Why Am I Not Getting Paid Disability?

Confused man

We see this all the time. A client who’s worked their whole life, and now, in their mind, it is obvious that they cannot work. And yet, their benefits have been denied. 

If you’re wondering, “Why do I keep getting denied disability?” there are a number of details that may stand in your way. 

You must be disabled or expect to be disabled for 12 months.

You may have heard you must wait up to a year before you can apply for disability benefits, but that’s not the case. You can apply for Social Security or Supplemental Security Income as soon as you become too disabled to work, or you are fired because of your disability. To qualify, you must prove your disability will keep you from working for at least a year.

The Social Security Administration calls this the “durational requirement.” If the SSA doesn’t think your disability will keep you from working for 12 months, you will receive a “durational denial” letter. 

The SSA does not treat every disability the same. If you lose a limb, or some other obvious, permanent disability befalls you, the SSA may approve you for disability benefits immediately. If you’ve had a stroke, heart attack, or some similar injury, the SSA will see how your recovery proceeds before assigning benefits. Usually, if an applicant still can’t work three months after becoming disabled, the SSA approves them to receive benefits.

Unlike SSI and Social Security, Social Security Disability Insurance, however, comes with a 5-month waiting period before approving an applicant for benefits.

You must prove the nature and severity of your medical condition.

To qualify for disability, you must demonstrate limited ability to perform functions like lifting, walking, standing, sitting, or remembering. It helps if you can substantially tie this impairment to a medical condition. This will require input from a doctor.

The SSA maintains a robust list of impairments addressing each major system of the body. This list covers everything from musculoskeletal disorders to cardiovascular and immune system issues. The list also includes mental and neurological disorders that may qualify an applicant for disability benefits. 

The more evidence you can obtain to establish your medical condition, the better. Document any tests or scans you’ve taken to assess your illness, as these will go much farther than a doctor’s opinion on its own. Keep track of treatments and rehabilitations meant to improve your condition. The SSA needs to see that you have attempted to recover from your disability. 

You may also seek the testimonies of your former coworkers. If you have photos or other evidence of the event or events that caused you to become disabled, keep them on-hand in case the SSA asks for them. If you seek legal representation in obtaining disability benefits, your attorney can provide a valuable legal perspective and argument for why you should qualify.

You must be completely unable to work.

Establishing that you cannot do any work, or even sit down, is a huge piece of the puzzle.

If you applied for disability immediately after you stopped working—or even while you were still working—you may need to prove that you weren’t able to work effectively. On your Adult Disability Report, the application required for disability benefits, you’ll note the pattern in which your disability reduced your work hours, or if you needed extra help to fulfill your tasks. 

To qualify for disability benefits, the SSA must decide that you can neither perform the work you did prior to your disability, nor perform any other type of work. The SSA will take your medical conditions into account, as well as your age, education, work history, and skills to make a determination about your ability to work.

Your ability to earn income affects your disability evaluation, too. In 2020, if your earnings average more than $1,260 per month, the SSA will not consider you disabled.

How does the SSA make its decision?

Each state has its own agency dedicated to evaluating the medical severity of disability applicants. These state disability determination services gather evidence from an applicant’s physicians, primarily, but if their search fails to gather enough information on which to make a decision, the agency will conduct its own examination.

Ultimately, two people make the decision: a medical or psychological consultant and a disability examiner, both of whom work with the agency. 

In the case that a denied applicant appeals the agency’s ruling, the agency will start over, except they will employ a different consultant and examiner to make the final decision.

Can you work and still receive disability benefits?

The SSA wants people to work, if at all possible. For this reason, the SSA offers a few provisions called “work incentives,” which allow a person receiving disability benefits to test the waters around returning to work or finding new work without losing their benefits. This is done by letting such people lessen their countable earnings to remain qualified for their benefits.

Work incentives are extremely complicated. Some are only applicable to SSI recipients, or to SSDI recipients, but a few provisions are available for both. The SSA offers a free book around work incentives that it makes available for free

Appealing your claim

At Affleck & Gordon, we pride ourselves on getting our clients the help they need. We’ve been helping individuals navigate Georgia’s social security system for decades. We’re ready to help you, too. 

If you’ve already been denied, there’s still hope. We’ll guide you through the appeals process and put you in the best position possible to win approval. 

There are no up-front costs, and you only pay if we win. Contact us today to arrange your free consultation.

If your Supplemental Security Income claim has been denied, or you’re thinking about filing and don’t know where to start, Affleck & Gordon can help. We’ve been helping people in Georgia just like you for over 45 years. Sign up for a free case evaluation here, or call us (404) 990-3945.

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