Reasons Why a Social Security Disability Claim Might be Denied
Aside from failure to meet the legal and factual requirements for Social Security Disability, there are other reasons that a claim might be denied:
- Drug Addiction or Alcoholism - Since March 29, 1966, a person CANNOT be found disabled if drug addiction or alcoholism is found to be "material" to the disability. That is, if Social Security determines that the applicant would not be disabled except for the substance abuse, the claim must be denied. Drug and alcohol addiction should not apply to conditions which are themselves disabling, even though they result from substance abuse and the abuse of a substance continues, if the impairment would not improve if the abuse stopped. For example: end-stage liver disease; irreversible organic brain disorders; illicit drug-induced cariomyopathy, etc.
- Failure to Cooperate - Social Security has numerous administrative requirements for the provision of information, questionnaires and medical releases. Failure to respond to each element of the appeal process can result in claim denial.
- Failure to Timely File Request Reconsideration or Appeal - If Social Security denies a claim, the applicant is generally allowed 60 days plus mailing time, to file a Request for Reconsideration and an Appeal. Although there are exceptions to the rule, failure to timely file the paperwork can terminate the appeal process.
- Failure to Follow Prescribed Treatment - A Social Security Disability applicant cannot refuse reasonable prescribed treatment. That is, a claim can be denied if the applicant refuses to undergo treatment from a doctor, if the treatment has a chance of restoring the ability to work.
In general, the burden is on the Claimant to produce medical evidence that s/he is unable to work by reason of a medical impairment or combination of impairments. Social Security must take some steps to assist the claimant in obtaining medical evidence. Social Security contracts with the state agency or Disability Determination Services (DDS) to perform this function.
Under Social Security Administration rules, the state agency can generally fulfill its duty to seek medical evidence by sending out an initial request and make on follow-up phone call. The result is that agency development of a claim is often incomplete and slipshod. The Social Security Administration frequently employs consultative examiners, rather than obtaining treating source information.
The need for evidence may arise on many issues, including but not limited to the following:
- Physical or mental impairments.
- Subjective complaints such as pain, shortness of breath, anxiety, nervousness, dizziness, fatigue, weakness, etc and their intensity, persistence, frequency and response to medication/treatment.
- Date of onset of disabling impairment and date last insured.
- Level of education, ability to communicate in English and literacy.
- Age, work history and/or existence of vocational skills.
- Transferability of skills.
- Activities of daily living (which may show ability to perform work-related tasks)
- Timely filing of appeals.
- Failure to cooperate with treatment.
- Non-citizen status.
- Credibility of documentary evidence and of testimony.
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