Can I be DENIED benefits if the SSA has not sent me to a doctor?The Social Security Administration (SSA) will make a disability determination for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) by reviewing a claimants medical records from qualifying medical sources.
According to the Social Security Administration, qualifying medical sources include:
Licensed physicians (medical or osteopathic doctors)
Licensed or certified psychologists.
Qualified speech-language pathologists
Medical reports can include the medical history of a claimant, clinical findings (such as the results of physical or mental status examinations), laboratory findings (such as blood pressure, x-rays), diagnosis (statement of disease or injury based on its signs and symptoms), treatment prescribed with response, and prognosis and statements about what the claimant can still do despite their impairment.
So what if you do not have enough medical records for the SSA to make a disability determination? They are supposed to send you for a consultative examination.
BUT wait, before any of this happens, the Social Security Administration will first determine if you have met the nonmedical requirements for either Social Security Disability Insurance or Supplemental Security Income.
If you have not met the nonmedical requirements for either of these programs they are not required to send you for a consultative examination; in fact, they are not even required to consider the status of your mental or physical health condition.
Reasons you could be denied for Social Security disability benefits without seeing a doctor
There are several nonmedical reasons you could be denied Social Security Disability Insurance or Supplemental Security Income.
You are making too much earned income
You can be denied SSDI and SSI benefits if you are performing substantial gainful activity (SGA) or working at a level the Social Security Administration considers substantial.
SSI or SSDI claimants will be denied benefits if they are working and making too much money ($1640 for blind claimants and $1000 for non-blind claimants). If you are working too much the SSA does not care about the severity of your condition; in fact, they will not even pull your medical records and review your disability claim.
The SSA determines your condition is temporary and will not last at least 12 continuous months
Although you could be severely injured or sick right now, many conditions will only last a few months and you could return to work. If your current medical condition is not expected to last for 12 continuous months, you will be denied SSDI or SSI benefits.
You do not have enough work credits to qualify for SSDI
Social Security Disability Insurance (SSDI) is only awarded to claimants who are considered disabled and who have worked long enough and paid enough employment taxes to be considered "insured.
To determine if you are insured you can contact the SSA at 1-800-772-1213 or you can preview your most recent SSA statement of earnings. If you do not have enough work credits, you will not qualify for SSDI.
You Income or Resources were too high to qualify for SSI
If you have enough work credits to qualify for SSDI the SSA does not consider your income and resource level, but SSI or Supplemental Security Income was created for low income families and to qualify for SSI you will have to meet certain income and resource limits.
If you do not meet the income and resource criteria you will be denied SSI benefits, regardless of whether you meet the other medical criteria (aged, blind or disabled).
Appealing a nontechnical or nonmedical denial
The SSA does allow claimants to appeal a technical or nonmedical denial within 60 days from the date of the denial. The reconsideration process allows nonmedical reconsiderations to be done through a case review, an informal conference, or a formal conference.