Table of Contents
- Signs That You Will Be Denied For Disability
- Work History
- What To Do If You’ve Been Denied Disability And Can’t Work
- How Many Times Can You Get Denied For Disability?
- How Long Does It Take To Get Disability?
- Approval Rates For Disability Denials
- Improving Your Possibility Of Success
- Sources and Additional Resources
Millions of people apply for Social Security disability benefits each year. Approximately only 30% of the initial Social Security disability applications received by the Social Security Administration (SSA) each year are approved. This begs the question: Why are so many Social Security disability claims denied?
Here, we outline the biggest potential signs and reasons for disability denials.
Social Security disability benefits can be denied for a variety of different reasons, but there are five main consistent reasons for disability denials. If you are applying for Social Security disability benefits, it is important that you understand these reasons so you may have a better chance of getting your claim approved by the SSA instead of denied.
Signs That You Will Be Denied For Disability:
#1: Lack of Hard Medical Evidence
The Social Security Administration (SSA) denies many Social Security disability claims because of a lack of solid medical evidence. To get disability benefits, you must show that you can't work because of your disabling condition. More specifically, you need medical records showing your disability has affected your ability to work.
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. And, if you were working prior to filing for disability and had to miss time from work due to the disability, keep a record of just how much time was lost.
For example, you may be seeing your doctor every month for severe back pain. However, if your doctor has not documented how your back pain impacts or interferes with your ability to work during those monthly visits, your Social Security disability claim may be denied. This is because conditions that qualify for disability in the eyes of the SSA must be severe and backed up by "objective medical evidence." According to the SSA, a severe condition is one that impacts a person's "ability to perform basic work-related activities" for at least 12 months.
Some examples of basic work-related activities include:
You may be wondering why there is such an emphasis on medical evidence throughout the disability application process. The answer is rooted in the fact that medical evidence is the cornerstone of the SSA's disability determination process. Every person who applies for disability is responsible for providing substantial medical evidence—highlighting (1) that they have a medically determinable impairment, and (2) the severity of said impairment(s)—so that the SSA is able to establish that they actually qualify for disability benefits.
In order for you to prove the existence of your medically determinable impairment, the SSA needs "objective medical evidence" from an "acceptable medical source."
Further Reading: "What is an ‘Acceptable Medical Source’?"
In terms of proving the severity of your impairment, the SSA will look at all of the evidence you've provided from both medical and non-medical sources in order to establish the extent to which the impairment impacts your ability to work. Some examples of acceptable non-medical sources include:
- the claimant
- family members
- public and private social welfare agency personnel
- educational personnel
Ultimately, by including such information and evidence in your claim, you will be presenting your best possible case to the SSA that highlights your need for disability benefits. In doing so, you can give yourself a higher likelihood of not getting denied for this reason.
#2: Prior Denials
Many people think that filing a new disability claim is a better alternative than and/or is what you should do instead of appealing their denied claim. 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 you were denied these benefits before.
Because of this, it is critically important that you go through the appeals process rather than altogether filing a new claim for Social Security Disability if your initial claim is denied.
#3: Your Income
Qualifying for disability benefits encompasses more than just disabling medical conditions. While having a disabling medical condition is a critical component, so is your income. This is because Social Security disability benefits are reserved for people who are unable to earn enough money to support themselves. In other words, the Social Security Administration (SSA) will only approve Social Security disability claims for people who are unable to work due to their disability.
To evaluate disability applicants' financial needs, the SSA uses something called Substantial Gainful Activity (SGA) which is measured in terms of dollar value. More specifically, you likely will not qualify for SSI or SSDI benefits if you earn more money than the SGA value for a given year. In 2023, the SGA earnings limit is $1,470 for non-blind individuals and $2,460 for blind individuals.
So, if you're earning SGA through employment at the time of your disability benefits application, it is probable that your application will be denied. This is likely because the SSA will take a look at your earnings and presume that you are not disabled because you can support yourself financially.
It's important to note that when determining SGA, the SSA does not take into account income generated from investments, interest, or other sources unrelated to employment.
#4: Failure to Follow Treatment
If you fail to follow the treatment prescribed to you by your doctor, or there are gaps in your medical care, the Social Security Administration (SSA) will likely deny your disability claim. The reason for this is that the SSA examiner would likely argue that they're not able to accurately determine whether or not your condition actually prevents you from being able to work if you are (1) unwilling to cooperate with treatment, and/or (2) not receiving the necessary treatment.
However, if you have a 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, probably want a Social Security disability attorney or disability advocate helping you in this case to give yourself the best chance of success.
#5: Failure to Cooperate
It's important to work and cooperate with the people handling your Social Security Disability claim, regardless of how you feel about them.
It is also critically important that you stay in touch with the person handling your disability case and give them any requested documents promptly. This is because, if you fail to provide the SSA with the additional documentation they requested or fail to show up to your scheduled medical exams, your claim will likely be denied.
