If Your SSI Was Denied Will Your SSDI be Denied Too?

SSI Vs SSDI if SSI was Denied

SSI and SSDI are both programs for supporting people who have disabilities that stop them from being able to work. 

However, the program that works best for you will be dependent upon a couple of different factors. 

If we break this down a little further, we can fully address the main question: 

If your SSI was denied will your SSDI be denied too?  

SSI Vs SSDI

We broke down the differences between SSI & SSDI in a previous article titled: Is Social Security the Same As Disability?

Here’s an excerpt that will help frame the answer to the question above:

Supplemental Security Income (SSI) is a program through the Social Security Administration (SSA) designed to provide a monetary benefit to Americans who are older than 65, blind, or disabled.  SSI is needs-based, meaning that the beneficiaries must be below a certain asset threshold.  And they must have limited income, and/or income earning potential.

SSI is often paired with Medicaid, administered by individual states.  Recipients of SSI often also qualify for food stamps.

Social Security Disability Insurance (SSDI) is similar to an insurance program you might buy into for the contingency that you might become unable to work due to an injury in the future.  In actual fact, it is essentially just that – an insurance program.  Though, it’s not really opt-in if you’re employed; you pay (or paid) into it through payroll taxes.

The payout for SSDI is typically higher than SSI, but it requires that you have a relatively recent work history, to base the amount of your benefits on.  Beneficiaries become eligible for Medicare after two years of being on SSDI.

Infographic: SSI Vs SSDI

Are You Eligible for SSDI?

The first question to help you understand whether or not your claim for SSDI is likely to be denied (assuming your application for SSI was denied) is, do you meet the eligibility requirements for SSDI?

We’re keeping it simple here, but here are the two basic qualification criteria for SSDI

Have a work history of jobs covered by Social Security (another great article on who is and is not included here as well)

Have a medical condition acknowledged by Social Security as a disability

Notice that none of these requirements are related to your previous income?  Alternatively, to your assets?  Unlike SSI, SSDI is not a means-tested/related benefit.

If you were denied SSI due to an asset issue (too much $ or property), you would not be denied from SSDI for that same reason.  However, you might be denied for other reasons, including not meeting the criteria listed above.

Is There a Reason Why Your SSI Was Denied?

In addition to assessing your basic eligibility criteria for SSDI, you might want to determine why you were denied for SSI in the first place.

If it is a lack of basic eligibility, that is pretty straightforward.  We covered eligibility for SSDI above, and because there are a lot of “if/else” caveats to SSI eligibility, we will link to the full eligibility criteria for SSI, here, so that you can review them in-depth.

If your reason for being denied SSI is not due to eligibility deficiencies, then we should look elsewhere to assess why you were denied.  Moreover, why you would be looking to SSDI as an alternative to SSI.

It is possible, for instance, that you should have filed for SSDI the whole time and only filed for SSI because of a knowledge gap of the differences between the two programs.  This gaffe does happen, and it is easy to see why! SSI & SSDI have a similar name, similar function, and provide support for similar groups of people.

However, bear in mind you may have been completely correct in filing for SSI in the first place, and were denied for other reasons.

Should you Re-File for SSI? 

Having a better understanding of why your SSI was denied will help you to get perspective on whether you should seek SSDI, re-file for SSI, or file an appeal on SSI.

In reality, if continuing to pursue SSI is the right decision for you, you should file an appeal vs. refile.  Unless, of course, you have missed your deadline to file your appeal.

Lastly, while you are assessing your options, you should re-consider all potential benefits you might be able to obtain.

Consulting with a local advocate or attorney is a good step in the right direction.  They will be able to advise you on likely reasons why your original SSI claim was denied, what to do now, and other benefits you may find value in seeking.

5 Reasons Social Security Denied Your Disability Claim When Your Doctor Said You Were Disabled

Your Doctor isn’t Necessarily an expert in your ailments

 

If you’re wondering why Social Security denied your disability when your doctor soundly believed that your ailments were disabled…you’re not alone!  That may offer some relief, but now that you’ve been denied (or were denied some time ago), you need to get ready to take another look at your application for social security disability.  

Whether you’re re-applying for disability or filing an appeal with a disability appeal lawyer, you probably want to know what led to the miscommunication or outright disconnect between your doctor and the Social Security Administration.  

To help you with this, we compiled the most common reasons we have noticed that Social Security denied claims against doctors’ opinions – for our social security disability appeal clients in Spokane, WA.  

 

Your Doctor Didn’t know How to Communicate your Disability to Social Security

 

This reason is so common that we should write a whole article for the purpose of talking to doctors about how to communicate with Social Security (and the VA).  The point here is that in almost every case doctors practice medicine, not law.  And while your disability is a medical condition, the benefit – and process of obtaining it – is a very legal process.

