When applying for disability benefits, many deserving individuals face the frustrating experience of claim denial. Understanding the common reasons for denial and knowing how to address them can significantly improve your chances of approval. Here’s an in-depth look at the five most frequent reasons disability claims get denied and the steps you can take to avoid these pitfalls.

Insufficient Medical Documentation

Perhaps the most critical factor in disability claims is thorough medical documentation. Many claims are denied simply because applicants fail to provide comprehensive medical evidence supporting their condition. Insurance companies and government agencies require detailed medical records that clearly demonstrate your disability’s severity and its impact on your ability to work.

To avoid this pitfall, maintain consistent medical treatment and documentation. Request copies of all medical records, test results, and imaging studies. Ask your healthcare providers to document specific limitations caused by your condition, including how it affects your ability to perform work-related tasks. Keep a detailed journal of your symptoms, treatments, and how your condition affects your daily activities. Additionally, ensure your doctors are using proper medical terminology and providing specific diagnoses rather than general descriptions of symptoms.

Failure to Follow Prescribed Treatment

Insurance companies and disability programs often deny claims when applicants don’t follow their prescribed treatment plans. This is viewed as non-compliance and can lead evaluators to question the severity of your condition or your commitment to recovery. They may argue that your disability could improve if you followed medical advice more closely.

To prevent denials based on non-compliance, consistently follow your doctor’s treatment recommendations. If you have valid reasons for not following certain treatments (such as adverse reactions or religious beliefs), document these reasons thoroughly and discuss alternatives with your healthcare provider. Keep detailed records of all treatments, medications, and therapy sessions you attend. If you must miss appointments, document the reason and reschedule promptly.

Income Exceeding Substantial Gainful Activity (SGA) Limits

For Social Security Disability Insurance (SSDI) claims, earning above the Substantial Gainful Activity limit can result in automatic denial. Many applicants don’t realize that continuing to work, even part-time, might disqualify them from receiving benefits if their income exceeds these thresholds.

Before applying, carefully review the current SGA limits and ensure your income falls below these thresholds. If you’re still working, consider reducing your hours or transitioning to less demanding roles that accommodate your limitations. Keep detailed records of any work attempts and why they were unsuccessful due to your disability. Document any special accommodations or assistance you require to perform even limited work.

Incomplete or Incorrect Application Information

Technical errors and incomplete information on application forms frequently lead to denials. Missing deadlines, providing incorrect personal information, or failing to include all relevant details about your medical condition and work history can result in automatic rejection.

Take time to carefully complete all application forms, double-checking every detail for accuracy. Consider working with a disability advocate or attorney who can review your application before submission. Keep copies of everything you submit, including supporting documentation. Respond promptly to any requests for additional information, and maintain detailed records of all communications with the disability determination office.

Lack of Long-term Disability Evidence

Disability programs typically require evidence that your condition has lasted or is expected to last at least 12 months or result in death. Claims are often denied when applicants cannot demonstrate the long-term nature of their disability.

To address this issue, work with your healthcare providers to document the expected duration of your condition and its long-term prognosis. If your condition is progressive, ensure medical records reflect this deterioration over time. Include statements from medical experts about your condition’s expected duration and impact on your ability to work. Consider obtaining a Residual Functional Capacity (RFC) assessment from your doctor, which details specific limitations and their expected duration.

By understanding and actively addressing these common reasons for denial, you can significantly improve your chances of having your disability claim approved. Remember that the application process requires patience, attention to detail, and thorough documentation. Consider seeking assistance from disability advocates or attorneys who specialize in disability claims, as their expertise can be invaluable in navigating the complex application process and avoiding common pitfalls that lead to denial.

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.