Applying for Social Security Disability (SSD) or Medicare benefits can be overwhelming—and unfortunately, many applications are initially denied. If you’ve received a denial, you’re not alone, and you do have options. Understanding the common reasons for these denials can help you take the right steps toward a successful appeal.
Common Reasons Social Security Disability (SSD) Applications Are Denied
1. Insufficient Medical Evidence
One of the most common reasons for denial is a lack of medical documentation that proves your disability meets Social Security’s strict criteria.
- Missing treatment records
- No documentation of how the disability impacts your ability to work
- Lack of recent medical updates
To strengthen your case, always ensure your records are thorough, up to date, and clearly link your condition to your inability to work.
2. Failure to Follow Prescribed Treatment
If you don’t follow your doctor’s treatment plan without a valid reason, Social Security may assume your condition isn’t as limiting as you claim.
3. Previous Denials
Resubmitting a denied claim without addressing the issues that caused the first denial can result in a fast-track rejection. A better approach is to file an appeal rather than start a new application.
4. Earning Too Much Income
For SSDI (Social Security Disability Insurance), earning above the Substantial Gainful Activity (SGA) limit may disqualify you, regardless of your condition. Make sure to understand these limits before applying.
5. Short-Term or Non-Severe Conditions
To qualify, your condition must be expected to last at least one year or result in death. If your condition doesn’t meet this threshold, your application could be denied.
Common Reasons Medicare Applications Are Denied
1. Ineligibility Based on Work History or Disability
Medicare eligibility is typically tied to work credits or SSD approval. If Social Security has not officially recognized your disability or you don’t meet age or work requirements, your Medicare application may be denied.
2. Incorrect or Incomplete Applications
Errors in your application—such as incorrect personal information or missing documentation—can result in a denial or delay.
3. Timing Issues
Applying too early or too late can impact your eligibility. For example, Medicare coverage begins 24 months after SSD benefits start, unless you have ALS or end-stage renal disease, which have different timelines.
How to Appeal a Denial
If your SSD or Medicare application has been denied, you have the legal right to appeal. Here’s how:
1. Review the Denial Letter
Start by carefully reviewing the reasons listed for your denial. This will help you identify what needs to be corrected or clarified in your appeal.
2. File a Timely Appeal
You generally have 60 days from the date of your denial letter to file an appeal. Missing this deadline could mean starting the process over from the beginning.
3. Gather Supporting Evidence
- Obtain updated medical records
- Get written opinions from treating physicians
- Collect any additional documents that support your claim
4. Attend the Hearing
If your case progresses to a hearing before an administrative law judge, this is your chance to explain your situation in person. Legal representation can be extremely helpful at this stage to ensure your case is presented effectively.
5. Consider Legal Assistance
Navigating the appeals process alone can be stressful and confusing. An experienced employment law attorney who focuses on SSD and benefits claims can help you build a strong appeal and advocate for your rights every step of the way.
Don’t Give Up After a Denial
SSD and Medicare application denials are frustrating, but they don’t have to be the end of the road. Many applicants are ultimately approved after appealing their initial denial. The key is acting quickly, understanding why you were denied, and presenting a well-supported case.
If your SSD or Medicare application has been denied, contact PLBH today at (800) 435-7542 for help with your appeal. We’re here to support you in getting the benefits you need and deserve.