In order to apply for Social Security Disability Insurance (SSDI), you need to have paid Social Security taxes and you must have earned a sufficient amount of work credits. In other words, you must have a work history. In general, SSDI applicants need 40 work credits to qualify—20 of which were earned within the last 10 years ending with the year when your disability began. However, younger SSDI applicants may qualify with fewer work credits.
Work credits are determined by your annual earnings. During any given year of employment, you can earn 1 work credit for every $1,640 that you make while working—up to 4 work credits per year.
Younger applicants may qualify for SSDI with fewer than 40 work credits because they might not have worked long enough to earn 40 credits. Regardless of a disability claimant's age, they must be unable to work to receive SSDI. So, if you are capable of working in your current position (either with employer-provided accommodations or in a modified capacity), then you will likely not be considered eligible for SSDI benefits.
Further Reading: "Number of Work Credits Required by Age of SSDI Applicant" Chart.
What To Do If You’ve Been Denied Disability And Can’t Work
If you have been denied disability and can’t work, don't panic. You might still be able to get disability benefits.
If you received a disability denial from the SSA, and still see yourself as needing those benefits, your first step will be to file an appeal (i.e., submitting a Request for Reconsideration). However, before you file your appeal, it is very important for you to read your denial letter carefully as its contents will explain why your initial claim was denied.
Understanding why your claim was denied is crucial because it will enable you to know exactly what aspect(s) of your claim need fixing. Additionally, your denial letter will likely highlight how and where you can provide additional supporting evidence and documentation in your appealed claim. Last, but certainly not least, your denial letter will specify your claim's specific deadline for filing an appeal with the SSA. It is critically important that you adhere to this deadline as failure to do so will usually result in you having to start the disability application process over from scratch.
How Many Times Can You Get Denied For Disability?
You might've been told that there are limits to how many times you can apply for Social Security Disability benefits. However, that's not entirely true. If you are unfairly or wrongfully denied benefits, you can file a claim or appeal your denial multiple times. In other words, there is no limit to how many times you can file a claim for disability benefits or appeal your initial denial.
If I've Been Denied Disability, Should I Re-Apply or Appeal? The answer to this question depends on a variety of factors. For many applicants who've had their disability claims denied, an appeal is probably the best course of action.
An appeal prevents you from having to start the claims process all over again from scratch.
This means you won't have to wait as long to be approved for benefits. By appealing your denial instead of applying again, you can reduce the risk of being denied again. This is because your appeal will include all the information from your initial application which will eliminate room for error—in terms of information discrepancies—on the SSA's side. More specifically, when people re-apply for disability with a brand new application instead of appealing, sometimes the SSA assessor reviewing the new application will reject it if they see that the claimant previously sought disability benefits and received a denial due to an erroneous discrepancy.
Finally, by appealing a denial instead of re-applying, you will be able to keep your protective filing date. Your protective filing date is the date when you first told the SSA that you wanted to file a disability claim. If your appeal succeeds, the SSA will calculate your back pay based on your protective filing date. So, by appealing your denial and maintaining your protective filing date, you could be entitled to more back pay.
How Long Does It Take To Get Disability?
You may have to wait several months or even years to receive your benefits.
Usually, it takes approximately 4-6 months for the SSA to process an SSDI or SSI application. However, if your claim is denied, it can take (on average) an extra 6 to 8 months longer to get a hearing for the appeals process. So, even if you ultimately win your appeal, two years could have passed since you first submitted your application.
Approval Rates For Disability Denials
Upon initial evaluation, Social Security disability applications face an overwhelming 70% denial rate according to the SSA. Various factors determine that percentage. These factors include applying for a condition that does not meet the criteria or not having proper medical documentation.
Fortunately, the SSA offers a comprehensive set of disability benefit appeals guidelines that have a great success rate.
Check your medical records to make sure you've given the SSA all the information they need to decide.
When you appeal a decision, the understanding at that point is that you truly believe you qualify for disability benefits. As such, it is important that you check the medical records and evidence you've submitted to make sure you've given the SSA all the information they need to make a decision regarding your eligibility. This is important because, in some cases, new information may have presented itself since you initially filed your claim, and this new information can help to make your claim even stronger. Remember, the more medical evidence you submit, the higher your chances of getting approved for disability.
The reality, though, is that your initial request for reconsideration still 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 Law Judge about your condition. For these hearings, 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. If you're interested in speaking with a Social Security disability attorney who can help you today (all at zero cost to you), complete the Free Case Evaluation on this page.
Improving Your 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 obtaining disability benefits.
In doing so, you can establish a game plan for how you can avoid repeats of the same mistakes (made in your initial application) in your appeal(s).
In addition to understanding the reasons for disability denials, it is equally important to know how to strengthen your claim to improve your possibility of success. As such, we’ve outlined some steps below to help you.
How to Use the Disability Blue Book to Your Advantage
The SSA evaluates every disability claim by using its own medical guide called the "Blue Book" to assess disability claims. The Blue Book features 14 different categories of conditions that qualify for disability. The purpose of the Blue Book is to allow both the SSA and disability applicants to quickly find a condition and see if it qualifies for disability benefits.
