WHY DOES SSA KEEP DENYING MY CASE?

WHY ISN’T THE SSA GRANTING YOUR BENEFITS?

At Cannon Disability Law, we hear a version of this question every day. People look at their neighbors and believe they should not be getting SSDI and SSI benefits. Also, people compare themselves to others and think their illness is worse. Therefore, they believe they should get benefits and can’t understand why the SSA denied their case. 

If you are asking yourself similar questions, then remember you may not know all of the details about the medical condition of someone else. SSA grants SSDI and SSI benefits for all kinds of reasons. For example, the SSA grants benefits for mental health issues, IQ issues, anxiety, or other medical conditions that may not be visible to the eye.

Additionally, contrary to popular opinion, the SSA does not grant SSD benefits to people who are drug addicts. In fact, Social Security law specifically states that the SSA will not pay benefits to people who cannot work simply because they have substance abuse issues.

USING THE MEDICAL VOCATIONAL GUIDELINES 

Another thing to keep in mind is that your neighbor may qualify for benefits under the Medical-Vocational Guidelines. The GRID Rules allow the SSA to pay benefits based upon a combination of age, education, and the ability to use skills.

If your neighbor is over 50 and they can no longer do that job, they may qualify for benefits. This is true even if they could do some sort of work simple, seated work. For a description of how the Medical-Vocational Guidelines work, review the SSA rules for people over 50 years old.

Social Security will make a finding about what you can physically do in a work setting. This is the only way the judge can apply the Grid rules. Usually, a judge will determine your “residual functional capacity” at a hearing.

The judge then looks to your medical records and the opinion of your doctor to determine what kind of work you can do. Additionally, the judge will review the medical record from the SSA’s doctors.

The judge will put you into one of the five levels of work. The five levels are seated, light, medium, heavy, and very heavy. If the judge decides you require an easier type of work and you are over 50 years old, then you may be paid benefits. This is especially true if you do not have any skills that could help you do other jobs.

IS YOUR NEIGHBOR ON SSI BENEFITS?  

If your neighbor has never worked a full time job and they are on benefits, then they are probably getting SSI benefits. For example, in 2024, SSI benefits are $943 a month in Utah. In 2023, SSI benefits were $914 a month in Utah. However, some states have a higher contribution to SSI, so the amount is more money than that.

The benefit is low, as it puts anyone who receives it at less than the poverty level.  SSDI benefits, however, are based upon the amount of money you have earned during your lifetime. If you are a high wage earner, then your SSDI benefit should be higher than the SSI amount.

One other thing to keep in mind is that many times people have no idea what benefits they are getting every month. For example, perhaps your neighbor is getting welfare benefits, not SSD benefits. Or, perhaps they are being paid private disability insurance payments. Likewise, they may be on Veterans benefits. Many people state in conversation that they are on SSD benefits or SSI benefits, when in fact they are not. Don’t let yourself become upset over what other people say or do. Just worry about yourself.

HAVE YOU BEEN OFF WORK FOR 12 MONTHS?

The SSA does not award SSD benefits for medical conditions that are not going to last for more than 12 months. Therefore, you will need to prove that your medical condition is going to keep you from working for at least one year. The SSA refers to this as the durational rule.

For example, let’s pretend that you broke your arm and you cannot do your construction job. It makes sense that you will not be able to work while your broken arm heals. However, most people are able to return to work following an injury like a broken arm. It usually takes 12 weeks for a broken arm to heal. That means you will be off work, at most, for 3 months. The SSA does not pay benefits for this type of short term injury.

Even if you have cancer, it is possible for the SSA to deny your case under this same rule. For example, if you have surgery for tumor removal, then it is possible for the SSA to decide you will not be off work for one year. Therefore, they may deny your claim. The SSA will often state that your cancer is doing better or has gone into remission. Once they decide that your cancer is in remission, they will deny your claim because they assume you will be back to work before a year goes by.

