Why Will A Social Security Disability Application Get Denied?

There are basically two types of disability application denials: technical and medical. If a disability application is denied for technical reasons, the application will never be sent for a medical determination. Technical denials include lack of insured status denials, performance of SGA denials, and res judicata denials.


The first type

1. Lack of insured status denial- A disability denial that is based upon an individual not having earned enough quarters of coverage to be insured for disability benefits. Quarters of coverage can be earned at a rate of four per year provided an individual has earned enough money for that year. An individual’s age at the time of they became disabled determines how many quarters of coverage are needed to be eligible for Social Security disability.

2. Performance of SGA denial- Each year Social Security determines a gross monthly earnings amount that it considers to equate with substantial gainful work activity. If an individual is earning over this amount, their disability claim will be denied.

3. Res judicata denial- A disability denial that is based upon a decision made in the past that was after the date an individual was last insured for Social Security disability. If the person has no new work activity, Social Security deems the Social Security disability issue closed.

4. Failure to cooperate denial- This is a denial that is based upon an individual’s failure to provide information or paperwork that is necessary to process their disability claim (whether or not a failure to cooperate denial is technical or medical will depend on where it occurs, i.e. at the social security field office or at the disability determination services agency).

The second type

The second type of denial is a medical denial. Medical denial decisions are made by disability examiners at the state disability agency and are based upon an individual’s medical impairment, residual functional capacity, work history, age, and education. Disability examiners can also deny a claim for failure to cooperate if an individual does not provide them with information or fails to attend a consultative examination, and these denials are considered medical denials.




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Social Security Disability Secrets

Social Security Disability Benefit Questions



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When You Apply For Disability Do You Get It From The Day You Were Disabled Or The Day You Apply?

From the standpoint of the social security administration, disability is synonymous with the inability to engage in work activity; in other words, an individual's state of disability begins when they become unable to perform substantial gainful work activity due to the effects of a disabling condition or conditions.

However, and this can be confusing for applicants, this does not necessarily mean a person who has filed for disability will be paid disability benefits back to the day they became disabled. This is because the date of application and the date of disability onset (when you became unable to work according to SSA) both play an important role in determining when you will be able to receive disability benefits. It is also because the two disability programs administered by SSA treat the issue of retroactivity differently.

A couple things to keep in mind with regard to SSD, or social security disability:

1) If you are entitled to Social Security disability, you are allowed twelve months of retroactive disability benefits from the date you file your disability application, provided, of course, that you have not been able to perform substantial work activity for at least seventeen months and that your medical records will support an early enough onset date.

2) Social Security disability has a five-month waiting period (in which no disability benefits are paid) that begins with the onset date and lasts for five full months. This means, if you became disabled on January 15, you would not be entitled to receive disability benefits until July.

Conversely, Supplemental Security income disability, a.k.a. SSI, begins with the month of application for disability.

Although Supplemental Security Income disability, or SSI, beneficiaries do not receive retroactive benefits prior their application date, they have the advantage of no waiting period. Consequently, if you are filing for SSI and are found disabled per your application date, you will receive disability benefits from the month you made your application for disability benefits provided that you meet the SSI program income and resource limitations. And if your case has been in the system for quite some time, as is often the case, you may be eligible for a considerable amount in back pay, or past due benefits (which people often get confused with retroactive benefits).

It should be said, of course, that most applicants who are approved for social security disability or SSI disability do end up receiving at least some amount in back pay ---though, as was indicated earlier, "retroactive benefits", or benefits that may be owed to a claimant prior to the filing of a disability claim, only apply to social security disability and not SSI.

A couple things to keep in mind with regard to SSI disability:

1) You may remain entitled to both disability programs if your Social Security disability (monthly) benefit amount remains lower than what is currently the full, or maximum, SSI monthly benefit amount.

2) Even if your Social Security disability benefit amount is more than the SSI monthly amount, you still may be able to receive SSI disability benefits for the five-month Social Security disability waiting period provided you meet the SSI disability income and resource limits.





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Social Security Disability Secrets

Social Security Disability Benefit Questions



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If I get disability benefits, will my family or kids get benefits?

If I get disability benefits, will my family or kids get benefits?. Well, FMAX or family max, is all the money that is payable on an individual's record. From the FMAX amount, the disabled individual must be paid their benefit (PIA). The remainder, if there is, any will be divided amongst their dependents.

The most a dependent beneficiary can be paid is one half of the disabled individual's PIA. If there is enough money remaining on the record, all dependents will be paid a benefit equal to half the disabled individual's PIA. If there is some money but not enough to pay half the PIA amount, then the money remaining on the record will be divided equally between dependents.

Additionally, if FMAX = PIA, there will be no money payable to dependents.

Now, to answer the question with which we began a bit more plainly, if an adult is approved for disability benefits under the social security disability program, their dependents may receive benefits. However, it really depends on how much the disability claimant has paid into the system via their work activity. Remember, a person's eligibility for disability benefits is based on their work history and what they've "paid in" through fica.

Now, if an adult is approved for disability benefits under the SSI disability programs, there is no provision for the claimant's dependents because SSI is a "needs" program, and even though the medical eligibility for disability requirements are the same, the program is nonetheless designed to help those do not qualify for social security disability, or who do qualify for SSD but receive a very small monthly benefit check.






Return to:

Social Security Disability Secrets

Social Security Disability Benefit Questions



Other Posts

Eligibility for SSI disability
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Are there social security disability retroactive benefits?