Why a Disability Claim Gets Denied
It's essential to understand why the Social Security Administration (SSA) denies disability claims. Knowing these reasons can help inform your approach to your Social Security disability initial application. It can also help you decide what information to include in your appeal to overturn a denial.
The SSA denies about two-thirds of all initial claims for disability benefits. An initial claim is your completed application forwarded by your local Social Security office to the Disability Determination Services. The SSA disapproves claims for Supplemental Security Income (SSI) slightly more often than claims for Social Security Disability Insurance (SSDI).
The SSA denies an even higher rate of claims on the first level of appeal, called reconsideration. The SSA approves only about 11% of claims on reconsideration. But don't give up after reconsideration. The allowance rate after a hearing before an Administrative Law Judge (ALJ), the next level of appeal, is a little over 50%. The ALJ level has the highest success rate of any appeals level, including the Appeals Council.
There are many reasons the SSA denies Social Security disability applications. These reasons include that a claimant doesn't meet non-medical program eligibility criteria. For example, the claimant may have too many resources (SSI) or insufficient work credits (SSDI). The SSA can also deny a claim for insufficient medical evidence to support a finding of disability.
Each person's circumstances are unique. The following article will help you understand why the SSA may deny your application and what you can do about it. See our main Social Security Disability (SSD) index for more articles about the SSA's disability benefits programs.
You Earn Too Much Money
A common reason the SSA denies Social Security disability claims is money. Specifically, that you earn too much of it.
Under SSA's eligibility rules, you cannot receive Social Security disability benefits if you earn over a certain monthly amount. If you earn over this certain amount, the SSA considers you able to engage in substantial gainful activity (SGA). Earning at SGA levels indicates to the SSA that you can perform significant mental or physical activities, which is inconsistent with a finding of disability.
The national average wage index sets SGA amounts. The 2023 SGA amounts are as follows:
- For non-blind people: If earnings average over $1,470 a month, non-blind individuals aren't eligible for SSDI benefits and SSI Benefits.
- Statutorily blind individuals: The SGA amount is $2,460 a month. SGA determinations don't apply to initial SSI eligibility for people who are blind.
Remember that part-time work may qualify as SGA. Whether you work full or part-time, if you average more than allowable SGA amounts, the SSA will find you ineligible for benefits.
You Will Be Disabled for Less Than One Year
Another common reason for a claim denial is a lack of evidence that your impairment or impairments will last long enough to keep you out of work or result in death.
The SSA has a 12-month duration requirement. This means you cannot work because of a medical condition (or multiple medical conditions) that has lasted or is expected to last at least one year. Or your medical impairment is likely to result in death. If you don't meet duration requirements, you are not disabled under SSA's rules.
The SSA will deny SSDI and SSI applications for non-blind applicants who don't meet the duration requirement. Statutorily blind people filing for SSI do not have a duration requirement.
Your Disability Is Based on Drug or Alcohol Abuse
It is vital to know program policy rules if you struggle with drug addiction or alcoholism. The general rule is that the SSA will deny your application for benefits if it determines you wouldn't be disabled if you stopped using drugs or alcohol.
The SSA may allow your claim if your drug addiction and alcoholism (DAA) don't cause or affect your disabling condition. Also, the SSA may still allow your claim even if the DAA does cause or affect your impairments. In that case, you would have to show that your other medical impairments would not improve to the point of non-disability if you stopped using drugs or alcohol.
You Didn't Follow Doctor's Orders
With some exceptions, the SSA will deny your claim if you don't follow your doctor's prescribed medical treatment for your condition.
Some medical and non-medical exceptions may include:
- You're unable to keep appointments or follow your doctor's orders, including taking your medication as prescribed, due to symptoms from your mental impairments.
- You won't follow the prescribed treatment because it is against your religion.
- Your doctor didn't prescribe an appropriate or effective treatment.
- You can't afford the prescribed treatment.
The SSA Is Unable to Contact You, or You Don't Cooperate
The SSA may deny your claim if it can't reach you. The SSA often contacts claimants, whether to schedule a consultative examination or to request evidence. It's important to ensure you have some way for the SSA to get a hold of you.
It is incredibly challenging for people experiencing homelessness to keep in contact with the SSA. These people may want to seek the help of national advocates or the Department of Social Services for help with their claims, including submitting medical information when asked by the SSA.
It may be a good idea to give the SSA the name of a third party. SSA must make a reasonable effort to involve a third party before it stops trying to get you to cooperate with a request. If the SSA can't find you or you fail to cooperate, the SSA will decide your claim based on the evidence of record.
Your Claim Lacks Sufficient Treatment Records
You must submit enough medical evidence to prove to the SSA that you cannot work. Medical evidence includes diagnostic testing results, doctor's notes, and physician's assessments and opinions. The SSA may deny your claim if you don't submit enough medical evidence.
Submitting sufficient medical evidence can ward off a denied claim. It can also get your claim approved earlier in the process. For example, suppose the medical records show your impairment is very severe. In that case, you are automatically disabled under the criteria in the Listings of Impairments (SSA's Bluebook).
You will have several opportunities to submit new evidence. If the SSA doesn't have enough evidence, it may pay for a consultative examination. This isn't always helpful for your case. Decisionmakers often give great weight to unfavorable findings from a source who has examined you only once.
Your Disability Is Connected to a Criminal Conviction
Your benefits will generally stop or suspend under the following circumstance:
- You are jailed for 30 days or more. Your SSI benefits may begin again the month after you're released. If your confinement lasts 12 months or more, SSA will terminate your benefits, and you must reapply. In that case, SSA's prerelease procedure may be helpful to expedite benefits.
You are not eligible for disability cash benefits if:
- You have a medical impairment sustained or worsened while in prison for a felony.
- You sustained or aggravated an impairment while committing a felony.
While you can't get cash benefits, you may be able to use your felony-related impairments to establish a period of disability.
Still Confused Why Your Claim Was Denied? Get Professional Legal Help
Suppose you don't understand why the SSA denied your claim. You may want to contact a Social Security disability attorney for a free case evaluation. A Social Security Disability attorney can help you understand your initial denial letter and whether it makes sense to go through the appeals process. A Social Security disability lawyer can also assist with the application process through federal court appeals.
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