Top 5 Signs You May Be Denied Disability (Updated for 2023)

Submitted by Chris on Fri, 10/07/2022 - 12:26

Millions of people apply for Social Security Disability benefits each year. Out of those millions of applications received by the Social Security Administration, only thirty percent are approved at the initial level of the disability claim process. Why are so many Social Security Disability claims denied?

You might have read our article discussing the signs your disability claim will be approved, however here, in this article, we will outline the signs and/or reasons your disability claim might, or will, be denied.

The reasons for a denial of Social Security Disability benefits vary individually—i.e., from one claim to the next—but there are five common reasons for a claim to be denied. If you are applying for Social Security Disability benefits it is important to understand the top five reasons why the Social Security Administration denies so many claims. 

The common reasons a Social Security disability benefits claim is denied are as follows:

#1: Lack of Hard Medical Evidence

Many Social Security Disability claims are denied due to a lack of solid medical evidence. If you want to qualify for disability benefits you will need to prove that you are unable to work due to your disabling condition.

In order to succeed in this, you must have medical records that show your disability has interfered with your ability to perform work activity.

For example, you may be seeing your doctor every month for severe back pain but if your doctor has not documented how that back pain interferes with your ability to work, your claim for Social Security Disability may be denied.

Many people assume that Social Security will send them to doctors who will gather the evidence needed to qualify and approve a claim for Social Security Disability benefits. This isn't the case. Even if you are sent for medical exam by the Social Security office, it may not be enough to prove your disability.

The medical records kept by your primary care physicians are what will be most important in determining the success of your claim for Social Security Disability benefits. Because of this, it is very important that you discuss how your disability is impacting your work life with your physician.

Doctor's notes excusing you from work or records suggesting a modified work schedule should be included with your medical files if possible. If you were working prior to filing for disability and had to miss time from work due to the disability, keep record of just how much time was lost.

This will help present your case for Social Security Disability to the Social Security Administration.

#2: Prior Denials

Many people think that filing a new disability claim is a better alternative than appealing a denied one. This is not the case. In some situations, a claim will be denied when the person reviewing the claim sees that you applied for Social Security Disability and were denied benefits before.

Because of this, it is important that you go through the appeals process rather than filing a new claim for Social Security Disability altogether if your initial claim is denied

Most disability claims are denied. Here are out top five reasons why!

#3: Your Income

This is only if you are applying for SSI benefits. Your income does not matter when applying for SSDI benefits. Some people who apply for SSI benefits can work part time and earn money during the process. However, if you are working and earning more than $1,470 per month when you apply for Social Security Disability, your claim could get denied.

The Social Security Administration will only approve Social Security Disability claims for people who are unable to work due to their disability.

#4: Failure to Follow Treatment

If you fail to follow the treatment prescribed to you by your doctor, the Social Security Administration will deny your claim. The reason for this is that the examiner will not be able to accurately determine whether or not your condition actually prevents you from being able to work if you are unwilling to cooperate with treatment.

If there is valid reason for not following through with the treatment prescribed by your doctor, you can bring this up during the appeals process. You will, however, want a Social Security Disability attorney or disability advocate helping you in this case.

#5: Failure to Cooperate

No matter how you feel about the people handling your Social Security Disability claim, it is in your best interests to cooperate with them during the application process.

If you fail to provide the Social Security office with requested documentation or fail to show up to your scheduled medical exams, your claim will be denied. Because of this, it is important to remain in contact with the person handling your case and provide any and all documentation requested in a timely manner.

How Long Does It Take to Get Disability?

You may have to wait several months or even years to receive your benefits.

In most cases, it takes four to six months for the Social Security Administration (SSA) to process an SSDI application or Supplemental Security Income (SSI). However, if your initial claim is denied, it can take an extra 6 to 8 months on average to get a hearing as part of the appeals process. Even if you win your appeal, two years could have passed since you first submitted your application.

How Many Times Can You Get Denied for Disability?

You may have heard that there are limits to the number of times you can apply for and claim Social Security Disability (SSD) benefits. However, that's not entirely true. If you've been wrongfully denied benefits, it's helpful to know that there is no limit to how many times you can file a claim or appeal your initial denial.

Whether you should reapply or appeal depends on a variety of factors. For many applicants who have had their disability claims denied, an appeal is the best course of action. An appeal means that you did not start the claims process all over again, which means you will not be subjected to the long waiting period before being approved for benefits. With an appeal, you retain your protective filing date—the date that you first informed the SSA of your intent to file a disability claim. If your appeal is successful, backpay is calculated according to your protective filing date.

Approval Rates For Denials

Social Security disability applications face an overwhelming 70% denial rate upon initial evaluation. That is a huge number but it is based upon several very different factors, such as applying for a condition that does not meet the criteria or lack of proper medical documentation.