If the SSA denies your claim for SSD benefits because they think your medical condition won’t last for 12 months, then do something about it. Get your doctor to write a letter that states you will not be able to work for over one year due to your medical condition. That letter confirms the duration of your condition.

DID YOU FAIL TO FOLLOW THE TREATMENT PLAN FROM YOUR DOCTOR?

One of the things the SSA is looking for when they review your medical records is whether or not you are following a treatment plan from your doctor. The SSA wants to see that you are trying all of the treatment options that are available to you. If you are following a treatment plan and you are still not able to work due to your medical condition, then it is likely that you cannot work. The SSA understand this. Therefore, if your symptoms persist despite treatment, they will probably award your SSD benefits.

However, if your doctor gives you a treatment plan and you don’t comply with it, then the SSA will probably deny your claim for benefits. The SSA can deny your case if you refuse to follow the treatment plan. They can also deny your claim if you are not taking the medications your doctor prescribes. Additionally, they can deny your claim if you refuse to go to the doctor.

The only time that the SSA will not deny your claim for failure to follow a treatment plan is if you cannot afford it. For example, if your doctor states that you need an expensive surgery, but you do not have health insurance to pay for it, then the SSA has no reason to deny your claim for benefits. Likewise, the SSA cannot deny your case if you are taking medications, but your doctor wants you to try an expensive medication you can’t afford. The SSA cannot deny your claim for being unable to afford the medication.

DO YOU LACK SUFFICIENT MEDICAL EVIDENCE?

When you apply for benefits, the SSA asks for a list of all of your doctors. They also ask when you last saw your doctor and when you will have another appointment. The SSA asks this information because they want to know if you are getting consistent medical treatment. Most people go to the doctor when they think something is wrong with their health. If you don’t go to the doctor, then the SSA will assume there is nothing wrong with you.

Of course, some people don’t get the medical treatment that they need. However, in order to win SSDI and SSI benefits, you must seek treatment. We have a list of free and low cost options for medical treatment. Use this list. Even if it takes a long time to get into a doctor, it is better than having no medical treatment at all.

Another problem occurs when your doctor orders tests, like an MRI or CT scan, and you cannot afford it. Ask your doctor if there are more affordable options. For example, your insurance may cover an MRI, but you might still need to pay a large portion of that bill. Ask you doctor if there are other clinics that can give you an MRI for less money. Additionally, your medications may be expensive. Ask your doctor if you can get samples of the medication. Or, ask your doctor if there is a way for you to sign up for a study and get your medication through the study.

The SSA can mistake not being able to afford treatment with not needing medical treatment. If you can’t afford medical treatment, then ask the SSA to send you to one of their doctors. The SSA can send you to a free medical exam. Learn how to obtain a free SSA medical exam.

MEDICAL EVIDENCE WINS SSD BENEFITS 

When you apply for SSDI and SSI benefits, the SSA will first look to your medical records to determine if they can pay you benefits. Medical records are crucial to winning benefits. Discover the importance of medical records in your SSD case.

First, the SSA collects your medical records. Next, an SSA worker reviews your medical records. The worker will be looking for evidence about your physical and mental conditions. For example, the SSA will want to see the following items:

• medical imaging, such as MRI, CT scan, or X-ray evidence
• physical exam notes or progress notes from your doctor that shows your symptoms
• a record of your medications for pain and any medical side effects
• the medical opinion of an expert in your physical or mental condition
• physical therapy records that help show your attempts to help your pain
• reports from surgery or any other medical procedures
• mental evaluations and progress notes

Remember, it is your responsibility to supply your medical records to the SSA. You should ask your treating doctor and any other treating sources to write a letter to the SSA that states you cannot work due to your medical issues. It is important to understand that the burden to prove you deserve benefits is on you.

