Why You Might Be Denied SSDI or SSI Benefits

Eligibility Team
Researcher & Writer
January 13, 2016

Each year, a large number of claims are denied for SSDI benefits. While there are a variety of reasons for those denials, they can all be traced back to one single thing overall. The applicant did not prove they have an inability to work in meaningful employment due to a medical condition that is going to last for at least one full year.

Essentially, a denied applicant did not meet the definition for what a disability is in the eyes of Social Security. While many people assume that Social Security looks almost exclusively at an applicant’s medical records, expecting them to stand on their own, Social Security will also take a strong and focused look at the applicant’s job history and their ability to work going forward.

An examiner will first look at an applicant’s medical records, specifically looking for a diagnosis and the origin of the condition. From there, they will look at other medical documents that support the diagnosis, ranging from test results, to blood work and physical examination results. Once confirmed, the examiner will look at how the applicant has been treated and what their prognosis is. From there, the examiner looks to confirm the patient’s residual functional capacity – defined as what the patient can still do for work despite their illness or condition.

If a claimant’s rated limitations, or their residual functional capacity (as indicated by a form completed by their doctor) does not meet minimum disability standards, they will be denied benefits.

In the eyes of Social Security, not meeting minimum standards means it has been determined that an applicant has the facilities to go back to the work they were doing, or do some other type of meaningful and comparable work. In some instances, because the application process is fairly long, those who apply will go back to work at their former job, pretty much guaranteeing a denial of benefits.

Those who are denied do have the option of a couple of levels of appeals by requesting a reconsideration, and then a hearing in front of an administrative law judge and finally having their case heard by an Appeals Council.

But in the case of each of these levels, the criteria and the basic test for employability will remain the same.

Eligibility Team
Written by
Eligibility Team
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