Getting approved for Social Security Disability benefits is difficult in North Carolina and around the country. Thankfully, the Social Security Administration (SSA) has a multilevel appeals process that gives applicants several opportunities to plead their case and receive the benefits they need.
Qualifying Factors for Disability Benefits
The Social Security Administration (SSA) offers two programs: the Social Security Disability Insurance program (SSDI) and the Social Security Insurance program (SSI).
To qualify for SSDI, there are two main criteria you must meet.
Are You Considered Disabled by Social Security Standards?
The first is the standard for being disabled. According to the Social Security Administration, a disability is a physical or mental impairment that can be medically determined which makes you unable to engage in gainful employment. The disability must also last or be expected to last one year or result in death.
Have You Earned Enough Work Credits?
The second qualifying factor for Social Security benefits is the amount of work credits you have earned. The credits you need vary based on your age when you became disabled. The Social Security Administration provides a table listing the disability work credits needed to meet its requirements.
Qualifying for SSI
The Social Security Insurance program gives benefits to the aged, blind or disabled who specifically have limited income and resources. Work credit history is not required for those applying for the Social Security Insurance program. The disability requirement must still be satisfied, though.
You May Be Denied Social Security Disability Benefits for Several Reasons
Disability benefits are denied for a variety of reasons.
You Do Not Have a Qualifying Disability
Many people assume that because they have an illness or impairment, they are automatically qualified for benefits. But you have to be disabled based on the SSA’s definition.
Your Condition is Not Severe Enough
If your disability doesn’t keep you from working, you may be denied benefits. If you are earning more than $1350 a month, the SSA does not consider you to have a qualifying disability.
Your Condition Won’t Last a Year
In other cases, it may be that your disability isn’t expected to last a year. For example, you may have a broken arm from a car accident, but the arm is expected to heal in four months. Your case examiner is likely to deny your claim for disability.
Not Enough Evidence to Support Your Disability
You may have a qualifying disability, but if there is not sufficient evidence to support it, your SSDI or SSI benefits claim can be denied.
The Disability Determination Services agency (DDS) will usually look at medical evidence from your healthcare provider first and give more weight to it as the treating physicians would be the most familiar with your situation. A new rule has modified this and put medical evidence from your physician on equal footing as the information from a one-time examination by a doctor who has never treated you.
A lawyer can explain how this might affect your application. If evidence from your medical provider is unavailable or insufficient, DDS will arrange for you to be examined by a doctor of their choosing.
You Failed to Cooperate
Lack of cooperation means DDS cannot make a determination of your disability. If they ask you for documents and you fail to submit them timely, your application may be denied. Further, if they determine that you need a medical exam from a third-party doctor, but you do not show up, they will deny your application.
You Couldn’t be Reached
It’s important that you ensure your contact information is correct and up-to-date. Be certain that you are accessible when necessary. If they can’t request documentation from you or ask you questions, they can’t move forward.
You Did Not Follow the Treatments
Failure to follow through on your doctor’s prescribed treatment, unless you have good reason not to, could lead to a denial of Social Security. The SSA has a list of good cause reasons to refuse treatment.
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Increase Your Chances of Being Approved for Disability Benefits
The Blue Book is your disability evaluation guide. It lists the 14 main categories of conditions that the SSA uses. The Blue Book also provides information about which types of documentation are used to support your disability.
Having a statement prepared by your doctors indicating your current health and work status will add to the evidence of your disability.