Common Reasons Why Mental Illness Claims Are Denied Disability

Why do mental health illnesses present special obstacles in getting a Social Security disability claim approved?

In sum, a lack of mental health treatment or treatment notes, not taking medication, and having an episodic illness are the most common reasons mental illness Social Security disability claims are denied.  The following assessment goes into a little more detail on these issues that often cause a disability claim for mental illness to be denied.

Poor treatment notes

One of the biggest problems we face in mental health claims is the fact that many mental health providers (psychologists, psychiatrists, counselors, etc.) keep relatively poor notes. Sometimes the notes are too abbreviated to collect any useful information from them. At other times the notes will be illegible and impossible to read.  Such doctors (or other mental health providers) will sometimes submit a summary of their notes to the disability claims examiner or the Administrative Law Judge because the notes from office visits provide little detail and are not helpful to evaluating the extent and severity of the underlying problems.

No record of mental treatment

All too often we find disability claimants who have have no record of mental health treatment for the condition(s) listed on the disability application. This is especially true in claims involving depression. This is most frequently due to the fact that the claimant’s family care physician has diagnosed depression and prescribed a common anti-depressant.  However, the claimant may have never been referred to a mental health specialist like a psychologist or psychiatrist. In such instances, the claimant will often not have sufficient mental treatment records to support the claim.

Noncompliance with recommended course of treatment or prescribed medications

In some cases, the mental health provider will recommend a course of treatment like counseling sessions or group therapy, and such recommendations are noted in the claimant’s medical records.  However, the medical records may further note that the claimant refused counseling or failed to show up for group therapy.  Later treatment notes will document the fact that the claimant was “noncompliant” with the recommended treatment plan.

In other instances the medical records will show that a claimant has been diagnosed with a specific mental impairment and has been prescribed medication, but records may further note that the claimant has not taken the medication. This is a particularly large problem for mental disorder disability claims because the Social Security Administration (SSA) focuses on what a claimant is still able to do despite the limitations of his or her condition. A claimant’s limitations cannot be accurately measured if the patient is not taking his or her medications as prescribed.

Why is medical non-compliance an issue for some disability claimants? Sometimes it is due to the cost of care or medication. Unfortunately, the Social Security Administration is not typically concerned with whether or not a claimant can afford care or medication.  If you cannot afford recommended care or medications, inform the claims handler or Judge that this is the reason that you don’t take your medication. According to the Social Security rules and regulations, such an excuse this should be an acceptable nonmedical excuse for failing to take medication. If the SSA can help you find free medication, however, this will no longer be a valid excuse. For more information, see our article on failing to following the prescribed treatment.

Lack of duration

Some Social Security disability and SSI disability claims are denied on the basis of duration. This means that a disability examiner or ALJ has concluded that the applicant’s condition has not lasted for at least one year or is not expected to last for one year. This is especially problematic in a claim with a medical condition that has a tendency to “cycle” (where the condition switches between getting better and getting much worse with regularity).  This is an issue in claims based on a mental condition (like bipolar disorder) and in claims involving a physical disorder (such as lupus). For more information, see our explanation of episodes of decompensation.

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