Monday, July 28, 2008



Why Most SS Disability Claims are Denied

Recent statistics indicate that as many as sixty four percent of all initial claims for Social Security (SS) disability are denied, more than eighty percent of all reconsideration appeals are denied, and many individuals are even denied at the administrative law judge hearing.

Why are so many Social Security claims denied? There are many reasons why Social Security claims are denied. For instance, many long-term disability companies insist that individuals apply for Social Security disability as a basis of offsetting any benefits they are required to pay the beneficiaries. This requirement causes many unnecessary claims to be filed with the Social Security Administration, thus increasing the amount of overall Social Security disability denials.

In addition to long-term disability companies clogging the system with claims that are unnecessary, many state social services offices will promote the idea that an individual should file for Social Security disability even if they are working at a level considered to be substantial work activity. Of course, these disability claims are denied for SGA.

Still other disability claims are denied for reasons totally unrelated to medical conditions or work activity. Some individuals who file for disability do not follow through with the requirements of their disability claim. Many claimants do not provide disability examiners with requested information or fail to attend scheduled consultative examinations; each of these may result in a Social Security disability claim denial.

This is not to say that Social Security does not deny legitimate claims for disability, because they routinely deny legitimate disability claims as well. So, what are some reasons that Social Security denies legitimate disability claims?

Often an individual files a disability claim due to traumatic injuries such as workplace injuries, car accidents, or even sudden onset medical conditions (stroke or heart attack). While these injuries or medical accidents may be disabling initially, they often are expected to improve over then course of twelve months (remember that the definition of Social Security disability requires that an individual must be disabled and unable to work for twelve months or be expected to be disabled and unable to work for twelve months).

If Social Security feels that an individual’s condition will improve to a level that leaves an individual able to perform substantial work activity (this activity does not have to be the individual's usual line of work), there is a possibility that the claim will be denied for durational concerns (not expected to last for twelve months) or even denied on the basis that an individual can return to their usual line of work or other work if the claimant's residual functional capacity allows (residual functional capacity is what an individual is able to do in spite of their medical and/or mental conditions).

For many, the Social Security disability process is a long an arduous one. If an individual is not allowed at the initial level their claim is likely to be denied at the reconsideration level because Social Security disability examiners are all bound by the same rules and regulations.

Social Security takes many things into consideration when they make a determination to approve or deny Social Security benefits. For example, disability examiners consider an individual's age, education, and medical condition when determining if an individual has the capacity to perform other work or even to be retrained to do other types of work.

As you can see, much of the disability determination is based upon what the disability examiner determines your residual function capacity to be, in addition to your ability to be retrained for other types of work that you are able to perform in spite of your impairments. Consequently, an individual may go through the Social Security disability process many times prior to being approved for disability benefits. In fact, there is no guarantee that an individual will ever meet the criteria for Social Security disability (though it should be pointed out that individuals who are denied and appeal their case all the way to the level of the disability hearing will stand a sixty percent chance of being approved if they have representation).




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