Disability benefits give financial support to those unable to work due to a medical condition.
These benefits help you to focus on your health without worrying about how to make ends meet.
Unfortunately, many applicants face the challenge of having their disability claims denied.
This can leave individuals like you feeling defeated and uncertain about their future.
Not only that, but claim denial also leads to:
- Feeling of frustration, hopelessness, and anxiety about your future.
- Exhaustion due to the stress of fighting for benefits affecting your existing health condition.
But don’t give up! If your claim is denied, there is still hope. You have the right to appeal. So, here we will discuss the reasons for denial and steps to navigate the denial process with the help of disability attorney in Miami.
1. Not Having Proper Guidance
Lack of proper legal support could also result in the claim being denied because of the following:
- Crucial information being omitted from the application.
- Incomplete medical documentation.
- Failing to navigate the complex process correctly.
So, hire a reliable and experienced disability lawyer for short-term disability to help in the process.
2. Lack of Sufficient Medical Evidence
SSA needs detailed documentation from your medical providers to prove the following:
- How severe your condition is
- And how your condition limits your ability to work
So, make sure to submit complete and up-to-date medical records, including:
- Treatment notes,
- Diagnostic tests
- Any specialist reports
3. Engaging in Substantial Gainful Activity (SGA)
Another reason the claims are denied is because the claimant is earning above a certain monthly income threshold while claiming disability benefits. This is also known as substantial gainful activity (SGA).
For 2025, the SGA limit is $1,620 per month for non-blind individuals and $2,700 per month for blind individuals.
If you are earning more than this amount, then SSA may determine that you are ineligible for benefits even if you have a medical condition.
4. Failure to Follow Treatment
If you fail to follow the doctor’s prescribed treatment, the SSA may deny your claim. This could include missing appointments, not taking prescribed medication, and not taking recommended therapies.
So, to avoid this, ensure that you follow the prescribed treatments. If you are unsure of the medication, then have solid evidence.
Also, make sure to connect with your doctor to record the challenges in your ongoing treatment.
5. Your Condition Isn’t Expected to Last Long Enough
To qualify for disability benefits, your condition must be long-term or expected to last at least 12 months. So make sure your medical records reflect the long-term nature of your condition.
6. Missed Deadlines
If you miss the deadline when filing the disability claim, it can also lead to the claim being denied. However, you may still be able to appeal for the denial if you can demonstrate a “good cause” for missing the deadline, such as;
✔Serious illness,
✔A family emergency, or
✔Not receiving proper notification about the deadline
So, ensure you don’t miss the deadline for filing the claim. If you miss the deadline, provide a valid reason for missing the deadline.
7. Drug and Alcohol-Related Disabilities
The SSA may deny benefits if drug or alcohol abuse is the primary cause of the disability.
However, if the substance abuse is a contributing factor but not the leading cause,
then the claim may be further examined.
8. Failing to Cooperate
Not following the SSA’s requests during the disability claim process, like:
- Missing scheduled medical examinations.
- Not providing essential documents on time.
- Not responding to communication attempts.
All of the following could also result in the denial of the claim.
How to Appeal a Disability Claim Denial
1. Reconsideration
The first step in the process is to request a reconsideration of your claim. In this step, the SSA reviews your case again with fresh eyes. You can submit any additional evidence or clarify existing documentation that might have been overlooked initially.
2. Request a Hearing
If your reconsideration is denied, you can request a hearing before an administrative law judge (ALJ). You can present your case in person during the hearing, with additional evidence and expert testimony to support your claim.
| NOTE: It is highly recommended to have a disability lawyer to strengthen your case. |
3. Appeals Council Review
If the ALJ denies your claim, you can request a review by the Council. They will review your case to make sure that:
- The law was applied correctly.
- All evidence was properly considered.
This step can take months, so patience is important during the journey.
4. Federal Court
If all the previous steps fail, you can finally take your case to the federal court. This involves a federal judge reviewing the entire process and decision. It is advised to have legal representation at this stage, as the process can be complicated.
