Navigating the disability claims process can be a daunting task, especially if you’re unfamiliar with the various factors that can impact the approval of your claim. Whether you’re applying for Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or other types of disability benefits, understanding the complexities of the application process is crucial to avoid unnecessary delays or denials. In this blog post, we’ll explore common signs that could indicate your disability claim may face rejection, and provide tips on how to avoid these pitfalls.

1. Incomplete or Inaccurate Documentation

One of the primary reasons for disability claim denials is incomplete or inaccurate documentation. The Social Security Administration (SSA) requires detailed medical records, work history, and other supporting documents to evaluate your eligibility for benefits. If any part of your application is missing or incorrect, it could significantly delay your claim or result in a denial.

What You Can Do:

Ensure that all medical records are up to date and complete. Provide your doctors with a clear and accurate description of your condition and symptoms.

Double-check that all forms and applications are filled out correctly, without leaving any sections incomplete.

Keep track of all the paperwork submitted and request copies for your records.

2. Failure to Meet the Medical Requirements

Disability claims are often denied because applicants fail to meet the SSA’s strict medical criteria. The SSA uses a five-step process to determine whether someone qualifies for disability benefits, assessing things like the severity of your condition, your ability to work, and your medical prognosis. If your disability doesn’t meet the SSA’s definition of “severe” or is expected to last for less than 12 months, your claim may be denied.

What You Can Do:

Ensure that your medical condition is thoroughly documented by your healthcare provider. The SSA typically looks for medical evidence that shows how your disability affects your ability to function in daily life and work.

Keep up with recommended treatments and attend all follow-up appointments. Failure to comply with prescribed treatments may raise doubts about the severity of your condition.

If possible, seek out a medical expert who specializes in your condition to provide an opinion on how your disability impacts your ability to work.

3. Lack of Consistent Work History

The SSA evaluates your work history to determine if you’ve earned enough “work credits” to qualify for SSDI benefits. If you don’t have sufficient credits, your claim for SSDI may be denied. For SSI, the focus is more on your financial resources and household income, but a lack of consistent work history may still impact your case.

What You Can Do:

If applying for SSDI, check that your work history meets the SSA’s criteria for recent work activity. Generally, you need 40 work credits, 20 of which must have been earned in the last 10 years.

If your work history is spotty or you’ve recently stopped working, make sure you have other supporting documentation that shows you have a legitimate disability and have been unable to work due to your condition.

Consider applying for SSI if your work history doesn’t meet SSDI requirements, as it has different eligibility criteria.

4. Not Following the SSA’s Guidelines for Residual Functional Capacity (RFC)

The SSA will assess your Residual Functional Capacity (RFC), which measures your ability to perform work-related activities despite your disability. If the SSA believes you can still perform work at some level, your claim might be denied. This assessment takes into account factors like your physical abilities, mental capabilities, and your capacity to sustain full-time work.

What You Can Do:

Be honest and detailed when describing your symptoms and limitations in your application. Be sure to mention how your disability affects your ability to sit, stand, walk, or perform any work-related tasks.

Get a comprehensive RFC assessment from your doctor, which may include testing to evaluate your physical and mental capabilities in relation to your disability.

5. Failure to Follow Through with Appeals

It’s important to understand that a disability claim rejection is not the end of the road. In fact, many claims are denied in the initial stage. However, if you don’t take action within the timeframe given (usually 60 days) to appeal the decision, you could forfeit your right to challenge the denial. If you don’t follow through with the necessary steps to request a reconsideration or a hearing, your claim will remain denied.

What You Can Do:

Act promptly if your claim is denied. The first step is typically to request reconsideration, followed by a hearing before an administrative law judge (ALJ) if needed.

Work with a disability lawyer or advocate who can help guide you through the appeals process and improve your chances of a successful outcome.

6. Insufficient Work Capacity Despite the Disability

If the SSA believes that you still have the capacity to work, even with your disability, your claim may be denied. The SSA uses a specific process called “substantial gainful activity” (SGA) to determine if you are able to earn enough income to be considered “working.”

What You Can Do:

Ensure that your work history, including any past employment after your disability began, is accurately recorded. If you have attempted to work despite your disability, make sure this information is included in your application.

If your condition has worsened over time and you’re no longer able to work, ensure you provide evidence of how this has impacted your daily functioning and employability.

Conclusion

Disability claims can be complex, and understanding the common signs of denial can help you avoid setbacks in the application process. The most critical steps to ensure your claim is approved include submitting accurate and complete documentation, meeting the SSA’s medical criteria, and following through with appeals if necessary. Remember, if you find yourself facing a denial, it’s not the end of the road—taking the proper steps to appeal or reapply could still lead to a favorable outcome. Consider consulting with a disability attorney or advocate to maximize your chances of receiving the benefits you deserve.

Navigating the intricacies of Social Security Disability benefits can be made more manageable with the assistance of the expert North Carolina disability specialists, Golson, McCracken Inc. Our team specializes in advocating for the rights of the disabled and offers our clients comprehensive support throughout the application and appeals process.

Golson, McCracken Inc. provides services across North Carolina including Raleigh, Sanford, Mebane, Greensboro, and Charlotte. If you suffer from a disability in North Carolina, contact North Carolina SSDI and SSI advocate Golson, McCracken Inc. to enhance your chances of successfully securing the benefits you need.