What is a Technical Denial? (2024)

FAQs

What is a technical denial? ›

What Is a Technical Denial? A technical denial occurs when the disability examiner issues a denial of benefits based on a non-medical requirement for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). For this reason, technical denials are also sometimes called non-medical denials.

Informal denials are typically seen with claimants seeking Supplemental Security Income or SSI. If the SSA determines that you earn too much (beyond the SGA limit) or have too many resources (i.e. bank accounts, stocks, bonds and property), you may receive an informal denial for disability.

SSA generally makes a non-medical decision on eligibility for both SSI and SSDI prior to forwarding the application to DDS for the medical decision. Many applicants without a sufficient work-history or relevant family coverage will be denied SSDI early on in the process.

Non-medical redeterminations are reviews of all of the non-medical factors of eligibility to determine whether a recipient is still eligible for Supplemental Security Income (SSI) and still receiving the correct payment amount. There are two types of these redeterminations: scheduled and unscheduled.

Types of Claim Denials

1. Soft Denial: A temporary or interim denial that may be paid if the practice takes corrective action; no appeal is needed. 2. Hard Denial: A denial resulting in lost or written-off revenue; an appeal is required.

Can I get approved for SSDI and denied for SSI? Yes, it is possible to get approved for SSDI but denied for SSI. If this happens, it's likely because you have too much income to qualify for SSI.

Although there is only a 1 in 10 chance that you will win at reconsideration, it is a necessary step in the appeals process and, at the very least, sets the stage for an administrative hearing, where the approval rating increases to roughly 45%.

What Is the Most Approved Disability? Arthritis and other musculoskeletal system disabilities make up the most commonly approved conditions for social security disability benefits. This is because arthritis is so common. In the United States, over 58 million people suffer from arthritis.

If you qualify for Supplemental Security Income (SSI), you could also receive back pay. Retroactive benefits might go back to the date you first suffered a disability—or up to a year before the day you applied for benefits. For SSI, back pay goes back to the date of your original application for benefits.

There is no limit to the amount of times that a claim can be denied. But that's not as disheartening as it sounds because there is also no limit to the number of appeals that you can make. That means that you can appeal every time your claim is denied.

Why are most SSDI claims denied? ›

SSDI applications are frequently denied because they don't have enough information to enable the SSA to award you SSDI benefits.

The field office is responsible for verifying nonmedical eligibility requirements, which may include age, employment, marital status, citizenship and residency, and Social Security coverage information. For SSI eligibility, the field office verifies income, resources, and living arrangement information.

Medical improvement is any decrease in the medical severity of impairment(s) present at the time of the most recent favorable medical decision that you were disabled or continued to be disabled and is determined by a comparison of prior and current medical evidence which must show that there have been changes ( ...

If the SSA denies your application, they will send you a letter advising you of the reasons for their decision. You have the right to request a reconsideration and have them review your entire file. Appeal. If your application is denied after you request a reconsideration, you can file an appeal and request a hearing.

Denial codes explain why insurance cannot cover a patient's treatment costs so medical billers can resolve and resubmit the claim. This not only benefits the patient, but it benefits the provider as well. Without being able to process claims, you don't get paid.