Fortunately, the Social Security disability benefits program offers a comprehensive set of appeals guidelines that have a great success rate.

When you appeal a decision, the understanding at that point is that you truly believe you qualify for disability benefits. You might go back and review your medical documentation to ensure that you have provided everything that the SSA needs to make an informed decision.

In some cases, new information has presented itself since you initially filed, and this new information can help to make your case even stronger.

The reality, though, is that your initial request for reconsideration goes back to the SSA so this appeal level only has an average success rate of 13.8%.

The best chance for a successful appeal comes at the disability hearing level, where you have the chance to speak with an administrative judge about your condition. You are able to bring witnesses who can support and corroborate your claims. There is an average success rate of 62% at this stage.

The two remaining levels are the Appeals Council and taking the case to federal court. The Appeals Council approval rate is about 13% and only 40% of federal court cases receive favorable decisions.

Given the complexities of the appeals process, it is incredibly helpful to engage a Social Security disability lawyer to help you navigate the course and ensure that you have everything you need so that you are in the best possible place to win your case. 

Even if you are denied Social Security disability 3 times you may be able to appeal or submit a new application.

How to Use the Disability Blue Book to Your Advantage

The Social Security Administration evaluates each claim using a comprehensive list of disabilities, the Disability Evaluation Under Social Security, commonly referred to as the Blue Book. The Blue Book features 14 different categories of conditions and their related diagnoses, symptoms and treatment. The idea is that the SSA can quickly locate a condition in the Blue Book and determine whether your condition qualifies you for disability benefits.

When you are in the initial application process or in the request for reconsideration phase, the Blue Book can help you determine what medical documentation will help to make your case as strong as possible. Thus, using the Blue Book during the application process and reconsideration phase can be one of the best ways and/or signs your disability claim will be approved—hopefully. If you locate your condition in the Blue Book, you can see what information will be used to decide your claim and you can provide as much evidence to support your case.

In some cases, though, your condition is not enough to qualify you for disability benefits, and so the SSA will request that you complete a residual function capacity form (RFC). The RFC determines how much work you are capable of performing given the limitations of your condition.

Your doctor is the one who fills out the RFC form, thus ensuring that the information provided is based entirely upon your medical history.

The RFC form is your chance to present specific information about your unique situation to the SSA. Your doctor knows your case and understands your limitations based upon examination and observation.

In many cases, your doctor was the one to make the diagnosis and prescribe the treatment plan, so if there is any question about your ability to work this is where the SSA will turn to for answers.

Make sure you inform your doctor of your intent to apply for disability benefits as soon as possible, and if your claim has already been denied then make sure your doctor knows that the RFC form must be completed as quickly as possible given the 60-day appeal period.

Improving the Possibility of Success

While it is true that only 30 percent of initial Social Security Disability claims are approved, understanding the reasons why so many disability claims are denied can help you increase your chances of a successful Social Security Disability application. Thus, and once again, taking the time to make sure you understand why so many disability claims are initially denied, and establishing a game plan for how your disability claim can not make those same mistakes could be one of the best ways and signs your disability claim will be approved—theoretically speaking. 

Keep the above tips in mind when applying for Social Security Disability benefits if you want to increase your chances of falling into that lucky 30 percent.

Work History

In order to apply for Social Security disability benefits, you need to have paid Social Security taxes and you must have 40 work credits. You earn four work credits for each year that you earn a certain amount of money; in 2022, that amount was $6,040. 20 of the 40 credits must have been earned within the last ten years prior to your diagnosis.

For younger applicants, the number of work credits needed is based on a sliding scale given that you might not have worked long enough to earn 40 credits. To receive disability benefits, you must be unable to work. If you are capable of working in your current position, or if you could work with accommodations for your condition or in a modified capacity, then you will not receive disability benefits.

However, the SSA provides opportunities like the trial work program for applicants who are unsure of their ability to work.

   You Could Be Entitled to $3,627 Per Month! Get a Free Disability Evaluation

The entire process of applying for Social Security disability benefits is overwhelming, from keeping track of deadlines to making sure that your application is complete.

Your attorney can help guide you through the appeals process so that you can be assured that you are doing everything the right way. Though there is no guarantee that hiring a disability benefits attorney will make you win your case, it can greatly improve your chances of success. The monthly Federal Social Security Disability benefit for an independent individual is $914 and $1,371 for a couple.  

You can bring in a disability benefits lawyer at any point in the application or appeals process. Your attorney will know what information should be included in your initial application, as well as what should be added to strengthen your appeal. He or she will know when the deadlines are, and your attorney will be able to help you through every stage of the appeals process so that you do not have to do it on your own.

