Every year, millions of people apply for Social Security Disability benefits. Unfortunately, 70 percent of initial claims are denied.
There are many reasons your claim may be denied, and it’s important to know why yours was before you appeal. That way, you know the concerns you need to address to make sure your appeal is successful.
Some of most common reasons disability claims are denied by the Social Security Administration (SSA) include:
1. You do not meet the basic non-medical requirements.
Known as a technical denial, the SSA won’t even look at your medical records if you don’t meet their eligibility requirements. For Social Security Disability Insurance (SSDI), you will receive a technical denial if you earn more than the substantial gainful activity limit of $1,090 per month or have insufficient work credits. For Supplemental Security Income (SSI), you cannot exceed the SSA’s income or asset limits.
“Some non-medical reasons people are denied benefits more apply to SSI. Because it is a welfare program, it has asset limits; you can’t have more than $2,000 in the bank as an individual or $3,000 as a couple. You can own a house and a car, but you can’t own a boat or two houses,” said Jonathan Riedel, a former employee of Social Security’s Office of Disability Adjudication and Review and a legal services coordinator at The Family Center, a nonprofit in Brooklyn, New York. “I have no statistics to back this up, but I would say the most common non-medical reasons people are denied [for SSDI benefits] have to do with failure to comply. They miss an appointment at SSA, they don’t provide the correct information about their income, they fail to report all the doctors they went to, they miss a consultative exam, they didn’t get the extra medical records that would have provided more support for their medical case, etc.”
2. Your medical condition will not last long enough (or isn’t severe enough).
Your medical condition must prevent you from working for one year or more, or result in death. If your medical condition is expected to significantly improve in less than a year or the SSA doesn’t consider it severe enough to keep you from working, you will be denied.
“You can be denied even when SSA acknowledges your medical conditions, usually because your medical conditions don’t preclude ALL work activity – only SOME work activity. So they deny you, because the definition of disability under SSA requires you to be unable to perform ANY ‘substantial gainful’ work activity,” said Riedel. “The reason it has these stringent criteria is because federal disability is supposed to be the final safety net in your fall down through the nets. Disabled people are not always permanently disabled, and the government (as well as your friends and family!) hopes and expects you to recover from illness and return to the workforce if you are not too young or too old. The government also wants to encourage people with disabilities not to just give up, which is a philosophy I think we can all get behind. Getting on Social Security disability is SUPPOSED to be challenging; it’s supposed to be the last recourse for a person who just can’t work, no matter what the conditions.”
3. You won’t follow your doctor’s prescribed treatment.
While there are definitely exceptions to this rule, generally the SSA will see failure to follow treatment as being unwilling to help yourself and your condition, resulting in a denied claim.
“SSA concerns itself only slightly with this matter. It’s important to realize that the government does not want to assign blame to people who become disabled, unless they are being purposefully duplicitous and fraudulent. For example, everybody’s doctors tell them to limit their intake of fried foods and sweets, yet millions of people, disabled and non-disabled, are keeping Dairy Queen in business,” said Riedel. “That said, behavior does factor a little bit into judges’ and claims reps’ decision. If the person is not TRYING to get better to regain entry into the workforce, whether or not they follow every piece of every doctor’s advice to a T, it would be hard for a thinking adjudicator to justify granting benefits.”
4. You won’t cooperate with the Social Security Administration.
If you refuse to give the SSA permission to gather your medical files, or you don’t show up for consultative exams, you will be denied for benefits.
“Consultative exams are usually ordered because there is not enough medical evidence in the file to support a finding of disability. With at least one doctor telling SSA that there is a huge problem, that’s something to go on,” said Riedel. “The SSA can’t just accept your complaints about pain without an evaluation from a doctor.”
5. The Social Security Administration cannot get in contact with you.
If you move or change your phone number, you must update the SSA with your new contact information. If they cannot get a hold of you to discuss your claim, you will more than likely be denied.
6. Your disability is primarily due to drug or alcohol abuse.
You cannot receive benefits because an alcohol or drug addiction prevents you from working. Additionally, if your disabling condition is the result of drugs or alcohol, and would improve if you completely quit, you will be denied benefits. That’s not to say you can’t receive benefits for conditions caused by drugs or alcohol; it just can’t be the main contributing factor to your illness.
“Drug and alcohol dependence IS a factor in your eligibility for disability, but [it] has a complicated relationship with the process,” said Riedel. “Let me give an example: I’m an alcoholic and I stop showing up to work because I’m drinking all the time. I’m not able to complete tasks appropriately, the customers complain, etc. I have no other medical problems– I am otherwise healthy except for the alcoholism. If i were to stop drinking TODAY and go into a rehab program, I would be completely fine and able to work. In this scenario, I would not be eligible for disability, even while I was in the throes of alcoholism and truly not able to hold a job. However, if I drank myself into having cirrhosis, a seizure disorder, and a mental disorder from all the lost brain cells such that I am no longer able to communicate effectively, then [the dependence] does not count towards the medical determination of disability.”
7. There’s not enough medical evidence.
Sometimes the SSA will deny disability benefits because there is not enough medical evidence to prove it will hinder your ability to work. If this is why your claim is denied, you should work closely with your doctor to document your limitations and appeal the decision.
“The more evidence can show a clear progression of an illness, or a clear start date of disability, the better. The more comprehensive the records, the better. Your own testimony is less valid than a doctor’s or hospital’s, so handwritten letters explaining your pain only count for so much. They look at MDs, NPs, PhDs, Ed.Ds and whoever else has been treating you for your conditions,” said Riedel. “Adjudicators are also looking for patterns in your treatment. You’ve tried EVERYTHING you can think of and nothing works to get rid of your pain. The medications you take have been changed in type and dosage amount, and nothing abates the schizophrenia. You have been working with your conditions for years, but the conditions have gotten progressively worse.”
8. You’ve been convicted of a crime.
You cannot earn disability benefits if you are currently incarcerated. That’s not to say you can’t get approved and start earning them once you are released; you just can’t receive them while in prison. Additionally, if your condition is the result of (or was made worse by) committing a felony, you will not be eligible for benefits. If you are on parole or probation, you are not entitled to benefits for any month you violate the terms of your release.
9. You’re committing fraud.
It probably goes without saying, but if you are trying to defraud the government for Social Security Disability benefits, you will be denied (or if you were already receiving benefits, they will be terminated), and you will be prosecuted to the full extent of the law. The government takes Social Security fraud very seriously; don’t do it.
Being denied for Social Security benefits can be frustrating, but hopefully knowing why you were denied will give you an idea of what you need to do to successfully appeal. Curious on how to appeal a denial? You might find our “How to Request a Social Security Reconsideration” article helpful.