Monday, August 11, 2008



What is the Difference Between a Technical Denial and an Informal Denial?

Technical denials and informal denials are similar in the fact that both denials result in your disability claim being denied prior to a medical determination. However, that is where their similarity ends. So, just what are the differences between a technical and informal denial?

Generally, informal denials involve Supplemental Security Income disability. If a Social Security representative determines that an individual’s income (i.e. wages, Social Security benefits, long or short term disability, workman’s compensation, public disability programs, etc) is too high, or it is determined that an individual has too many resources a.k.a assets (i.e. vehicles, land, homes, retirement plans, stocks, bonds, trust funds, etc.) to qualify for disability in the program, then the social security representative may issue an informal denial.

An informal denial basically saves interview time for the disability applicant, because they will not be required to provide all the information involved in a full claim. Of course, an individual has the right to request a formal denial for Supplemental Security Income disability on the basis of income or resources, however this will require a full disability interview with a claims representative.

Social Security disability and Supplemental Security Income disability both use technical denials. Basically, you could consider technical denials to be formal non-medical denials.

For instance, as I mentioned above you can request a formal denial for Supplemental Security Income benefits based upon your income or resources. Supplemental Security Income claimants may also receive a technical denial because of substantial gainful work activity. If an individual is working and earning over the substantial gainful activity monthly amount (set each year by Social Security), their disability claim will receive a technical denial and will not be forwarded to the state disability agency for a medical determination.

Social Security disability technical denials might be based upon the following: 1) lack of insured status (i.e. you have not earned enough quarters to be covered or you have not worked enough in the last ten years to be insured for disability), 2) inability to prove relationship in the case of adult disabled children or disabled widow/ widower disability claims, 3) failure to cooperate (when an individual has not cooperated with the claims representative or disability examiner by providing necessary information needed to forward their disability claim to the state disability agency for a decision), or 4) performance of substantial gainful activity as mentioned above.

All technical and informal denials occur before an individual’s disability claim is sent for a medical determination, except for failure to cooperate technical denials.

What determines if a failure to cooperate denial is a medical or non-medical denial? If the state disability agency denies a disability claim for failure to cooperate, it is considered a medical determination. However, if a claims representative denies the disability claim prior to sending it to the state agency it is considered a non-medical denial.

Since technical denials require an actual determination by Social Security, they also contain appeal rights. This means an individual has certain amount of time to disagree with a decision by requesting that the denial be reconsidered.




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