Using the Blue Book can help get your disability claim approved. Whether you're in the initial disability application process or you're in the midst of the request for reconsideration phase, the Blue Book can help you determine what medical documentation and evidence you will need to help make your case as strong as possible.
You should search for your condition in the Blue Book to determine the information that's required by the SSA for your claim. Provide strong medical evidence—and lots of it—in your application to support your case and increase your chances of getting approved.
Sometimes, your condition may not be severe enough to get disability benefits. In such cases, the SSA may ask you to fill out an RFC form. The RFC (Residual Functional Capacity) determines how much work you are capable of performing given the limitations of your condition.
Your doctor completes the RFC form using your medical history to provide accurate information.
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 on examination and observation.
You should make sure that you inform your doctor of your intent to apply for disability benefits as soon as possible. This is because, given the fact that your doctor diagnosed you and prescribes you treatment, the SSA may reach out to them if they have questions about your condition or your ability to work. Thus, it's important that your doctor is prepared for and expecting such inquiries.
Additionally, given the 60-day appeal period for disability, it is important that you ensure your doctor is aware that they need to complete the RFC form for you as quickly as possible if your claim has already been denied.
Further Reading: “SSA’s Blue Book in 2023”
Working With A Disability Lawyer
From keeping track of deadlines to gathering the proper evidence to making sure that your application is complete, the entire process of applying for Social Security disability benefits is oftentimes overwhelming.
A disability lawyer can help guide you through the application and appeals process so that you can be assured that you are doing everything the right way along the way.
What Are The Benefits of Working With a Disability Lawyer? Working with a disability lawyer or advocate has several benefits. Though there is no guarantee that hiring a disability attorney will result in you winning your case, it can greatly improve your chances of success. In fact, according to data released by the SSA, disability claimants who worked with lawyers had overall higher success rates (i.e. ended up getting approved for disability benefits) compared to those who didn't.
This is likely because of a number of reasons. For instance, disability lawyers can:
- Have a better understanding of what information should be included in initial applications, as well as what should be added to strengthen disability appeals.
- Keep track of the various deadlines to make sure that their clients are on the right track.
- Ease your angst and allow you to focus more on yourself (and your health) by taking on more of the work to complete your disability application and/or appeal.
- Be brought in for assistance at any point during the disability application or appeals process.
- A disability lawyer will be able to tell you how much disability you can get.
- Not be paid unless they actually win your disability claim.
How Do Disability Lawyers Get Paid? Most disability benefits attorneys work on what is called a contingency fee basis. This means that you don't have to pay anything unless they win your case. Furthermore, disability lawyers are oftentimes paid directly by the SSA via your back pay.
In disability benefits, "back pay" is a term used to refer to the lump sum of money you receive with your first disability check from the SSA. Back pay is calculated by the SSA. Specifically, the SSA will calculate your back pay by taking the months between your initial disability benefits application date and your eventual approval date and multiplying that by the monthly disability benefit payment you've been awarded. For example, if you've been awarded a disability payment of $995 every month, and it took the SSA nine months to ultimately approve your application, you would be entitled to $8,955 in disability back pay.
When a disability lawyer gets paid via their client's back pay, it is typically done directly through the SSA—meaning the SSA will withhold a claimant's back pay until they pay the claimant's lawyer directly from that lump sum of money. Lawyers can either be paid 25% of the back pay or $6,000—whichever is less. So, in keeping with the example used above, your lawyer would either get 25% of $8,955 (the total back pay value) or $6,000—whichever value is less.
To find out an exact estimate of how much money you could receive from disability benefits, use our Social Security benefits calculator.
Ultimately, the road to securing Social Security Disability benefits can be a challenging one, with only about 30% of initial applications receiving approval. Thus, understanding the key reasons for disability denial is crucial for those seeking assistance because knowing what not to do can allow them to avoid common mistakes. Perhaps equally as important is understanding how and where disability claimants can find help throughout their journey to give themselves the best chances of getting approved.
Let's summarize the key points we discussed in this article:
- Lack of hard medical evidence stands out as a primary factor for disability denials, emphasizing the importance of thorough documentation and communication with healthcare providers.
- Previous denials and income levels are additional significant considerations when it comes to disability denials, while compliance with prescribed treatments and cooperation throughout the application process are essential to disability approvals.
- Patience is also key, as the disability application process can be lengthy, involving appeals and hearings.
- Engaging a disability lawyer can significantly improve your chances of success, and their payment is typically contingent on winning the case which can be a game changer.
- By being informed and proactive, you can increase your likelihood of falling within the fortunate 30% who receive the crucial disability benefits they need after their initial application.
Complete our Free Case Evaluation form on this page to get connected and speak with a disability lawyer who can help you today—all at zero cost to you.
Acceptable Medical Sources – U.S. Social Security Administration (SSA)
Disability Evaluation Under Social Security – U.S. Social Security Administration (SSA)
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