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What Disqualifies a Person From Disability?

Disability benefits can be extremely complicated for everyday people who do not have a legal or medical background. Understanding how one can qualify for a disability benefit usually requires specialized knowledge of disability programs, soliciting expert medical opinions, and lengthy reviews by government officials.

Disability benefits are an extremely complex topic involving matters of medicine and government. Even disabled Americans with a clear case for disability benefits can experience many barriers to accessing those benefits. In other instances, people may do or state things to unintentionally disqualify themselves from disability benefits because they fail to fully understand the process or the rules that govern it. Therefore, many people choose to retain the services of a disability law firm like Gade & Parekh, LLP, of Sacramento before ever filing for disability in the first place.

What disqualifies a person from disability?

Defining Disability

When Americans who have been injured or who suffer from debilitating medical conditions talk about “going on disability,” they are typically referring to Social Security Disability Insurance, or SSDI. It is a federal program that provides cash benefits to Americans who meet the Social Security Administration’s definitions of disability.

Qualifying for Disability

The Social Security Administration (SSA) maintains a two-part list (one section for adults and another for minor children) of specific conditions that make someone eligible for Social Security Disability Insurance benefits. However, simply being diagnosed with one of these conditions is not always enough to automatically qualify someone for SSDI. In most cases, specific criteria will have to be met to qualify for benefits. Even after qualification, a determination may still need to be made as to the level of disability (total, partial, etc.), which can greatly affect the level of monthly benefits received.

Why Was I Disqualified from Disability Benefits?

There are several reasons why a person’s Social Security Disability Insurance claim might be denied, even a legitimately sick or injured person. Sometimes, people who have previously been approved for SSDI can also have their benefits reduced or revoked.

Some of the most common reasons a claimant might be denied SSDI benefits are:

  1. Income From WorkingOne part of the SSDI equation is a number called “SGA”. This stands for “substantial gainful activity,” and if you are making more money than this threshold (thereby indicating that you can support yourself without government benefits), you will be considered “not disabled enough” to qualify for SSDI. The SGA limit for 2022 is $1,350 per month, which represents a 5.9% cost of living increase over the 2021 SGA. This means that your opportunities to earn your own income will be very limited if you choose to pursue SSDI benefits. However, investment income is not counted towards the SGA. SGA limits may also be different for blind applicants.
  2. Severity of DisabilityEven if you are diagnosed with one of the conditions listed in the SSA’s directory of legally disabling conditions, you may need to meet other criteria. Often, these details will be based on expert medical opinions.
  3. Expected Length of DisabilityTo be eligible for the SSDI program, the SSA must determine that your impairment is severe enough that you will be disabled for at least 12 months (or that the impairment will result in your death). Since every illness, injury, and human body is completely unique, each case must be evaluated individually to determine the expected length of disability. This work is done by a special determining body that works hand in hand with the SSA, called the Disability Determination Services, or DDS.
  4. Inability to Communicate with Claimant/Lack of CooperationIf you want to be approved for SSDI benefits, you will need to be in touch with the SSA on a regular basis. This means making sure SSA officials have your current address and phone number, and that you are willing to respond to communications in a timely fashion. To prove the level of your disability, it is likely that the SSA will require certain medical appointments or test results. Special medical examinations with SSA-approved doctors will be required, along with full access to your medical records. If your disability makes it difficult to maintain communication with the SSA, the experienced disability lawyers at Gade & Parekh, LLP, can help navigate the Social Security Administration’s demands while you focus on your healing.
  5. Failure to Follow Through With Treatments or TherapiesIf you want to qualify for SSDI benefits, you must follow your doctor’s orders. This means taking medicine, attending therapy sessions, following dietary restrictions, and whatever else your medical team prescribes. If you have an issue with your doctor’s prescribed regimen, you need to discuss it with your doctor rather than refuse to follow their directions. Otherwise, the SSA could see this as a sign that your impairment is not severe enough to warrant benefits.There are a few exemptions to this rule, such as:
    • Medical exemptions for people who are too mentally ill to comply with their doctor’s orders
    • An intense fear of surgery that makes recommended treatment impossible
    • A physical disability that directly prevents you from completing prescribed therapies
    • A contrary opinion from another qualified medical professional

    Valid non-medical exemptions exist for people who are too poor to follow through with recommended treatments and for those with religious beliefs that don’t allow certain treatments. In general, though, you must do as your doctor says if you wish to qualify for SSDI benefits.

  6. Drug or Alcohol IssuesAlthough this is controversial among some experts in the medical and social work fields, the SSA will deny your claim if your disability is rooted in drug addiction or alcoholism.

FAQs

Q: What Conditions Are Considered Disabling?

A: The Social Security Administration maintains separate lists of qualifying disabling conditions for adults and minor children. It’s important to understand, however, that other medical, financial, and circumstantial criteria will still need to be met even after you have been diagnosed with one of those conditions. The level of benefits you receive will also be determined by the severity of your condition.

Q: What Will Disqualify You From Disability Benefits?

A: There are many factors that can qualify someone for disability benefits. These can include income levels, the severity and duration of your condition, and the degree you cooperate with medical professionals and the SSA. It is not an exhaustive list, however. Other disqualifiers can also include imprisonment and fraudulent activity.

Q: How Hard Is It To Get Disability?

A: Looking at disability benefits as a matter of “hard vs. easy” is not the ideal framework for approaching an SSDI claim. It is not a matter of difficulty, but of objectively determining whether you meet the criteria for SSDI benefits. This will require a large body of medical evidence and a great deal of time acquiring it. You must also meet a variety of medical and financial requirements as set forth by the SSA.

Q: Why Did I Get Denied for Disability?

A: There are many reasons why someone might be denied federal disability benefits. These can include medical, financial, or criminal activities. You may have also committed some form of error or omission in your application. Most likely, it will involve the severity of your disability and the degree to which the SSA determines that you are able to provide for yourself.

Gade & Parekh, LLP: Your Trusted Partner for the SSDI Process in California

If you want to pursue SSDI benefits by submitting a disability claim, but aren’t 100% certain whether you qualify, the expert team at Gade & Parekh, LLP, of Sacramento is here to help. Contact us today for a consultation, and we’ll help determine the best way to proceed with your unique case.

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