reasons for denial

Four Reasons Social Security Disability Claims Get Denied

Whether it’s for a physical or mental disability, getting Social Security disability benefits is hard and takes time. The Social Security Administration has a strict definition of “disability,” and it’s nothing like what you imagine. Each applicant must meet certain criteria before the SSA approves their claim or risk denial. Unfortunately, this means that it can take months, possibly even years, to navigate the system. Below, we’ll explain four common reasons for denied claims. That way, you can maximize your chances for approval the first time!



Understanding How the SSA Defines “Disabled” Is One of Many Reasons 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 completing the same work tasks that you did before in your full-time job
  • Make you unable to take on other jobs that pay a similar wage, specifically due to your mental or physical condition
  • Last for at least one year (i.e., 12 months in a row) or is expected 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; if not your claim automatically gets denied.)

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 applicants later get approved during the appeals stage! 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 your SSDI claim may get denied:

Reason #1: The SSA Cannot Locate You

Filing your claim for SSDI benefits is just the beginning. After you apply, the SSA may have additional questions about your claim. In same cases, an SSA-approved physician must examine you to confirm your diagnosis. However, if they cannot easily contact you over the phone or via email, that alone may get your claim denied. If your address, phone number or email changes while they’re still reviewing your claim, notify the SSA immediately! A lot of people don’t realize how long the claim review process will take (typically 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.

Reason #2: You’re Younger Than 50

The SSA generally thinks disability applicants under 50 can find other work, despite their mental or physical disability. Sometimes, the SSA thinks people in their 20s, 30s and 40s could switch 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. Younger applicants with cancer, progressive diseases (like muscular sclerosis) or injuries that limit mobility should qualify for disability benefits. That said, the agency’s “grid rules” make it easier for applicants aged 50-64 to qualify for disability benefits. So if you applied at age 48 and got denied, we strongly recommend re-applying once you turn 50. At that age, the SSA stops expecting you to seek additional education/job training, change career paths or move locations just to find comparable work. They have a lot fewer reasons to turn you down for benefits.

Reason #3: You Won’t Cooperate

If the SSA requests additional information about your case but you refuse to cooperate or don’t respond, your SSD claim’s denied. (Common reasons for such requests include asking for copies of your complete medical records, or that you attend a scheduled DDS exam.) Without this extra data, the SSA cannot confirm your condition meets the agency’s internal disability criteria. Going along with every SSA request after you apply 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 Sufficient Medical Evidence to Prove Your Case

You need to give the SSA sufficient and complete medical evidence in order to prove you’re truly unable to work. Without convincing evidence, it’s incredibly hard to get your disability claim approved. (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 40 hours each week. 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/week? If so, what job tasks can you no longer do? Are your current limitations specifically due to your health? For example: Can you stand for eight 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.

You May Qualify for Legal Assistance

Since the disability claims process is often long and very confusing, talk to an advocate or attorney for free first. Many people wait until after they’re denied benefits to seek legal assistance. This is a huge mistake, since having a lawyer file your claim doubles your chances for winning benefits right away. Those who qualify for legal assistance through our website typically get $10,000 in lump-sum backpay as well as monthly benefits. An attorney can maximize your benefit amount and potentially cut your wait time for your first payment in half. Since these attorneys work on contingency, you owe $0 for legal assistance if the SSA doesn’t approve your claim. And if you win, then you’ll only pay a small, one-time fee.

Ready to see if you may qualify? Click the button below to start your free online benefits evaluation now!

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