In Social Security disability, the most common denials are medical denials. This means that Social Security doesn't believe the medical evidence in your case meets the exacting standards for an award of disability. There are technically two kinds of medical denials:
1. You are able to perform some of your past relevant work. They have looked at your work history for the past 15 years and judged that your medical conditions permit you to perform one or more of your past jobs. This is what we call a "Step 4 denial."
2. You are not able to perform any of your past work - but there is other work in the national economy that you are able to do. This is called a "Step 5 denial" because it occurs at the 5th and final "step" in the decision making process.
There are other types of denials, not nearly as common as the two above. We sometimes think of these as "automatic" denials or "technical denials." They are not medical decisions, but are based on some other factor. Here are 3 examples:
- You are still working at "substantial gainful activity" or (SGA) during the period you claim to be disabled. You cannot be disabled under SSA rules while you are still working at SGA level, no matter how severe your impairments or how old you are. In 2023, working and earning compensation of at least $1,470 per month (gross) will produce a "step 1" denial. Medical issues are not even considered.
- You have a severe medical or mental impairment; however, it cannot be shown to have lasted for 12 straight months, be expected to last at least 2 straight months, OR to end in death. Simply put, your impairment doesn't meet Social Security's duration requirement.
- You don't have enough "work credits" to be insured by Social Security. For most claimants, they must have worked and paid FICA tax for at least 5 years out of the past 10 year period. In short, you must pay into Social Security for a certain period before you can "take out" from the trust fund. These work credits "fall off" after a few years of not working. If you are "uninsured" under Title II of the Social Security Act, it doesn't matter how sick or injured you are, there is no coverage.
Note: Not all "work" will qualify you for coverage under the Social Security Act. Work which does not deduct and pay FICA tax (the Social Security and Medicare tax) won't count toward insured status. Examples might include: sitting with the elderly, babysitting, cleaning some friends' houses, or working from home if you pay no FICA tax. Generally, no work which pays "under the table" counts for Social Security credit.
So, there are several reasons why Social Security may deny a disability claim.
Reasons 1 and 2, "medical denials," may be appealed. In fact, a majority of claims denied on medical reasons are eventually paid on appeal.
A qualified Social Security disability lawyer or advocate can advise you whether an appeal is appropriate to win your benefits.
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Charles W. Forsythe represents disabled clients in an application, appeal or hearing for disability benefits. You will not be charged a fee until you win your case and are approved for past due benefits.
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