People get denied disability benefits every day. But do they really know why they got denied?
Some claimants are certain they will win their case simply because they have a diagnosis and they feel they can’t work anymore.
No one thinks about what it takes to win a case and all they think is that if “the neighbor got disability benefits and I see him moving around just fine, I should too”.
Today, I will be giving you the top 15 reasons people are denied disability benefits.
Important: this list is not foolproof.
There are many other reasons people get denied
This list will not show what you will see in the denial letter. That is very specific to each person’s case but remember my post about the canned denial letters?
In that post, I talk about the actual content of the denial letter and its significance. What I am listing here today is basically the “background”, the “backstage” or what went on in the mind of the “decision maker” when he/she decided to deny your case.
Here it goes:
1) 90% of cases are denied in the first round! Sad but true. But consider this denial as part of “the game”. We talked about this and more in the post about the Social Security denial letter.
2) Your medical records may not describe your conditions very well. I’m not talking about the diagnosis listed in the records or the part where you describe how you feel. I’m talking about the objective examination conducted by your doctor. What your doctor actually describes when he examined you.
3) You are not receiving the right treatment(s) for your condition(s). You may have been denied simply because you may not be seeing the right doctors.
Other times people concentrate on one medical issue and see only one specialist. They forget all other impairments and yet list all these impairments in their application without seeing a doctor for each of them.
Check my post about combination cases about what to do when you have several impairments.
Another issue with doctors that I see all the time and this should be a basic rule in disability and most people don’t know:
Treating with a primary physician alone will NOT win cases no matter how well intended and qualified your primary physician is.
4) Your records are too old and you are not seeing doctors now. A lot of people file thinking that their diagnosis and records from 3 years ago will be sufficient to win their case. It doesn’t work that way. You need to be treating right now!
5) Diagnosis alone does not win cases. I get this one a lot. People get diagnosed with something serious (for eg, heart attack, cancer) and because of this diagnosis, they think they can win right away. I talk about this in my post about listed impairments.
A lot of these diagnosed conditions are serious and some people will never work again because of them. But you need to realize that people have heart attacks every day and eventually they go back to work. People have cancer and go back to work.
It may take a little while, but they go back to work.
This is the very reason why the “decision maker” wants to know about your treatment NOT just the diagnosis.
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The treatment is what will tell them if you are disabled “permanently” or not.
6) You think you are disabled under the rules but you are not. Social Security only needs to show that you can do some other job than the one you can’t do anymore and case closed.
I talk about this in more detail on the post about the Social Security Denial letter.
7) Your doctor may not be supporting the notion that you are disabled. Either because they are unsure how the process works or the doctor simply doesn’t believe in disability (it happens more often than you think).
8) Some of your treatment may be a violation of the rules. I know, it sounds weird but it’s true. There are medical treatments that violate the rules. Eg, medical marijuana.
While it is legal in some States, it’s not yet legal in the federal system (The Social Security System, for example, is federal).
Even if this is a claim for Long Term Disability through a private insurance system and your State allows for medical marijuana treatment, it still carries an “illegal drug” stigma to it and it can hurt your case.
9) Your case is less than sympathetic because your behavior may be causing the impairment or making it worse. Illegal drugs is a pretty obvious one but what if you are smoking when you have lung issues, or stomach and intestinal issues? or Drinking when you have cirrhosis or hepatitis? The list goes on.
The decision maker may feel “less sorry” for you simply because, despite a serious condition, you are still doing the one thing you shouldn’t be doing for a person with your medical issue
10) Procedurally, you don’t qualify or you need to overcome a remote onset of disability. This is a big one. It means that if you haven’t worked in years (more than 5) you may not qualify for benefits because you are no longer insured under the system. Or it can mean that you have “too much money” to qualify (more on that in a future post).
11) It’s too early to file. You need to show that your condition has lasted or is expected to last 12 months. We talked about this on the post about what you need to qualify. It explains about the timing to file a claim.
12) Anger issues and bad attitude shown in your medical records. In mental disability cases, certain behavior is expected because people are not in their best mental shape. Now, in physical cases (bad back, heart problems etc), that’s a no, no!
Do not throw tantrums at your doctor’s office. A lot of times doctors will write that in their notes and the “decision maker” will see it.
No matter how objective the reviewer is, people always connect with the “underdog” or the ones “who are suffering”
Don’t ruin that by being a jerk at the doctor’s office no matter how wrong the doctor or staff is!
13) Incarceration. You can’t get benefits while incarcerated. Simple as that. Wait until you’re out. They will also not pay for the period you were incarcerated even if you qualify for it medically during the time of incarceration.
14) Faking Disability: This one is the one thing that gets me. People sometimes call and say they are disabled and they are all mysterious about their medical condition but they want to hire a lawyer to “fight for them”.
They present some records to show there is a diagnosis and they think that’s enough. They talk about the neighbor getting disability and they think they should get it too, thinking that just because they hired a lawyer things will magically happen. They don’t!
Attorneys and “decision makers” in Social Security and private insurance companies can spot fakers in seconds!
Fakers are the reason it’s so hard to win disability these days. Just don’t even try!
15) You’re receiving Unemployment Benefits: Yep, I know you need money during the pendency of the disability case but the sad reality is this: if you are receiving unemployment your case will be denied or your benefits will be paid pro-rata during the time you were receiving those benefits.
Stay tuned! In the next post Why you should immediately appeal your Social Security denial, I will explain the first reason people get denied in detail and I will give you ideas on how to fix it if your situation falls into this category.
Books By Realtactics4DisabilityClaims
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You will also learn how to read your medical records so you can see if they are supporting your claim, and learn how to organize your file so you never lose track of your treatment. Finally, I offer an exclusive Facebook group just for the book where you can ask questions about the concepts you learned in the book.
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Courses by Realtactics4disabilityclaims.com
You just learned 15 reasons why your claim is being denied. Half those reasons have to do with your medical records. But do you know how to read them to see if they are actually supporting your disability?
Learn how to read and how to improve your medical records like a pro with my new course “Medical Records Reading 101 for Disability Claimants”. Stop wasting time “hoping for the best” with your current records. The course also includes a Checklist and Worksheet so you can keep track of your treatment to make sure you don’t have any “gaps” that could jeopardize your claim. Take a quick “free sneak peek” before you purchase the course and learn the ins and outs of improving your medical records with actionable instructions from Yours Truly (Yes, Me!).
If you were denied disability and you are looking to appeal with “better” evidence, I created a course about using a Residual Functional Capacity Report to add to your medical records. This is a form you can take to your doctor to complete in support of your claim. The course includes forms for physical or mental impairments and instructions on how to ask your doctor to complete them. You can take a “free sneak peek” to see if this course is for you. Click on the image below and you will be directed to the course page:
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You know the blog, now you can take one step further and learn the process of preparing and filing your claim.
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See you soon,