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How to Get Disapproved for Disability Benefits

Riddle Brantley LLP   |  July 31, 2020   |  

In past blog posts we have discussed ways to get approved for disability benefits based on different types of impairments. In this post, we’ll take the opposite tack and discuss the situations we sometimes see that prevent people from collecting disability benefits.

Reasons Disability Claims Are Denied - Riddle & BrantleyIn no particular order, here are some of the situations that could result in a denial of disability benefits:

Continuing to work

People suffering from serious medical or mental health problems often face a difficult dilemma:

  • OPTION A: Continue to work even though doing so is literally killing them or putting them in unbearable pain; or
  • OPTION B: Quit their job and risk not being able to provide themselves or their family with food, shelter and clothing because they are the only income producer in the household.

The length of time it takes to pursue a disability claim (in some cases upwards of two years) makes the situation even more frightening.

The very first principle of our Social Security Disability system is this: if you are still working in what the SSA calls “substantial gainful employment” (a job from which you earn at least $1,260/month, gross), you are, by definition, not disabled. It doesn’t matter how sick you are, and it doesn’t matter how hard it is to get up and go to work. If you’re working enough to earn that much, you’re not disabled by the SSA’s definition. Once you stop working (whether from being fired or from quitting voluntarily), then you can be considered for disability benefits, but not before that time.

Many of our clients continue working part-time (earning less than the $1,260/month limit), or as much as their pain level will allow, in an effort to avoid homelessness and hunger while their cases are pending. Our standard advice to these clients is to minimize the number of hours they work and the difficulty of the work they do. Even though, technically, working something like 30 hours a week and earning in the neighborhood of $1,000/month does not disqualify you from receiving benefits, that much work implies that you can work full-time.

Once you apply for disability benefits, the more you work, the more you are considered able to work, so be very cautious about working more than a minimal amount while your claim is being considered.

Willfully refusing to follow doctors’ orders

Failure to Follow Doctors Orders and Disability - Riddle & BrantleyThis may sound obvious, but if you fail to follow your doctor’s orders for treating your medical or mental health problems, you might not be able to collect disability benefits. For example, if you are diabetic and you refuse to take medication, and because of that refusal your condition gets so bad that you can’t work, the SSA can (and will) take the position that your refusal to follow doctors’ orders precludes you from receiving disability benefits.

When a person applies for disability benefits, their credibility is important. When you file an application, you are saying that you cannot work because of your health problems, even though, in good faith, you want to. If your doctors say that you could get well enough to work if you did what they tell you to do, it damages your credibility because it creates the impression that you really prefer not to work.

In this context, mental illness is viewed somewhat differently. For certain mental illnesses, the refusal to take medication or otherwise comply with treatment is itself a symptom of the mental illness. If that is proven to be the case, this refusal will not be held against the applicant.

There are other limitations on the general “non-compliance” rule whereby certain failures to seek treatment will not be used against the disability applicant, including:

  • Certain “lifestyle choices” like smoking, drinking (in moderation), or being overweight;
  • A legitimate inability to pay for recommended treatment or medication (our firm maintains a list of no- or low-cost treatment clinics for our clients who cannot afford treatment);
  • Being at risk for opioid addiction when the prescribed pain management regimen is narcotic medication;
  • Certain sincere religious objections to treatment.

There are other exceptions, but the general rule is that if there is a treatment for your illness or condition that you refuse to use without legitimate cause, you can be denied disability benefits.

Ongoing drug or alcohol use

Back in the “old days” (before 1996), a person could be approved for disability benefits if their drug or alcohol addiction was so severe that it kept them from working. That is no longer the case. The law was changed in that year to make it so that suffering ONLY from drug or alcohol dependence cannot qualify a person for disability benefits.

Alcohol and Drug Dependence and Disability - Riddle & BrantleyThe rule now is that you can only be found disabled while suffering from drug or alcohol dependence if you have OTHER conditions so severe that they would preclude you from working even if you never took another drink or drug.

