A Guide to Understanding Why Your Disability Claim Was Denied

Submitted by rsg on Mon, 08/30/2021 - 08:33

Thousands of people who become disabled every year and submit a claim for disability benefits have their claim denied after the initial application. There are many reasons for this, including lack of evidence proving you are disabled and unable to work for at least 12 months, insufficient medical documentation proving you are disabled and cannot work and your medical condition which is causing your disability is not in the Social Security Administration’s (SSA) Blue Book listings.

The SSA uses certain criteria when deciding to award disability benefits. These include the following:

  • whether the claimant's symptoms and medical test results meet the requirements of a disability Blue Book listing;
  • the type of the claimant's previous work;
  • the requirements for the claimant's previous work;
  • the mental or physical limitations of the claimant due to his or her medical condition;
  • whether the claimant will ever be able to return to past work, based on his or her present mental or physical limitations;
  • whether the claimant could ever undertake any other types of work.

Claimants who are found to be unable to perform their past work and are also found to be unable to perform some type of other work will be found disabled and thus eligible to receive Social Security disability or SSI disability benefits.

The Denial Letter

When the SSA denies your disability claim you will receive a denial letter explaining why your medical condition does not allow you to be eligible for disability benefits.  In the denial letter the SSA will refer to the evidence you have provided with your application and use this to justify its decision for your denied disability claim. This includes reports from the medical treatment providers who have treated your medical condition and statements made by co workers, family members and witnesses regarding your physical and mental limitations.

The SSA sometimes uses technical rationale when deciding whether an applicant is eligible for benefits. This means that the applicant was found ineligible for benefits for non-medical reasons and the SSA doesn’t even have to review the medical evidence. According to Social Security, almost half of SSDI applicants and 25 percent of SSI applicants receive technical denials. The main reasons for this are:

  • earning more than the "substantial gainful activity" (SGA) limit which is $1,310 in 2021. This applies to both SSDI and SSI claims;
  • the SSA is unable to contact you so after a period of time your claim is denied;
  • the claimant hasn’t worked long enough to have gained sufficient work credits. For example, a person who is 50 years old needs to have worked for 7 years which will mean you have accumulated enough work credits;
  • the claimant hasn’t worked enough in recent years because to qualify for SSDI benefits you need to have worked for 5 out of the last 10 years. Any time spent unemployed in that period could mean you are not eligible for disability benefits and your claim will be denied.

how long do I have to be disabled to receive Social Security disability?

Other Common Reasons for Denials

Lack of medical evidence can lead to a disability benefits denial.  This could include any of the following:

  • failure to visit your physician regularly which implies you do not need to seek regular treatment for your disability;
  • lack of proof that you have been following a program of treatment as advised by your physician;
  • lack of a recent medical report from your physician;
  • no recent test results showing that you still have a medical condition that means you are disabled;
  • any failure to cooperate with the SSA may also be a reason for denial such as not providing more medical evidence when asked to do so;
  • if you are still earning a living earning too much could lead to an SSDI denied as you are only allowed to earn  $1,310  in 2021;
  • filing alone without the help of family, friends, or an attorney may lead to a denial too;
  • if you have had your disability benefits claim denied before it’s better to appeal than to restart an initial application.

What to Do After a Denial

A disability denial is what most claimants experience following a claim for disability benefits with the SSA. The denial rate for an initial claim is 67%. A denied disability claim means that you will need to file an appeal in the hope that the SSA views your appeal differently from the initial claim.

Just because you have been denied disability benefits doesn’t mean you won’t eventually win your claim. You shouldn’t give up but file an appeal immediately. You are given 60 days to do so from receipt of the denial letter.

By enduring the Social Security disability appeals process you have the best chance of winning a disability benefits claim so that you get the benefits your deserve. You should try and do this within the deadline date set otherwise you will have to submit a new application which will probably be denied based on the same reasons your first claim was denied.

Before you appeal your denial you should try and work out why your first claim was denied. This could be lack of medical evidence showing you are disabled and unable to work for at least 12 months. If this is the case you try to gather together more convincing medical evidence showing that your medical evidence prevents you from working for at least 12 months.

Get a Free Case Evaluation Today

It is not always easy to determine exactly why your disability benefits application was denied. If you are sure you are eligible to receive disability benefits you shouldn’t hesitate but file an appeal.

You should ensure you have accumulated more medial evidence to back up your claim in the appeals process as this is often why a claim is denied. Get an up-to-date medical report from your physician, showing that your symptoms prevent you from working for at least 12 months. Fill out a Free Case Evaluation today to get in touch with a disability attorney who may be able to help you appeal your denied claim.  

Additional Resources

Add new comment