The Social Security claims process can be a daunting experience, especially when your application for benefits is denied.
In Tampa, as in many parts of the country, the road to approval for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) can be long, frustrating, and complex.
If you’re like many people who have had their Social Security claims denied, you may be wondering why it happened—and, more importantly, what you can do about it.
Understanding why Social Security claims are commonly denied can give you a clearer path to success when appealing the decision.
Let’s cover the top reasons claims are denied and how a social security disability attorney in Tampa can help.
1. Lack of Medical Evidence
One of the most common reasons Social Security claims are denied in Tampa—and across the nation—is the lack of sufficient medical evidence.
Social Security’s criteria for disability are rigorous, and they require detailed medical documentation to prove that you are unable to work due to a severe medical condition.
Why it Happens: Your condition must be well-documented with medical records, test results, and statements from healthcare providers that clearly demonstrate the severity of your disability.
Without this evidence, the Social Security Administration (SSA) cannot confirm that you meet its disability requirements.
How to Avoid It: Be proactive about gathering all medical records related to your condition. This includes doctor visits, hospital stays, lab results, and any treatments or medications you’ve been prescribed.
It may also be helpful to get a medical statement from your doctor that explains how your condition affects your ability to work. Work with your healthcare provider to ensure you have the necessary documentation.
2. Not Meeting the Work History Requirements
To qualify for SSDI, applicants need to have worked a certain number of years and paid into the Social Security system. This is done through FICA taxes taken from your paycheck. Without sufficient work history or work credits, your claim may be denied.
Why it Happens: If you haven’t worked long enough or earned enough credits, the SSA will deny your claim. Even if you have a serious medical condition, if you haven’t paid into the system for a sufficient period, you won’t qualify for SSDI.
How to Avoid It: Review your work history carefully. Ensure you have accumulated enough work credits by checking your Social Security statement. If you don’t have enough credits, you may still be eligible for SSI (if you meet the income and resource requirements), so consider exploring this option if your work history is limited.
3. Failing to Prove That You Can’t Work
Social Security doesn’t just ask if you have a medical condition—they also need to know if your condition prevents you from working.
Many claimants assume that having a medical condition is enough to qualify for benefits, but the SSA will evaluate whether your condition significantly limits your ability to perform substantial work.
Why it Happens: The SSA uses the Listing of Impairments to determine whether your condition is severe enough to prevent you from performing basic job functions. If your condition doesn’t meet the criteria or if the SSA believes you can still perform some work, your claim may be denied.
How to Avoid It: Clearly demonstrate how your condition limits your ability to work. This includes showing that your condition affects your physical and mental abilities to perform tasks and interact with coworkers.
Make sure your doctor provides detailed reports on how your disability affects your ability to hold down a job. If your condition doesn’t match the SSA’s Listing of Impairments, your claim may still be considered under medical-vocational guidelines.
4. Inconsistent Work History or Frequent Job Changes
If your work history shows frequent job changes, inconsistent employment, or gaps in employment, Social Security may be skeptical about your claim.
While job changes alone aren’t a reason for denial, the SSA will closely examine how long you’ve worked and whether your work history supports your disability claim.
Why it Happens: Frequent job changes or gaps in your employment may suggest that your disability didn’t affect your ability to work consistently, raising concerns for the SSA.
If you’ve struggled to hold a job over the years, they may question the severity of your condition or assume that you’re capable of working in some capacity.
How to Avoid It: If you’ve had gaps in your employment due to your medical condition, provide details about how the illness or injury affected your ability to maintain consistent work.
If you have a history of fluctuating work activity, you’ll need strong documentation that proves your condition worsened over time and made work impossible.
5. Not Following Treatment Recommendations
Social Security takes the failure to follow prescribed treatments seriously. If you’ve been advised by your doctor to undergo specific treatments, therapies, or medications and you haven’t followed these recommendations, it can be used as a reason for denial.
Why it Happens: The SSA expects claimants to make a good-faith effort to improve their condition.
If you’ve been advised to take medication, undergo surgery, or follow other medical treatments but have chosen not to, they may conclude that your condition is not as serious as you claim.
How to Avoid It: Always follow your doctor’s treatment plans. If for some reason, you cannot follow the recommended treatments, make sure to explain why in your application.
For example, if you can’t afford a treatment or medication, provide evidence of this to the SSA.
6. Failure to Cooperate with the SSA
If you don’t respond to the SSA’s requests for information or fail to show up for a disability examination, your claim may be denied. The SSA has strict deadlines for submitting forms and providing requested documents.
Why it Happens: Failing to cooperate with the SSA’s requests for additional information, medical exams, or other necessary documentation can lead to automatic denials.
How to Avoid It: Always respond to the SSA’s requests promptly and keep track of any appointments for medical exams or hearings. If you are unable to attend an exam, inform the SSA as soon as possible and request a reschedule.
7. You’re Earning Too Much Money
To qualify for SSDI, you must not be earning above a certain monthly income threshold.
If you’re working while applying for benefits, Social Security will review how much you’re earning. If you’re making too much money, your claim could be denied, regardless of your medical condition.
Why it Happens: Social Security has Substantial Gainful Activity (SGA) rules, which state that if you are earning more than the SGA limit, you are not considered disabled.
The SSA assumes that anyone who is earning above the SGA threshold can work and is therefore ineligible for benefits.
How to Avoid It: If you’re still working, make sure your earnings are below the SSA’s SGA limit for SSDI. If you’re working part-time or earning less, make sure you provide the SSA with the correct documentation of your income.
Final Thoughts
The Social Security claims process can be complicated, and the reasons for a denial are numerous.
However, understanding these common pitfalls and how to avoid them can significantly increase your chances of approval.
If you’ve had your claim denied in Tampa, don’t lose hope. With the right medical evidence, a thorough understanding of the process, and perhaps even legal assistance, many people are able to successfully appeal a denial and get the benefits they deserve.
If you’re struggling with your Social Security claim, consider consulting with Social Security lawyers who can help you navigate the system, file an appeal, and provide expert guidance.