One example is cirrhosis of the liver; if you have cirrhosis that has progressed so far due to your drinking that your liver cannot be healed even if you totally stop drinking, and the liver disease prevents you from working, you can be approved. But if your liver disease has not progressed to that point, so that your liver could heal if you stop drinking now, then you would not be approved.

This issue gets even more complicated when it comes to disability for mental health impairments like anxiety, depression, PTSD, or bipolar disorder. On one hand, underlying mental health impairments can be a CAUSE or at least a contributing factor to a person’s substance abuse; some people “self-medicate” to a degree so profound it prevents them from working.

Viewed from a different perspective, however, the symptoms of mental health impairments can be EXACERBATED by drug or alcohol abuse. A person suffering from paranoia-like symptoms is not likely to benefit from continued abuse of mind-altering substances.

And from yet another standpoint, if a person with an underlying mental health diagnosis STOPS abusing drugs or alcohol, he or she may be able to recover to the point of being able to hold down a job. The key issue the SSA will look at is, what condition would the person be in BUT FOR the substance abuse? If the answer is “good enough to work,” then most likely the person will not be approved for disability benefits.

The practical effect of this change in the law is that applicants for disability benefits must demonstrate, through a significant period of abstinence from drugs or alcohol, that they cannot work even if they stop their substance abuse. Our standard advice to clients with a drug or alcohol history is to:

  • document your treatment and therapy,
  • be able to prove (via written attendance slips) that you attend 12 Step meetings or the like, and
  • know your exact sobriety date

The word the SSA uses in this context is “materiality”. If your drug or alcohol abuse is not “material” to the question of whether you are disabled (i.e., if it does not matter whether or not you stop drinking or using drugs), then you can still be found to be disabled on the basis of your other, non-drug or alcohol-related medical or mental health impairments.

Dying before you receive benefits

It can take a long time – well over a year, sometimes more – to pursue a claim for disability benefits. If you are sick enough that you cannot work, your illness or disease might very well be severe enough to cause your death before your disability claim can be resolved. The sad reality is that many applicants die each year while waiting for their benefits.

Different rules apply to deceased claimants depending on when they died relative to where they were in the process, and on whether their claim was for Supplemental Security Income (“SSI,” the program for impoverished people even if they have never worked) or for Social Security Disability Income (“SSDI,” the benefit system you pay into while you’re working).

Claims for SSDI benefits can be started, pursued, and concluded, and benefits paid to certain surviving family members, even if the claimant dies before the claim is begun. The deceased person earned the right to collect those benefits while he or she was working, so his or her surviving family members can collect them, if the deceased person’s documentation shows that he or she could not work during the time period before his or her death.

If a claimant dies while pursuing a claim for SSI only and dies before the benefits are awarded, the deceased person’s heirs can pursue the claim, but only if the deceased person started the application process before he or she died, and only if other conditions are met. In other words, if a person who would have been entitled to SSI dies before making the claim, the surviving heirs cannot start a new SSI claim for the deceased person’s benefits.

Finally on this topic, if the applicant dies less than 5 months after he or she stopped working due to disability, then no SSDI benefits would be available. The SSA has a rule called the “disqualification period” that, harshly, prevents the payment of SSDI benefits during the first 5 months of the “period of disability.” This disqualification period does not apply to SSI claims.

Do you have a disability claim in North Carolina?

North Carolina Disability Lawyer - Riddle & Brantley (1)If you suffer from a disability and are unable to work as a result, you may be entitled to Social Security disability benefits and our North Carolina disability lawyers may be able to help.

For a FREE consultation with a Board-Certified Specialist in Social Security Disability, please call 1-800-525-7111 today.

There is no obligation and you won’t pay any attorney fees unless we successfully resolve your claim and you receive disability benefits from the SSA.

Please call 1-800-525-7111 today and let’s review your claim.

Justice Counts for North Carolinians who are no longer able to work due to disability, and we would love to help you seek benefits and justice if we can.