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Why Disability Claims Might Be Denied

Why Disability Claims Might Be Denied


When filing for Social Security Disability, claimants can almost expect to be denied on the first try. While statistics vary depending upon state of residence, denials average about 65 percent of all first-time applications for benefits. The first step of appeals can carry an even higher rate of denials, at about 85 percent.

Generally, Disability benefits are denied due to two reasons. The first is related to the claimant’s income or resources. Since Social Security can and does make mistakes in calculations, it does make sense to review the facts and make sure the denial was accurate. If it was indeed accurate, however, benefits won’t be awarded unless income and resource information changes for that claimant.

If the case was denied on the basis of medical proof, Social Security will send a denial notice briefly detailing the condition, supporting evidence, and reason for the denial. Some denial notices may state that there are jobs which the claimant is still able to perform, despite the disability. Other denials are made based on Social Security’s estimate of the claimant’s “residual functional capacity”(RFC). This is a measure of the amount of activity a person is capable of performing.

Most appeals concern a disagreement with Social Security’s estimate of the claimant’s ability to perform work, or a disagreement over the level of the disability. In order for an appeal to be successful and for the claimant to begin receiving benefits, Social Security generally needs more in-depth proof of the individual’s medical circumstances. Generally they need more statements from doctors, more up-to-date testing, and a variety of other evidence in order to prove the extent of the disability. The claimant must prove that the disabling condition prevents him or her from gainful activity (work).

Since most appeals are denied in the first stage, it’s imperative to seek out expert guidance. Once the case reaches the second stage of appeals, the entire process can often be drawn out for years.