Most disability benefits attorneys work on a contingency fee basis, so you do not have to pay anything unless you win your case. They will collect their fees from any back pay you are owed, which can either be 25% of the back pay or $6,000, whichever is less. Since you do not have to pay up front and you only pay if you win your case, there is a major upside to working with a lawyer through the process.

Curious what conditions automatically qualify you for disability? Click here to find out.

Additional Resources

Blog comments

Mary (not verified)

I am one of the 30% that was approved the first time. I had all my medical records together, the names of my doctors, hospital, contact information for the doctors, upcoming doctor appointments - that is one of the questions asked - when is your next appointment. Social security wants to make sure you are actively getting medical care. The reasons why you are disabled and can't work. The diagnosis you were given. Social security will check everything out, they will call you and see how you are doing and verify what is on the application. It took me six months, which is pretty normal to find out I had been approved. Social security disability is not an immediate form of income. They will look at any other kinds of income such as time loss if you have a work injury. I was fortunate that I didn't need to hire an attorney, but I understand why people do.

Sat, 08/12/2017 - 11:51 Permalink
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In reply to by daniel cruz (not verified)

Hi Daniel,

You may qualify under the SSA's Blue Book listing 1.00. Your condition will need to meet the guidelines laid out here. You can call the SSA at 1-800-772-1213 to find out more or review the Blue Book listing to see if you meet the outlined criteria.

Wed, 08/15/2018 - 16:57 Permalink
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In reply to by Anonymous (not verified)

Hi There,

You may be able to qualify for Social Security disability with Osteoarthritis. I would look over the SSA's Blue Book with your doctor to make sure you meet the listing's requirements.

Wed, 02/05/2020 - 16:25 Permalink
Deborah (not verified)

In reply to by Mary (not verified)

Hi Mary
Did you have office notes? I have all of my test results that indicate I have problems. Did you send in the medical paper work when you first applied?
Thanks Debbie

Tue, 05/19/2020 - 16:29 Permalink
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In reply to by Deborah (not verified)

Hi Debbie,

Many claims are denied due to lack of medical evidence. When you apply you'll need to submit your medical evidence.

Fri, 05/22/2020 - 12:23 Permalink
Mike K (not verified)

I just got denied a second time. I had open heart surgery over a year ago and have had complications from the surgery. My sternum split and did not heal correctly and I have tremendous pain from it. I have degenerative lumber disc disease, 2 of my heart chamber are enlarged, and I picked up an extra 9 heartbeats a minute & to top it all off I have an aortic root aneurysm that is in the moderate range. No shoveling, no lifting over 25lbs, no bearing down to poop or the aneurysm could rupture. If it does I will be dead before I hit the floor. Yet SS says I can work cause I don't have heart failure. What a joke. And yes I have a lawyer working on it.

Thu, 03/14/2019 - 08:28 Permalink
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In reply to by Mike K (not verified)

Hi Mike,

You could try to qualify by having your doctor completing a residual functional capacity (RFC) assessment. These can help those who are unable to work for at least a year but don't meet a Blue Book listing get approved for benefits. Your doctor will need to fill it out to show why you cannot work.

Thu, 03/14/2019 - 16:47 Permalink
krystal A (not verified)

In reply to by Mike K (not verified)

I also have a moderate Aortic Root anuerysm, along with peripheral nueropathy, auto immune microvasculitis and more and more and yet they have denied me 4 times i am going to my first hearing tomorrow. Let me know how yours turns out

Thu, 11/14/2019 - 14:55 Permalink
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In reply to by jose (not verified)

Hi Jose,

Those with Lupus may qualify. Review the Blue Book with your doctor to see you meet the qualifications! Lupus is listed under section 14.02 (ssa.gov/disability/professionals/bluebook/14.00-Immune-Adult.htm#14_02).

Tue, 05/28/2019 - 16:46 Permalink
Lee (not verified)

Had back surgery on l3 l4 and l5 for Stenosis. Doctor said he had to take 50 percent of the bone out the create room. Asked me after surgery about taking disability but I went back to work. He said I’d eventually need a second surgery to put rods in for support. It’s been three years and the pain is starting to come back. I deal with pain every day. Barely making it. Would I have a chance at approval

Thu, 07/11/2019 - 09:38 Permalink
Nancy (not verified)

I have been diagnosed with epilepsy and have not worked for years due to this and other issues. I am on medication for it, but I do have a couple of seizures every month that impare me for a few minutes and make me confused. I'm not sure if I should try to apply for benefits. Should I try?

Sat, 08/10/2019 - 13:07 Permalink
Jasper (not verified)

My girlfriend has severe gastroparesis with a stomach emptying time of 18+ hours instead of the normal 8. She also has severe depression and ptsd. She has never worked due to her condition, which has been present since 6th grade (she is now two years graduated from highschool). Even without having worked, could she be approved the 1st time?

