Common reasons why SSDI claims are denied

On Behalf of | Nov 8, 2022 | Social Security Disability

American workers may need the protection that Social Security Disability Insurance provides. But this protection is not guaranteed, and it is important to know how SSDI works so they receive benefits if a medical condition or disability prevents them from working.

Rejection rates

Social Security Disability denial rates are high. The reasons for these denials are important to understand as more workers are seeking SSDI assistance for debilitating conditions.

One in four 20-year-olds will ultimately suffer a period of disability. But less than 40% of the 2 million people each year who apply for SSDI will receive it according to Social Security Office of Retirement and Disability Policy data. The Social Security Administration denies approximately 67% of first-time applications.

Only 8% of former workers will receive benefit approval after their first appeal, known as reconsideration. At the hearing level, only two percent of applicants appealing benefits are successful.

Work history

Failure to meet work history requirements is a major reason for claim denial. Workers who pay FICA taxes long enough are usually insured for benefits. But they may be ineligible for benefits because they did not comply with SSDI’s technical requirements.

Workers must meet the SSA’s disability definition by having a physical or mental impairment that prevents them from performing any substantial gainful activity for at least 12 months or leads to death. Qualified workers received $1,350 per month in 2022 or $2,260 for blindness.

Qualified applicants had to work for 5 of the previous 10 years. But this requirement may be different for younger workers. Applicants must be at least 21 and below their retirement age.

Documentation

Detailed medical evidence documenting a disability and its impact on a worker’s ability to perform SGA is critical. This should include diagnosis, medical tests and results, treatment history, prescriptions, surgeries, emergency room and doctor visits and other evidence documenting ongoing medical treatment.

Strong medical evidence and details showing how a disability impacts activities of daily living for mental disorders, neurological conditions, dysfunctions from an injury or disease or other invisible disabilities is essential. Ongoing monthly treatments and drug therapies with specialists can also be important proof.

Medical evidence should show that an applicant meets an SSDI medical listing. These are details that help provide a worker’s disability which are organized around diseases and body systems. SSA complies with complicated vocational guidelines based upon age and educational levels.

Attorneys can help claimants present a better case. Attorneys can also help present evidence supporting their claims.