There are many reasons why SSDI benefits can be denied, and it can happen more than once in the claims review process.
Belleville, Ill. (Vocus) December 17, 2010
Nearly 300,000 people applied for Social Security Disability Insurance (SSDI) benefits in October, according to the Social Security Administration (SSA). Since approximately two-thirds will be denied for technical or medical reasons, they will begin to ponder their next steps, according to Allsup, a nationwide provider of Social Security disability representation and Medicare plan selection services.
The SSA’s disability evaluation involves review of work and medical history, and applying for Social Security disability benefits can be a complicated and lengthy process. “There are many reasons why SSDI benefits can be denied, and it can happen more than once in the claims review process,” said Cindy Ratermann, manager of disability claims specialists at Allsup. SSDI is a federally mandated insurance program that taxpayers and their employers fund through payroll taxes. In 2010, more than 152 million workers were insured through SSDI.
A number of factors can lead to an application being denied, including the SSA’s determination the applicant can return to work. SSDI is designed to provide monthly benefits to those who have experienced a severe disability and can no longer work for 12 months or longer, or who have a terminal condition.
Choosing professional SSDI representation such as Allsup can make a significant difference—including getting over the hurdle of a denial. “You can choose representation like Allsup at any point in your application—if you are just applying, or if you’ve just been denied benefits,” Ratermann said.
Why Was I Denied SSDI Benefits?
The SSA follows stringent criteria to determine SSDI eligibility. Work history, earnings, previous jobs, as well as medical condition, medical documentation of that condition and treatment are evaluated. The goal is to determine an applicants’ ability to work, either in the field in which they used to work, or work they can do now. Read more about the SSA’s five-step process on Allsup.com, under “General Guidelines” for SSDI.
If SSA denies your initial application, there may have been paperwork errors or your application did not tell the whole story in enough detail.
The type of work you did factors into how your claim is evaluated. Even if the SSA agrees that your medical condition prevents you from continuing in your present line of work, it also will look at other jobs you might be able to perform. If the agency determines you can perform a different job, your claim is likely to be denied.
It’s possible that you did not provide sufficient work or medical history to support your claim. Although medical records are a major source of information to the SSA, doctors’ reports may not contain all the information needed to fully explain your medical condition. Keep in mind that an SSDI representative such as Allsup can help determine what’s in your records, as well as identify what might be missing. They also can help retrieve important information from your physicians.
My SSDI Benefits Were Denied – Now What?
Allsup outlines some common mistakes applicants make to help people with disabilities cope with the disheartening experience of being denied SSDI benefits.
1. Applicants give up. Don’t give up. SSDI is a strictly regulated program, so don’t be surprised if the SSA denies your initial claim. More than two-thirds of claimants who reach the hearing level are awarded their Social Security disability benefits, and 90 percent of those have representation such as Allsup.
2. Applicants don’t appeal the decision. It’s important to appeal the decision before the SSA’s deadline. “Many people miss the appeal deadline and later re-apply,” Ratermann said. “But this means you are literally spinning your wheels.” Seeking representation after denial can take some of the worry about handling the appeal process, she said. “You won’t be handling your SSDI claim alone.”
3. Applicants don’t provide enough information. Details about work history, medical issues and physical limitations are absolutely critical. “If you don’t provide enough information or detail, it can limit the SSA examiners’ understanding of your claim,” Ratermann said. “Applicants can forget to list all their doctors, leave out a specialist, or even their primary care physician. Then those records are not included in the case when it is considered.” Allsup SSDI representatives can handle many of these steps, including contacting physicians and retrieving and submitting important medical records.
4. Applicants try to correct inaccurate information. Information submitted in the original application stays with the claim, including the denial letter. “Even if there is a mistake that nobody caught early in your claim, you have to move beyond it,” Ratermann said. “It’s important to file your appeal and use that opportunity to clarify the information in your claim.” Getting help with more detailed information and clarification are additional benefits from working with an experienced representative.
5. Applicants underestimate the extent of their disability. This can go hand-in-hand with not providing enough information. Many people with disabilities struggle with acknowledging that they cannot work any longer. “Sometimes it comes down to simply forgetting the changes you’ve made in your life to accommodate your disability,” Ratermann said. “Your Allsup representative can help you step back and take a closer look at the effects of your disability on your life. This examination is important when appealing your SSDI claim.”
6. Applicants don’t realize they can get representation services at any time. In a survey of nearly 300 successful SSDI applicants who Allsup helped on appeal—51 percent said they were not aware they could retain representation with their initial SSDI filing. “We have helped thousands of applicants get their benefits with their initial application. That means they don’t have to deal with making appeals or attending a hearing to receive their benefits,” Ratermann said. “But an SSDI denial also is a good time to get help.”
These common mistakes help illustrate the confusion and complexity of applying for SSDI benefits. “It’s important not to give up even though this can be a stressful experience,” Ratermann stressed. “If you are not capable of working any longer because of your disability, you have the right to apply for benefits—and to have help doing so.”
If you have questions about appealing your SSDI denial or about your eligibility for SSDI benefits, please contact the Allsup Disability Evaluation Center at (800) 279-4357 for a free disability evaluation.
Allsup is a nationwide provider of Social Security disability, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs more than 700 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis. For more information, visit http://www.Allsup.com.
(800) 854-1418, ext. 65065
(800) 854-1418, ext. 65760
# # #