Imagine you’re taking your car into a shop because it is misfiring.

You have someone that’s willing to pay for the repairs, but they need to know how it’s misfiring so they give you a form that says, “please describe what’s wrong with the car.”

You show up to the shop and ask the mechanic to fill out the form, and without context, the mechanic looks at the form and examines the car.  On the form the mechanic accurately describes what’s wrong with the car:

“The car’s tires are 40% worn, they need to be rotated. The car needs an oil change.  Windshield wipers need to be replaced.  Rear window is cracked.  Electrical issues – radio doesn’t work.  Transmission needs service.  Car Idles rough.”  

Technically the mechanic answered the questions.  But when you turn the form back in to get the repair $, your benefactor says, “I looked at the mechanics response, the problems with the car are generally superficial and are what you can expect from a 20 year old car, there’s no mention of a misfire, I’m denying your repair”

“Why,” you wonder?  The reason, without context the mechanic had no idea what to focus their report on.  They didn’t necessarily know that you needed to have that one item assessed.  They didn’t know how their report would play into the overall discussion.  Had they known they might have written something to the effect of:

“vehicle has wear and tear in a number of places, however, there is a critical misfiring causing a rough idle and imminent breakdown.”

Both statements are true – but in one the mechanic didn’t have context, and in the second one the mechanic knew the context.

This happens more often than you can believe!  And it’s not only Social Security disability that this occurs in, VA claim denials are famous for this situation. A doctor will describe a constellation of issues, but not focus on the issue that is material to your disability claim.  As such, it can create predictably poor results.

 

Your Doctor (or you) Didn’t Get Your records to Social Security Fast Enough

 

At every step of the Disability Application and Disability Appeal process you are under a ticking clock.  You have timelines you have to hit, and the system will not wait for you.  From the SSA’s (Social Security Administration) perspective, they have tens of thousands of cases to assess and to keep the process moving forward they have to decide or decline by a standard deadline date.

A side note to this reason is that if you missed timelines as a result of a disability of yours, that would be something you’d want to be documented in your reconsideration/appeal.  You might also want to get help in filing those, as you don’t want to have the same problems at that point.  If your doctor missed timelines, that’s going to be something that needs to be addressed too.  A great advocate or local disability lawyer is great for this.

 

Your Doctor Never Even Met You

 

Be honest.. did you show up to your doctor appointment(s)?  Did you know you had doctor appointments?  Were you aware that the SSA might try to get ahold of medical records for the care you received (or sought to receive) on your conditions?  In some cases, applicants have a pattern of not showing up to doctor appointments, even critical doctors appointments set by SSA for the purpose of evaluating your disability.

This is common enough of a problem that we had to cover it.  It also means that you probably need some additional help when you file your new application or appeal.  If you need someone to remind you, provide you transportation, give you motivation and a helping hand – reach out to them and ask for help.   We don’t mind providing reminders either!

 

You Gave Your Doctor Confusing Information

This is in the same arena as the mechanic story above.  If you’re not clear about why you are seeing your doctor, they may not be clear about what you are needing.

Also, confusing statements that appear to contradict your claims occur very often in medical records.  Consider the simple question, “how are you today?”

Do you even think before answering this question?  Most people don’t – it’s become a salutation like, “hi” and “hey.”  You probably get asked some variation of this question at least 4-5 times a day without giving it a second thought.  Here’s the issue…

If you’re filing a claim for Social Security Disability, there is likely some aspect of your health that is not “fine” – “good” – or “grand.”  And you need to be deliberate, honest, and accurate in answering that question and others like it when speaking to a doctor, or a judge.

 

Your Doctor Isn’t Necessarily an Expert in Your Ailments

We use terms like “doctor” or “lawyer” in generic ways.  However, like lawyers, most doctors have specialties.  For instance, a dermatologist has a different specialty than a neurologist. There’s a lot the two will have in common, including a great understanding of medicine.  However, one is far more prepared to give testimony on skin issues whereas another is better for brain issues.

A general practice physician may not be able to provide enough information to declare the limits of your abilities or disabilities if they’re very specific.  Ideally, a specialist can provide a more thorough diagnosis and prognosis.  If your only medical testimony is from a doctor who doesn’t specialize in your challenges, you may be reliant upon the judgment of an adjudicator at the SSA.

 

On That Note…

You probably want to work with someone who knows disability and disability law if you’re in a situation where you have already been denied benefits.  A social security lawyer is different than a family law lawyer, or a tax lawyer, etc.  In this manner, a social security lawyer in Spokane is different than one halfway across the country!  If you’re going to consult a lawyer, make sure they have experience in Social Security Law, and that they are actually located nearby.

 

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