MOST SSD BENEFIT CASES ARE DENIED   

Another thing to keep in mind when you are wondering why the SSA hasn’t granted your case, is that most case are denied multiple times. Denials occur during the five step SSA review process. The SSA has set a goal for all of the judges in the country, telling them they can only grant an average of 40%-50% of SSDI and SSI cases. This means that at every level of the appeal process, people who deserve benefits are denied. Is it fair for judges to deny or grant a set percentage of cases? Is that justice?

Some argue that ALJs should not be swayed by SSA’s goals. Instead, cases should be decided on merit alone. Nevertheless, most cases are going to end up being denied during the appeal process. Then, the cases must go before a judge at the hearing level. If you were a judge, wouldn’t you feel pressure to comply with what the SSA wants you to do, considering they employ you?

When a judge denies or grants a case, the Appeals Council has the right to review the decision. They do this on their own motion. The Appeals Council decides whether to remand case back to the judge to make a new decision. They can do this even if the judge grants the benefits. Find out about Appeals Council review.

Funded through payroll taxes, SSDI pays benefits to individuals with a work history. If the SSA approves you for benefits, then you will receive benefits after a six months waiting period. The first six months after your onset date is a waiting period. SSDI benefits are not payable during that time. SSI benefits, however, are payable during the waiting period.

Once your waiting period is over, you can receive your monthly SSDI benefit payment. If you receive SSDI, then you can also get Medicare benefits. There is a 29 month waiting period for Medicare benefits. The 29 month waiting period is made up of the waiting period and 2 years. Therefore, after the 29 month waiting period, you can get Medicare benefits.

If you file an SSI application and receive benefits, then may also be able to get Medicaid benefits. To receive Medicaid benefits you must meet your state’s income and asset rules. Medicaid payments, like SSI benefits, begin the date you file your application. There is no waiting period. However, there are also no past due benefits prior to the application date. Learn about past due SSD benefits.

WHAT OUR LAW FIRM DOES FOR YOUR SSD CASE

You do not have to win SSD benefits on your own. Our firm can help file your SSD application. Also, we can help you through each of the appeal stages of the Social Security review process.

When you leave that up to us, you can focus on your health. Our attorneys and staff can:

• Help you file your application for SSD and SSI benefits
• File an appeal if you receive an initial denial from DDS
• Collect your medical records
• Help you confirm your free SSA Doctor Exam
• Request a Hearing with an SSA judge
• Prepare you to testify at your ALJ hearing
• Represent you at your hearing and question the expert witnesses
• Read about job expert testimony
• Learn about medical expert testimony
• Request review of an decision with the Appeals Council
• Request review of an Appeals Council denial in Federal Court

If you file your SSD application online at Social Security’s website, then you have 6 months to complete the application. It is best to complete the application quickly. You don’t want to run out the 6 month time limit.

WIN YOUR  SSD BENEFITS, EVEN IF YOU GET A DENIAL

Even if you don’t know why the SSA hasn’t granted your case, just remember that almost everyone is denied. All the denial proves is that it is more difficult to win benefits today than it was 30 years ago. But, you can still win benefits.

To win SSD benefits, you will need to see your doctor regularly and collect all of your medical records. Additionally, you need to confer with your lawyer so she can help you with your case. If you have questions about your SSDI and SSI case, then contact us now.

Cannon Disability Law wants to be your legal team and win your SSD benefits. We represent clients in Utah, Nevada, Idaho, California and Colorado. Review Utah SSD benefits. Nevada SSD benefit and California SSD benefit information is also available. If you have a hearing in another state, like Colorado or Arizona, then we can represent you where you live.

The attorneys and staff at our law firm are Social Security law experts. Learn about our legal team on our About Us page.

Take advantage of our free review of your case. We can explain what your chances are in terms of winning SSD benefits. Also, if we don’t win your SSD benefits, then you will never owe an attorney fee. While you are looking for an attorney, consider our success rate and our legal experience. Then call us today. If you do, then it will help you stop worrying about why the SSA hasn’t granted your case.