We understand just how complex and time-consuming the application for Social Security Disability Insurance (SSDI) benefits can get. This is why you may be frustrated and/or confused upon hearing the news that your claim was denied. Continue reading to learn under what circumstances your SSDI claim may get denied and how an experienced New Jersey SSDI appeals lawyer at The Law Offices of Sheryl Gandel Mazur can assist you in filing an appeal.
Why Are SSDI Claims Commonly Denied?
It’s important to understand that, unfortunately, a number of SSDI claims may be initially denied. Most often, this is due to technical issues or problems with the evidence provided by the applicant. As such, claims are commonly denied when:
- Medical evidence is incomplete or unclear
- The applicant earns too much income
- The condition does not meet the definition of a disability by the SSA’s definition
While many applicants may be initially denied, you’ll also find that, upon an appeal and correction, the denial may be overturned, and thus, the applicant receives benefits.
Income-Related Reasons an SSDI Claim May Be Denied
Unfortunately, one of the primary reasons that applicants may be initially denied by the Social Security Administration (SSA) is due to their income.
Earning Too Much Income
In general, you’ll find that, to qualify for SSDI benefits, you must be unable to engage in substantial, gainful activity. If you earn too much, you may not qualify, regardless of the severity of your condition.
When you file for benefits, the SSA will review:
- Your wages
- Income generated from self-employment
- Your work activity following the disability onset date
Medical Reasons SSDI Claims are Denied
It can be frustrating to learn that your SSDI claim has been denied on the basis of medical documentation. However, as mentioned before, you’ll find that this primarily revolves around issues with documentation, though you’ll find that, in some instances, the SSA will deny your claim if it does not meet the administration’s strict definition.
The Condition Is Not Considered Severe Enough
In order to qualify, the SSA requires that New Jersey applicants provide evidence that:
- Their condition significantly limits their ability to perform basic work tasks
- The condition prevents them from adjusting to other work
In most instances, short-term, mild, or manageable conditions are denied. This is because the condition must:
- Last at least 12 months (or be expected to last)
- Result in death
Lack of Sufficient Medical Documentation
You may also find that, without proper medical documentation to support your claims, your application may be denied. This is common when:
- Medical documentation is incomplete or missing
- There are significant gaps in your treatment history
- You have failed to follow the treatment
- No objective supporting testing has been conducted
Work History and Eligibility Issues
Many New Jersey applicants are surprised to learn that, even when they have a qualifying disability, if they do not meet the non-medical eligibility requirements, their application can be denied. Essentially, this means that if a worker has not paid into the social security system long enough or recently enough, they won’t qualify.
Not Having Enough Work Credits
To qualify for SSDI benefits, you must have work credits based on your age at the onset of your disability. Generally, adults need:
- 40 credits
- 20 credits earned in the 10 years prior to the onset of the disability
It’s important to understand that younger workers may qualify with fewer credits than older applicants.
Procedural Reasons SSDI Claims Are Denied
Unfortunately, the SSDI claims process can be incredibly difficult to navigate, as there is a considerable amount of paperwork that must be filed and deadlines that must be met. As such, it’s important to understand that, even if you meet the medical and non-medical eligibility requirements, procedural errors can result in the denial of your claim.
Failure to Respond to SSA Requests
The SSA may send requests for additional information. Failure to do so, such as failing to send forms, missing deadlines, or ignoring phone calls, can result in the denial of your claim
Failure to Attend a Consultative Exam
In some instances, you may be required by the SSA to attend a medical exam with a specific provider. Failure to do so can result in the denial of your claim. You are required to attend even if you have treating physicians.
Missing Deadlines
Due to the number of claims the SSA handles each year, ensuring you file your claim on time and meet the deadlines is critical, as the administration will be unable to process your claim after the deadline, which includes filing an appeal within 60 days of denial.
Why Many Valid Claims are Initially Denied
Unfortunately, it’s not uncommon for a valid claim to be denied by the SSA. This is because:
- Reviewers often lack a full medical context
- There are insufficient explanations of work limitations
- Technical errors may be present
As such, the appeals process can allow you to provide additional evidence and clarifications surrounding these matters.
What To Do After an SSDI Claim Is Denied
If you believe that you are eligible for SSDI benefits but your initial application gets denied, then you may file an appeal.
Steps to Take Immediately After a Denial
- Review the SSA denial letter carefully
- Identify the specific reason for the denial
- Continue medical treatment and documentation
- File an appeal within 60 days of the denial decision
Contact Our New Jersey SSDI Law Firm Today
With all that being said, suffering from a medical condition that disrupts your ability to work is difficult enough. But being denied your initial SSDI benefits claim can make this all the more difficult. So, to receive the benefits that you deserve, you must acquire the services of a skilled New Jersey SSD appeals lawyer with the Law Offices of Cheryl Gaundel Mazur as soon as you can. Contact us today to learn how we can help you.
