benefits.
Failure to Follow Medical Treatment
Denial of disability benefits can also be attributed to failure to follow the required medical treatment. The SSA assumes that an applicant will adhere to medical treatment programs that would enable them to heal or even resume work. When an individual fails to follow medical instructions, there may be doubt about the genuineness of their disability. Some common cases include:
- Refusal to take prescribed medicine without justification. The Social Security Administration might construe the failure to take prescribed medication as indicating that the condition is manageable.
- Failure to attend therapy sessions. Not attending scheduled physical therapy sessions may adversely affect your case. The SSA may assume that your injury is minor and that you do not need the benefits.
- Disobeying the doctor's orders. Whenever your doctor advises you to follow certain protocols or seek specialists, you should heed your doctor's words. Otherwise, the SSA will reject your application.
- Failing to undergo surgery without proper reasoning. The refusal to undergo surgery without good cause may make the SSA conclude that the condition is self-limiting.
However, there are valid reasons for not following treatment. These reasons can exempt you from a disability claim denial, and they include:
- Medication side effects. Some medications have serious and uncomfortable side effects that make it hard to adhere to them. Refusing to take such medication will not be considered grounds for rejecting your claim by the SSA.
- Unavailability of funds to access treatment. People might not be able to afford surgery, medication, or certain therapies. You are entitled to your benefits even if you refuse such treatments.
- Religious reasons. There may be specific types of therapy that may be against your religion. Failing to undergo such therapy on religious grounds does not affect your benefit entitlements.
- High medical risks. Some procedures may carry serious health risks. Refusing to go through with these procedures may not result in the denial of your claim.
If you refuse a particular treatment, you should provide a reasonable explanation for the refusal.
Incomplete or Incorrect Applications
The SSA analyzes each disability application claim before approving it. You must provide accurate and sufficient information. Making errors in the application process can result in a denial. These errors center around omissions and incorrect information, and they include:
- Providing wrong contact information. The SSA will contact doctors and clinics that may have treated you. During the contact, they verify the information you provided. Your claim is considered incomplete if you fail to provide correct information.
- Giving inconsistent answers. The information you give to the SSA should be consistent with the information in your medical records. Inconsistent information could constitute dishonesty and lead to a denial.
- Incorrect work history descriptions. The SSA needs accurate job details to determine whether you can still work at your previous position.
Missing Deadlines
The disability application and appeals process has strict deadlines. Your chances of approval for the benefits can be reduced if you miss the deadlines. Sometimes, you may have to restart the entire process from the beginning. Most applicants only have 60 days to appeal a denial decision. If you fail to respond within that time, the SSA may close the case. Starting over can delay benefits for several months or even years. Sometimes, the SSA may request the following additional documents:
- Medical records. The agency may ask for updated test results and treatment notes. These notes can help assess whether your illness is improving.
- Work history form. Alongside the medical documents, you can discuss Job history, responsibilities, and any physical demands of the previous job.
- Clarification documents. The examiner may seek additional information for clarification.
When you ignore requests for further documentation, the SSA may think that you have lost interest in applying for any benefits. In some cases, you may not be able to appear for your scheduled appointment because you have moved or updated your contact details. Some claimants face severe health issues, which can make completing the documentation process quite challenging.
Problems With Mental Health Claims
Mental health disability claims can be harder to prove than physical ones. This is because mental disorders do not always exhibit their symptoms externally. Some of the common mental disorders include depression, anxiety, PTSD, and bipolar disorder. In applying for a mental disability claim, one may be asked to prove that:
- Ongoing treatment
- Medication history
- Therapy participation
- Functional limitations
If the records are too limited or you have not received consistent mental health treatment, the SSA may deny your claim.
Failure to Attend Medical Exams
In some cases, SSA may refer your case for independent medical examinations. This procedure helps provide more information about your illness. If the SSA finds the information supplied by you to be insufficient or outdated, it can order such an examination. Failure to meet the deadlines may lead to claim rejection. Some of the typical causes of missing such appointments are:
- Failure to receive a notice
- Transportation problems
- Medical conditions or hospital confinement
Regardless of your reason for missing the appointment, the SSA may interpret the absence as a lack of cooperation. Missing the appointment may leave the agency without enough medical information to approve benefits. If you have a valid reason to skip the appointment, you must notify the SSA.
Short-Term Conditions
Disability benefits are meant for long-term medical conditions. The SSA denies claims involving conditions expected to improve within a short time. This is because disability programs are designed for people who cannot work for at least 12 months. Many people apply for benefits after surgery, injuries, or temporary illnesses. In such a case, your claim may be denied even if you are currently unable to work. The short-term problems that can lead to the denial of your claim by the Social Security Administration include:
- Minor fractures and back problems
- Health conditions related to pregnancy
- Fast recovery following surgery
- Mental disorders
Medical evidence plays an important role in these cases. In some cases, the doctor will need to justify the duration of the condition. Past medical records may help to substantiate your claim. You stand a better chance of being accepted if you have a progressive illness.
Find Expert Legal Insight Near Me
Disability payments could help you cover your necessities when you are unable to work. To get these disability payments, you must file a disability claim with the Social Security Administration. Various reasons could lead the SSA to reject your disability claim. Some denials result from insufficient medical evidence and incomplete applications. Others occur because the SSA believes that you can still work.
The process for obtaining disability benefits is rigid, and many legitimate claimants have their applications rejected at the initial stage. You can enhance your claim and improve your chances of approval by having proper medical documentation. Additionally, you should respond quickly after receiving SSA notices. If the SSA denies your claim in the initial stages, you can still appeal the decision. Your chances of approval at the appeal will be higher if you have stronger evidence.
While navigating your disability claim in California, you will need the expert legal insight we offer at Leland Law. Call us at 866-449-6476 to discuss your case.
