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Social Security Disability Blog

3 Reasons Your Claim Was Denied

Monday, November 08, 2010

1. You Are Still Working

The most basic eligibility requirement to receive Social Security Disability Benefits is an inability to engage in substantial gainful activity that has lasted or is expected to last for 12 months. In other words you cannot be working. When the disability examiners evaluate your claim, they will look at your earnings record. Remember how Social Security taxes are taken out of each paycheck? Social Security knows how much you have earned during each month of your working life. If the examiner finds ongoing wages, it’s pretty easy to deny the claim.

2. Lack of Medical Evidence

When you apply for disability benefits, the Social Security Administration (SSA) requires that you provide the names and addresses of any doctors or hospitals that have provided treatment. SSA also requests that you sign medical authorizations. SSA will then request your medical records from all the providers that you identify. When the examiners review your file to determine your eligibility for benefits, the medical records received are the most significant evidence considered.

In many cases, when the examiner finally gets around to your case the medical records contained in your file are thoroughly incomplete. This is for a variety of reasons. First, you may not have identified all the providers – thus SSA would have never requested those medical records. This could be a hospital visit you forgot or the diagnostic imaging center that performed your MRI. Second, obtaining medical records requires persistence. Many times the first request to a medical provider gets no response and a follow up request is required. Other times no records are received because the identity or address of the provider is wrong. SSA employees simply do not have the time to follow up on requests that don’t get a response. In these situations, the examiner often denies the case because there are no medical records to support your allegations of disability.


3. The Wrong Kind of Medical Evidence

Even if SSA has received the medical evidence – it is probably the wrong kind of evidence. To understand my point here, you need to understand medical records. When doctors create a record from your visit, they generally write it in the SOAP (subjective, objective, assessment, plan) format. The medical record typically contains these four categories of information: history (subjective), examination (objective), diagnosis (assessment), and treatment recommendations (plan). There is no category called “Disability” or “Work Restrictions.” Hence, most medical records will typically not contain any information about how the condition affects your ability to work.

The medical evidence that will support your claim for disability is information about restrictions. How much weight you can lift? How long can you stand or walk? How often will you be absent from work due to your condition? When the examiner looks in the medical records he or she may see that you have lumbar disk disease. The examiner needs to know how that condition prevents you from doing work activities. What restrictions does that condition impose upon you? The examiner, because the medical record is usually silent as to restrictions, is allowed to formulate his or her own opinions as to how your lumbar disk disease may impair your ability to work.

By David Galinis


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