3 Reasons Disability Claims are Denied (and What to Do About It)

3 Reasons Disability Claims are Denied (and What to Do About It)

Why Are Disability Claims Denied?

When you contact Riddle & Brantley for help with your Social Security Disability claim, we do not automatically agree to take you on as a client. We first gather from you and from the Social Security Administration (SSA) the information we need to make a judgment call on whether your case is likely to be successful. To be fair to our clients, we only take cases when we determine that there is a good chance of disability benefits being awarded. However, even with this screening process, not every client we represent ends up winning their case. This is the reality for all disability attorneys. Regardless of the effort put in by the legal team and client, some cases result in an “unfavorable” decision based on many possible factors. A recent article highlights some of them.

3 Common Reasons Why a Social Security Disability Claim is Denied

The SSA routinely denies disability claims. These are some of the more common factors that might impact the SSA’s decision to deny benefits:

• Lack of taxes paid — some disability applicants who are medically disabled simple haven’t worked long enough to have paid enough into the Social Security system over a sufficient period of time to be eligible for benefits at all, even if they are clearly disabled.
• Lack of medical care — some disability applicants do not get ongoing medical care, no matter how bad their health conditions are. You must have treatment records to back up your claim that you are disabled. You can have the most serious medical condition imaginable, but if you can’t prove it with evidence from medical professionals and facilities, you cannot win your case.
• Lack of legal representation — some disability applicants don’t hire lawyers, mainly because they don’t want to pay the fee. It’s true that if you hire a disability lawyer and you win your case and you are found to be owed “back pay” going back to or near the time you stopped working, you will owe, usually, 25% of that back pay to your lawyer as his or her fee. It is also true that, by any measure, you are FAR more likely to win your case when a lawyer helps you. The SSA also “caps” the amount that a disability attorney can charge.

Is It Getting Harder to Get Disability Benefits?

Statistically speaking, the odds of a person being approved for benefits after a hearing before an Administrative Law Judge (ALJ) have fallen over time. Roughly 63% of claimants were approved after ALJ hearings back in 2008 and 2009. That number has fallen to roughly 47% in the most recent year statistics were available. There are many theories for why this has happened, but the reasons are less important than the reality: it is tougher than ever to win a disability case. But all things being equal, your odds of winning your case go up significantly if you have a lawyer helping you — even more so when that lawyer is a Board-Certified Specialist in Social Security Disability.

How to Improve the Chances that Your Disability Claim is Approved

So, armed with the above knowledge about why some cases fail, what should you do to give yourself the best odds of success? Here are some tips for increasing your odds of receiving disability benefits when you apply or appeal to the SSA:

• If you can work, work for as long as you can. This is easier said than done when you have severe physical or mental health problems. But the longer you work and pay into the system, the higher your benefit will be when you absolutely must stop working.
• Report your earnings and pay your taxes. It’s very tempting to find a job where an unscrupulous employer pays you cash without deducting state, federal, and Social Security taxes. In the short term, it puts more money in your pocket. But you pay a high price for that short-term gain. When you become old or disabled (and almost everyone does), you and your dependents will not be eligible for the full range of benefits from our society’s “social safety net.” Do not be tempted by the “sugar high” of under-the-table work. It’s not worth it in the long run and can put your potential disability benefits in jeopardy.
• Be prepared and make sure your case is documented. Make sure you tell your lawyer about all your medical problems (physical and mental) and all the places where you are getting care for them. Make sure the SSA and your ALJ can see that your problems are real and that you are getting proper care for them, to the extent you can afford it.
• Be honest with your judge. Maybe you’ve been treated in the past for drug or alcohol dependence. Maybe you currently use cannabis products for pain or anxiety control. By the time you get into a disability hearing, your ALJ doesn’t really care. They are not the police. They want to know from you, honestly, what is keeping you from working and what you’re doing about it. The subject of active substance abuse is a whole other topic in the disability context, but when you are testifying to an ALJ, you must be honest, because if what he or she hears from you does not match what he or she reads in your medical records, it’s a huge problem that will make you less likely to receive benefits.
• Be old(er). The rules that ALJs apply to a person’s claim for disability benefits change as the person reaches certain age milestones. Those over 50, and even more so those over 55, have a much greater chance of winning their case than those under 50. These rules are arbitrary and unfair in a lot of instances, but they are what they are, and we cannot change them — we can only help you navigate through them.
• Be lucky. There is a dirty little secret in the disability world: your chances of winning your case depend to a great degree on the luck of the draw as to which judge is assigned to your case. Some ALJs award benefits in approximately 30% of the cases they hear, while others pay closer to 70%. The same case could get two different results depending on which judge hears it. It’s not fair, but again, it’s the system we are stuck with. A lawyer who knows from experience the preferences and tendencies of the disability judges can give you the best chance of winning your case.

No lawyer or law firm can guarantee that you will win your disability case. But if you hire a lawyer, take their advice, and follow these guidelines, you will position yourself to be in the group of people who win.

Have You Been Denied Disability Benefits?

At Riddle & Brantley, our North Carolina disability attorneys have secured disability benefits for countless clients who have been previously denied. We offer a free consultation to review your claim and discuss your legal options and are ready to help however we can. For a FREE, no-obligation consultation concerning your potential disability appeal, please call 1-800-525-7111 or complete the fast and easy form below. If you’ve previously been denied disability benefits, you may still have legal options for seeking compensation. Please call 1-800-525-7111 and let’s review your claim. We believe Justice Counts for North Carolinians with disabilities and we’re ready to help however we can.