The Bottom Line
Now, you have got an answer to your question: Why would short-term disability be denied?
Lack of proper guidance, insufficient evidence, failure to follow medical treatment, missing deadlines, and many more are the reasons for the denial of short-term disability.
However, you can appeal against disability claim denial in four steps: reconsideration, administrative law judge (ALJ), appeals council review, and federal court.
So, with the help of a disability attorney, you can navigate the process.
Do You Need to Get a Lawyer to Apply for SSDI the First Time?
Getting Social Security Disability Insurance benefits is life-changing, providing you with financial assistance when you are unable to work.
However, many applicants struggle with the complex paperwork, medical documentation, and strict requirements set by the SSA. Even small mistakes can lead to delays or denials. Thus, small errors can make it harder to get the benefits you deserve.
So, you might be asking, “ Do I need an attorney to file for disability?”
While some people are successful on their own, legal support increases the chances of approval, especially if your case is complex.
Here, we will discuss when hiring a lawyer makes sense.
What is SSDI?
Social Security Disability Insurance is a federal government program that provides monthly payments to people who have a disability that stops or limits their ability to work.
Who Qualifies for SSDI?
The criteria for qualification for SSDI are:
✔Those who worked in jobs covered by Social Security.
✔Have a medical condition that meets SSA’s strict definition of disability.
- You cannot do substantial gainful activity (SGA) due to your condition.
- The condition prevents you from doing past work or adjusting to new work.
- The condition must have lasted or be expected to last for at least 12 consecutive months or result in death.
Special Situation That May Qualify
✔ Blind or Low Vision Individuals.
✔ Surviving Spouses with Disabilities:
- Who are 50-60 years old &
- Their disability started within 7 years of the worker’s death.
✔Disabled Adult Children (DAC): Adults with disabilities that began before age 22 may qualify on their parent’s Social Security record.
If you meet both work plus medical requirements, you may be eligible for SSDI benefits.
Steps for Filing for SSDI:
Let’s know the steps to apply for SSDI:
1. Gather medical records.
2. Contact the SSA.
3. Complete the application form (SSA-16).
- Information about personal details, work history, and medical condition
4. Explain how your medical condition affects your ability to work (limitation and daily activities).
5. Submit supporting evidence such as:
- Medical records
- Work history documentation
- Contact info for your doctors
6. Wait for the decision..
7. Apply for appeal if denied.
Common Challenges in the SSDI Application Process
First-time applicants face difficulties such as:
- Incomplete or incorrect paperwork.
- Insufficient medical evidence.
- Delays in getting a decision.
- A high denial rate.
When Should You Consider the Help of an SS Disability Lawyer?
Now, let’s know when you should take the help of disability attorney:
✔If your condition is difficult to prove.
✔If you have already applied and been denied.
✔If your condition is not on the SSA list of approved disability.
✔If you struggle with paperwork due to your condition or other reasons.
✔If you are unfamiliar with SSDI rules and requirements.
Benefits of Hiring a Lawyer for Your SSDI Application
Here are the advantages of hiring a lawyer:
✔More likely to get approved.
✔Know what medical records are required and can work with your doctor to obtain the necessary records.
✔They only get paid if you win your case.
✔They assist with the appeals process, which includes:
- Reconsideration
- Hearings
- Court reviews
✔Less stress for you.
Final Verdict: Should You Hire a Lawyer?
Now, you have got the answer to your question: Should I get a lawyer before applying for disability benefits?
Yes, you should hire a disability lawyer if you are applying for SSDI for the first time. These legal experts increase the chances of SSDI approval rate as they understand the complex requirements set by the Social Security Administration (SSA).
They know how to properly complete your application, gather medical evidence, and present your case in a way that meets SSA’s strict standards. Many first-time applicants, without proper guidance, may make small mistakes that prevent them from getting the benefits they deserve.
So, a lawyer ensures your application is accurate, well-documented, and more likely to get approved the first time.