Why SSI and SSDI Claims Receive Rejection

Before you spend time and effort on the application process for federal Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), consider some of the major disqualifiers. Eligible individuals can benefit from both programs though they have distinct differences. The major difference is SSI eligibility qualification relies on age, disability, and limited resources and income, while SSDI eligibility determination relies on disability and work credits. In most states, SSI recipients automatically qualify for Medicaid health care coverage, which could result in additional supplementary benefits through your state’s Medicaid program. However, both programs have some common reasons that can disqualify your claim.

Typically most people think about the reasons they should receive benefits without ever considering why they may be denied. Some of the reasons are beyond your control, while other reasons are missteps you can avoid that result in denial. Things to consider include:

In the case of  SSI , the disability benefit for low-income individuals, you cannot exceed the substantial gainful activity ( SGA ) threshold. However, it is permissible to earn more money after your approval. Still, there is a limit of about $1,600 a month on all earned and unearned income for SSI. This dollar amount applies to both application for and collection of benefits. Any time your monthly income exceeds $85, your SSI payment will receive a reduction based on a complex formula. Anything over $1650 per month, and you will no longer qualify.

When you apply for SSDI (the benefits program for workers who paid into the Social Security tax base over multiple years), your claim may be denied if you work above the threshold considered substantial gainful activity. Going over this amount means you earn too much money to be considered disabled. It is permissible to earn a small amount during your application and collecting of SSDI but not over the SGA limit. This limit (for non-blind individuals) was $1310 per month in 2021, and the figure is adjusted annually. It is worth noting income from investments does not count toward the SGA; only work income determines your ability to work.

Qualification for both SSI and SSDI benefits means the Social Security Administration (SSA) must believe your impairment is severe enough to continue for at least 12 months or result in your death. Blind SSI applicants are the only exception to the duration requirement.

Many claims based on bone fractures resulting from acute trauma from accidents are commonly denied since the disability is unlikely to last 12 months. Nearly all bone fractures heal in under a year. If your bone fractures are severe enough and have not healed after six months, you may resubmit your claim as the SSA will likely believe your impairment will last a year. Each case receives an individual evaluation.

If your medical condition is not trauma-related, it must still cause severe limitations of disability to qualify for SSI or SSDI. Most denied claims are due to the applicant’s impairment not being severe enough. You can learn about the disability determination for benefit claims  here.

Both the SSA and Disability Determination Services ( DDS ) agencies need to be able to communicate with you regarding your application. If they cannot reach you, schedule examinations, appointments, or communicate about critical matters, you will likely be denied benefits. Every day claimants are denied because the SSA cannot locate them. If you opt to name a representative (such as a disability lawyer) to handle your application, you may not have to contact the SSA. However, you most certainly must maintain contact with your disability attorney.

The SSA requires medical information about your impairment, and if you refuse to release these records, your claim of disability will likely be denied. If you provide medical records, but the SSA deems them incomplete, or you lack a regular doctor for treatment, they will schedule a consultative examination ( CE ) with an SSA doctor. Refusal to accept this exam(s) and requesting a determination of eligibility be based on existing medical records may be cause for denial due to inadequate medical data or failure to comply with a CE. Your attorney also helps you gather the correct medical information according to the requirements.

If you receive medical treatment, failure to adhere to the doctor’s prescribed therapy when you are able to may cause a denial of disability benefits. Some acceptable medical excuses include:

Some acceptable non-medical excuses include:

Your attorney can review the details of your situation to see if any exclusions apply and collect the necessary documentation.

If a contributing factor to your disability is DAA, the SSA will deny your claim for benefits. The DDS medical consultant will determine whether you would still be disabled if you ceased using drugs or alcohol. You can read more about DAA determining factors  here.

Certain conditions relating to criminal conviction or imprisonment will prevent approval of SSDI.

If these conditions apply to your situation, it is still worth the effort to apply for SSDI benefits. Although you will not receive cash benefits, you may still be granted a benefit-free disability period that freezes your earnings record, preventing the decrease of eventual disability, retirement, or dependents benefits. Talk to a disability attorney if your claim is complicated by these circumstances.

The above conditions do not prevent your receiving SSI disability benefits, although you will be unable to collect them while incarcerated.

Always apply for disability benefits honestly. If you receive them by dishonest means, the SSA may terminate your benefits and choose to prosecute you for fraud. Benefits obtained through fraudulent methods by your representative or someone working for the SSA also may cause the termination of your benefits.

These common reasons stop you from legally obtaining SSI and SSDI benefits. Before you become too involved in applying, be certain you meet the minimum standards for approval. A disability lawyer can help you sort out any issues, avoid missteps, and properly present your case for disability approval. If you have questions or would like to discuss your legal matters please  contact  us at 989-495-2555.

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