One thing we’ve covered many times at this point is that when you apply for SSI, or SSDI & Veterans service-connected disability benefits – you are very likely to be denied the first time.
You can certainly optimize your chances of success by working with a disability lawyer or advocate upfront. But even when you seemingly do everything correct, things go sideways sometimes.
SSI Denied Because…Your Income Is Too High for SSI
Sometimes applicants don’t necessarily know or understand the application requirements for SSI. If you’re earning more than the benefit you would receive from SSI, generally you aren’t eligible. Most years the income threshold changes, but a great place to keep up to date on the earned income caps is, here.
In addition to earned income limits, there are personal and family asset caps. To qualify, you must have less than $2000 in personal assets, or $3000 if you have a significant other.
You Missed Paperwork Deadlines
Throughout your claim, the Social Security Administration is going to be asking you for various pieces of documentation. It’s imperative that you return forms, files, records, and anything else they ask for in a timely manner. Failing to return a critical piece of information quickly could (often does) result in a decision being made prematurely.
Think about this from the adjudicator’s perspective. They have to try to understand your situation on paper, and they’re under a time crunch to make decisions in doing this. If they’ve asked for information, and don’t get it, they don’t have the ability, or even necessarily discretion to delay making a decision.
Your Medical Records Show Conflicting Information
How do you feel today? You’re going to be asked that everywhere you go. Perhaps one of the hardest things for us to do is to be honest in answering that question. Now imagine you’re Dr. is writing down your answer – and later on someone is evaluating your claims based on what they wrote down.
A simple note stating: “Ms. Smith reports feeling in good health and has no apparent pain…” is going to create confusion in your claim for SSI, especially if the crux of your disability is in regards to what that doctor’s appointment was about.
On that same note, one of your medical records could very easily conflict with another one for reasons as simple as two or more doctors seeing or understanding your condition(s) in different ways. Most claimants don’t even know this is an issue until they see a denial. It can be avoided, and it can definitely be overcome on appeal.
You Aren’t Following the Doctor’s Orders
The crux of your claim is that your condition as it is today is a barrier to you being able to engage in substantially gainful activity (work). This means that if there is a medical treatment that would/could/will get you to the point where you can work, and you are not following your doctor’s prescriptions (or directions) for care, you are the barrier to your own improved condition. The SSA needs to see your condition, under treatment, to make a determination on your ability to work. If you’re refusing treatment, you’re risking having your SSI denied.
Your Case Lacks Evidence
Do you have treatment records? Do you have other records or statements to support your claim? Is the only medical opinion going to be the exam the Social Security Administration makes you go to prior to making a determination? The problem with presenting only the one piece of evidence that the SSA collects is that if the evidence presents your claim in an unfavorable way, the adjudicator will have no counter opinion to assess. Presented with one side (or even no sides) of the story, their SSI determinations will be limited to their understanding.
You Are Already Better
It’s going to take a couple of months to get the SSI worked out, even if your claim is successful. Is your disabling condition permanent or will it be mended by the time your claim is decided? A broken arm is likely to be more temporary than a broken back or neck, for instance.
In addition to this, the severity of the impairment is often assessed. Consider, at what point does a behavioral health challenge turn into a complete barrier to social interaction? For each person the answer to this is different. If there’s one thing that a system like SSI has a hard time with, it’s individual assessment of an ambiguous impairment.
You Disappeared…
This is taking the failure to respond to another level. Have you gone to ground; complete radio silence? One of the biggest challenges for lawyers and advocates helping people to get an SSI claim processed is losing contact with claimants. If the SSA can’t get ahold of you, they can’t get information from you. They certainly can’t let you know when appointments will be. If you move, change mailing addresses, or even if you haven’t heard from the SSA in a long time – it’s worth checking in to make sure everything is still moving along.
SSI Denied Due to Incarceration
Have you been in jail or prison recently? You cannot receive SSI benefits while incarcerated, but you can often apply for them under pre-release programs.
You Never Showed Up
Skipping doctor appointments and skipping hearings are big no-nos for this process. Your claim will almost assuredly be denied if you fail to show up for appointments scheduled for you. This can be a very frustrating situation for many claimants simply due to inconvenient, or sometimes unknown appointment times and dates. Do your best to stay on top of appointments when they’re made and to be flexible or make yourself flexible enough to make appointments even if you learn about them at the last minute.
English