4 Common Ways Social Security Disability Claims Get Denied When They Could Be Approved — Part 1

Wednesday, 20 April 2016 15: 47
Written by Joni B. Bailey


The #1 way that a claim gets denied when it could be approved is:

The claimant’s residual functional capacity (RFC) gets overestimated.

How much can you still do despite your illness or injury? 

That is the most critical issue in every Social Security Disability Insurance claim. 

The Agency has a name for this--residual functional capacity, or “RFC” for short.  The decision at every level of a claim will be based on the RFC assessment, or how much you can do on a sustained basis on a full time work schedule.

  • The RFC is the most an individual can do despite his or her limitations or restrictions.
  • The RFC considers only the impact of medically determinable impairments.
  • The RFC does NOT consider age and natural body build and the activities the person has previously done.

The record must contain both allegations of limitations/restriction and information that such a limitation/restriction exists. 

One of these without the other will not be enough.

The medical consultant evaluating the case will assess a person’s RFC on a “function-by-function” basis.

When there is no allegation of a physical or mental limitation or restriction of a specific functional capacity, and no information in the case record that there is such a limitation or restriction, the adjudicator must consider the individual to have no limitation or restriction with respect to that functional capacity.

What exactly does the RFC assess?

 If it interferes with working, it will be assessed.

These are the abilities that an RFC will consider:

  • Physical abilities: sitting, standing, walking, lifting, carrying, pushing, pulling, or other physical functions (including manipulative or postural functions, such as reaching, handling, stooping or crouching).
  • Mental abilities: understanding, remembering, and carrying out instructions, and in responding appropriately to supervision, co-workers, and work pressures in a work setting.
  • Other abilities: environmental restrictions such as inability to work around airborne irritants or dangerous equipment or unprotected heights.

See 20 CFR 404.1545 - Your residual functional capacity and SSR-96-8p ASSESSING RESIDUAL FUNCTIONAL CAPACITY IN INITIAL CLAIMS:

How does a claimant make sure the record contains adequate evidence to support an RFC assessment that will lead to a favorable decision? 

An experienced, diligent Southern Illinois Social Security disability representative will help the claimant build a strong record in these ways:

  • take the time to get to know the claimant,
  • start thinking about the RFC from the very first contact,
  • pay attention to every report the claimant fills out,
  • obtain and submit every medical record that relates to the disability,
  • obtain medical opinions about limitations/restrictions.

The next posts in this series will address these common ways claims get denied when they could be approved:

2.  An impairment is determined to be “not severe”.

3.  The claimant’s allegations of pain are not properly evaluated.

4.  The claimant does not have sufficient evidence to prove their impairment.

Many claimants make the mistake of thinking the Social Security Disability claim is a simple process, so they go all the way through the process and attend their hearing without a Southern Illinois Social Security attorney representing them.  Many are shocked when they receive a denial based on the ALJ’s finding that their impairments do not limit or restrict their ability to function enough to qualify them for benefits.  Then they have to decide whether to appeal or start a new claim.  See this earlier blog article about how many claims get denied at the hearing level.

Even though it is a “non-adversarial” hearing and the Agency has some responsibility to help develop the record, it is the claimant’s job to build a record that supports a favorable decision.  Most claimants need an experienced, dedicated Southern Illinois Disability attorney to accomplish that.

Joni Beth Bailey is a Southern Illinois Social Security Disability attorney.

social security disability lawyer in murphysboro, il

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