Fri, 09/13/2019 - 17:46 Permalink
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In reply to by Jasper (not verified)

Hi Jasper!

It depends on if she meets the Blue Book listing(s). She should review them with her doctor to make sure she can medically qualify. She'll also have to meet the technical requirements. She likely won't have enough work credits for SSDI. Depending on how much she has in assets, she may qualify for SSI.

Mon, 09/16/2019 - 16:55 Permalink
Mimo Mimov (not verified)

Is there a requirement when the credits are accumulated? I am 55 and I have 36 credits. Can I apply for disability?

Fri, 10/11/2019 - 10:02 Permalink
Hind (not verified)

Hi I have two Korpal tunnel surgery And waiting for neck surgery and loss of hearing sever head aches lower back and knee problem left leg surgery can get ssdi

Sat, 11/16/2019 - 17:02 Permalink
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In reply to by Hind (not verified)

Hi Hind,

You may be able to. I'd recommend you look over the SSA's Blue Book with your doctor to make sure you meet one of the listings. You'll also have to make sure you have enough work credits.

Mon, 11/25/2019 - 17:19 Permalink
Katie Van Noy (not verified)

Im 19 and have had seizures sense i was a baby i had to get brain surgery when i was 8 i got sick after had a stroke and was in acoma my seizures went away for awhile but they came back when i got older and now i have multiple kinds of seizures i havent worked before i went 6 months with no seizures but i they came back so i couldnt drive anymore i havent worked before i have been in the hospital multiple times and have rid in an ambulance more than once i have had to stay in the hospital for more than one day a bunch of times i have been on meds for as long as i can remember i suffer from short term memory loss i have to go to a doctor in a coty cause the doctors here cant figure me out i had to get a different kind of surgery not that long ago it didnt work and a new kind of seizure started i rely on my parents but sense i have never worked i dont know if they will accept me

Sat, 11/30/2019 - 06:09 Permalink
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In reply to by Katie Van Noy (not verified)

Hi Katie,

You may qualify for SSI! It's not based on work credits but rather it's based on income. So if you are currently not working and have under the asset limit, then you may qualify. You'll also have to meet a Blue Book listing. I would go over the Blue Book with your doctor to make sure you meet one of the listings. Best of luck!

Tue, 12/03/2019 - 16:57 Permalink
M c robertson (not verified)

I submitted an ssdi application in August of 2019. Requesting an onset date when I left my job in Sept of 2017. I have arthritis in my knees and lower back. Can't sit or stand more than 20 minutes at a time. and am 57. I sent in all the paperwork sent to me but my application still shows sent to state medical determination. Pending still and it's now april 2020. What does that mean. I can't get my contact person on the phone.

Tue, 04/07/2020 - 14:36 Permalink
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In reply to by M c robertson (not verified)

Hi There,

Unfortunately, the time it takes to hear a decision varies case by case. I would continue to monitor your claim incase they need more information.

Fri, 04/10/2020 - 14:33 Permalink
Julie (not verified)

My son will be 18 soon and has Crohn's. I looked at the blue book and he meets the criteria. He has been home bound from school for the past year due to his health as well. What information do I need when I go to the social security office and how will it affect him since he has never been able to work at all?

Wed, 05/20/2020 - 23:00 Permalink
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In reply to by Julie (not verified)

Hi Julie,

He can apply for SSI, which is for those with a lower income. If he applies when he is over 18, then it will only be his monthly income that the SSA takes into consideration. You'll need to provide documentation of his income as well as medical documentation that he meets the Blue Book listing.

Fri, 05/22/2020 - 11:54 Permalink
Angela (not verified)

I have several mental conditions that are debilitating. I have anxiety disorder, bipolar disorder disability, Panic attacks, ADHD, PTSD And depression. My anxiety has increased along with depression. I tried to start a new job after 22 years Of working in the same field. I had so much anxiety and panic attacks so was only able to make it a little over a week. I don’t know a lot about disability but I recently filed. How are they with mental diagnoses

Fri, 08/28/2020 - 01:08 Permalink
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In reply to by Angela (not verified)

Hi Angela,

You'll have make sure you meet a Blue Book listing for at least one of the conditions you are experiencing. Make sure you add as much supporting information as you can!

Fri, 08/28/2020 - 14:07 Permalink
Kim (not verified)

I was wondering in degenerative disc disease, arthritis, depression, anxiety, CPTSD will qualify me for benefits.

Mon, 08/31/2020 - 17:05 Permalink
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In reply to by Kim (not verified)

Hi Kim!

You may qualify based on one, or more than one, of the. conditions you are experiencing. I would look over the SSA's Blue Book with your doctor to see if you meet at least one of the Blue Book's listings for your conditions. You will also need to be within specific income limits or have enough work credits to qualify.

Fri, 09/04/2020 - 11:29 Permalink

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