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5 Reasons Why Your Social Security Disability Insurance Claim Could Be Denied

5 Reasons Why Your Social Security Disability Insurance Claim Could Be Denied

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If you are applying for Social Security Disability Insurance (SSDI) payments, you may be wondering what are common reasons for denial of an SSDI claim.

What Is SSDI?

SSDI is a program administered by the Social Security Administration (SSA) that pays disability benefits to those who cannot work due to a qualifying medical condition. To qualify for SSDI, you must meet the SSA’s disability criteria. SSA defines disability as a condition that significantly limits a person’s ability to do basic work-related activities for at least 12 months. SSDI does not provide benefits to people with a partial disability or short-term disability.

In addition, the individual applying for benefits (or their spouse or parent) must have worked for a certain amount of time (based on age) in a job where they paid into the Social Security system.

If approved, an applicant’s monthly SSDI payment amount is based on their lifetime average earnings covered by Social Security. The SSDI payment may be reduced if the applicant receives workers’ compensation payments or other public disability benefits. Under some circumstances, children may also receive a monthly benefit.

Common Reasons for Denial

Although millions of people apply for SSDI yearly, only a small percentage get approved. For example, in 2022, approximately 3 million people applied, but SSA only made 543,445 SSDI awards.

So, why do such a large percentage of claims get denied? Here are five common reasons.

1. Insufficient Medical Evidence

A common reason SSDI claims are denied is that the SSA disagrees that an applicant meets its disability criteria. This is usually because the application lacks adequate medical evidence supporting an individual’s claim that they are disabled and unable to work.

Medical records need to document not only the existence of a disability, but also that this condition has interfered with their ability to work. Medical records that do not have a clear diagnosis, are sparse, or do not have any doctor’s notes on how a specific condition has limited your work abilities will not support an SSDI claim.

As an example: if you have not sought medical attention for your condition or have inconsistent or insufficient medical information in your records, you may face a denial of your claim. If you are considering filing for SSDI, it is essential to seek medical care as soon as possible and discuss with your physician how your disability is affecting your work life.

It may also help your claim to supplement your medical file with any doctor’s notes that excused you from – or asked your employer to limit – your work activities, as well as any employer records of the time you had to take off from work. 

2. Multiple Applications and Failure to Pursue the Appeal Process

Another common issue occurs when someone submits an additional application for the same claim instead of appealing a denial. If the SSA reviewer sees you were previously denied benefits based on a similar application, you may find yourself being denied once again.

SSDI applications are frequently denied because they don’t have enough information to enable the SSA to award you SSDI benefits. It is better to appeal a denial first before submitting a new application. An appeal comprises multiple levels, so you can correct or supplement your application through this process.

The first level, called reconsideration, is where you ask the SSA to take another look at your request. It is not uncommon for an applicant to be denied again at this stage. The next step, where your appeal is heard by an Administrative Law Judge (ALJ), is where you may have more success. In this part of the appeal process, you can testify about your disability and how it affects your life and ability to work.

Beyond this, there are two additional stages of appeal – 1. requesting a review from the SSA’s Appeals Council; and 2. filing an action with the federal district court. It is recommended that you seek the counsel of a special needs planning attorney to help you navigate this process.  

3. You Earn Too Much

If you are working and making more than a certain threshold that qualifies as “substantial gainful activity” (SGA), your claim for SSDI may be denied. The SSA typically will not approve an SSDI benefits award if your earnings are more than $1,470 monthly (in 2023).

4. Your Condition Is Not a Qualifying Medical Condition

Even if your condition is severe and limits your ability to work, the SSA may still find that you can do other work to earn an income.

The SSA maintains a list of medical conditions that are serious enough that a person cannot engage in SGA. However, an applicant’s medical issue may not neatly fit into one of these impairment categories. In that case, the SSA has to decide if the individual’s condition is comparable to one of the conditions on the list.

If the SSA determines your condition is not comparable and that you can engage in other types of work, your claim will likely be denied.

If you disagree with the SSA’s determination that your medical condition is not a qualifying one, you may need to appeal their decision. 

5. Your Employment History Is Not Long or Recent Enough to Qualify for SSDI

In addition to qualifying as disabled per SSA guidelines, an applicant must have worked long enough and recently enough to be eligible for SSDI benefits. An applicant needs a certain amount of “work credits,” which are earned from reported yearly wages or self-employment income (on which they paid taxes). Work credits are earned for each quarter of the year a person works as long as they make a certain amount of income. 

In addition, the amount of work credits someone needs in order to qualify for SSDI depends on the age they became disabled. The general rule of thumb is that a person needs 40 credits, and 20 of these must have been earned in the last 10 years. However, younger applicants may need fewer work credits.

If someone doesn’t have enough work credits, their SSDI claim can be denied, even if they qualify as disabled.

SSDI Attorneys

Applying for SSDI is a challenging task. The process can be long and arduous, with the average time for an initial decision taking seven months.

Working with an attorney can significantly improve the outcome of your case. Federal law allows applicants to access attorneys without paying attorney’s fees upfront. Under this law, an attorney who helps you file for SSDI benefits can be paid up to 25 percent of the disability back pay award (capped at $7,200, effective November 30, 2022) in exchange for their legal services. If your claim is not approved, you have no financial responsibility for the attorney’s fees.

If you want to speak to a qualified special needs planning attorney this list is a good place to start.

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