Important: We updated this article in July 2023 to make sure all info below is both current and correct. No matter what health issues you have, getting Social Security disability benefits is hard and takes a long time. The Social Security Administration has a strict definition of “disability,” and it’s nothing like what you imagine. Unfortunately, this means that it can take months, possibly even years, to get monthly benefits. Below, we’ll explain four common reasons for denied claims. That way, you can increase your chances for success the first time you apply!
Understanding How the SSA Defines “Disabled” Explains Why Some People Get Approved While Others Don’t
According to the SSA, to fulfill their internal definition of “disability,” your medical condition must:
- Stop you from working your usual job tasks
- Make you unable to take on other jobs that pay a similar wage, specifically due to your poor health
- Last for at least one year (i.e., 12 months in a row) or your doctor expects it to result in your death
Additionally, the SSA has its Blue Book that lists more than 300 different medical conditions. This Blue Book also lists the criteria your condition must meet for the agency to consider you disabled. If you find your condition or diagnosis in that Blue Book, you must also prove you meet the requirements. (In other words, your diagnosis alone isn’t enough to qualify you for disability benefits. You have to first prove your symptoms force you stop working at least one year. Otherwise, the SSA will automatically deny you benefits.)
If you suffer from something not on the SSA’s Blue Book list, that doesn’t always mean you’ll get denied benefits. Instead, you must successfully prove your condition is similar enough to another one that qualifies under the Blue Book’s criteria. Do that, and you’ll show that you fit the SSA’s definition of disability.
Reasons Why 4 Out of 5 Initial Disability Claims Get Denied
Data from the SSA shows that approximately 20% of SSDI applicants get approved on their first try. The rest must then go through the claim appeals process for different reasons. As hard as that might sound right now, it’s not impossible. In fact, almost as many people turned down the first time win benefits on appeal! It’s helpful to understand reasons why claims get denied in order to avoid the same pitfalls yourself.
Four Common Reasons for Denied Disability Claims
Here are some of the most common reasons for a denied SSDI claim:
Reason #1: The SSA Cannot Get In Touch With You
Filing your claim for SSDI benefits is just the beginning. After you apply, the SSA may have further questions about your claim. In same cases, a Social Security doctor must examine you to confirm your diagnosis. However, if they cannot easily contact you by phone, email or a mailed letter, they’ll simply deny you benefits. If your phone number, email, or address changes while they’re reviewing your claim, notify the SSA immediately! A lot of people don’t realize how long the claim review process will take (usually 3-5 months). If you’re about to move or change phone numbers, make sure you include both the old and new information on your SSD application.
Pro Tip: Always call your local Social Security office to notify the SSA of any changes to your contact info as soon as possible.
Reason #2: You’re Younger Than 50 When You Apply for Benefits
The SSA generally thinks disability applicants younger than 50 can find other work, even with serious health issues. Sometimes, the SSA thinks people in their 20s, 30s, and 40s can change career paths, or go back to school. However, your age alone won’t automatically get your SSD claim denied. You just need to provide solid medical evidence that you can no longer work enough hours to support yourself.
Cancer, progressive diseases (like multiple sclerosis) or injuries that limit your ability to move should help younger people qualify for benefits. That said, the SSA “grid rules” make it easier for applicants aged 50-66 to qualify for disability benefits.
So if you applied before and got denied, we recommend filing again once you turn 50 years old. At that age, the SSA stops expecting you to seek additional education/job training, change career paths, or move just to find another job. They have a lot fewer reasons to turn you down for benefits.
Reason #3: You Won’t Cooperate with the SSA’s Requests
If you refuse to cooperate or don’t respond to the SSA’s requests for certain information, then they’ll reject your claim. Common reasons for such requests include:
- Asking for copies of your complete medical records, marriage certificate, military service records, etc.
- Scheduling a required consultative exam through your state’s Disability Determination Services (DDS) office. Do NOT skip this exam if you want monthly benefits!
Without this extra data, the SSA cannot confirm your health meets their claim approval criteria. Going along with every SSA request after you apply can provide good reasons to approve your claim. Skipping exams, missing deadlines to respond, or filing incomplete paperwork are all good reasons to deny you benefits.
Reason #4: Your Claim Lacks Enough Medical Evidence to Prove You Can’t Work for At Least 12 Months
You need to give the SSA recent and complete medical evidence in order to prove you’re truly unable to work. Without that, it’s incredibly hard to get disability benefits. (Newly diagnosed terminal illnesses are often one exception.) That’s because the SSA needs to know specifically how your condition limits your ability to complete work tasks for at least one year. Insufficient medical evidence is one of the biggest reasons most claims get denied.
Many people think worsening symptoms, unpaid bills, etc. might help them get disability benefits. Unfortunately, those same people often get their claims denied. What the SSA looks for is this:
- Does your health make it impossible to complete your usual job tasks for 40 hours per week?
- If so, what job tasks can you no longer do?
- Are your current job limitations specifically because of your health issues? For example: Can you stand for 8 hours, pick up a dropped pencil without help, or walk up or down a few steps on your own? If not, then the SSA will likely decide that you’re disabled.
But if your doctor expects your condition to improve in less than 12 months, they’ll automatically deny your claim.
How to Get Free Expert Claim Help at Home
Since the application process is often long and very difficult, consult a SSDI attorney for free about your claim. Many people wait until after they’re denied benefits to seek help. This is a huge mistake, since having a lawyer file your claim nearly triples your chances for claim success. Those who qualify for expert help through our website usually get $13,800 in back benefits along with monthly payments.
An attorney can maximize your benefit amount and potentially get your first payment made faster. Since these attorneys work on contingency, you owe your lawyer $0 if the SSA doesn’t award you benefits. And if you do win, then you’ll only pay one small fee.
Want to talk to a local expert for free by phone? Click the button below to start your free online benefits quiz now and see if you may qualify:
Lori Polemenakos is Director of Consumer Content and SEO strategist for LeadingResponse, a legal marketing company. An award-winning journalist, writer and editor based in Dallas, Texas, she's produced articles for major brands such as Match.com, Yahoo!, MSN, AOL, Xfinity, Mail.com, and edited several published books. Since 2016, she's published hundreds of articles about Social Security disability, workers' compensation, veterans' benefits, personal injury, mass tort, auto accident claims, bankruptcy, employment law and other related legal issues.