Reasons why Social Security disability claims may be denied  

On Behalf of | Mar 15, 2024 | SSDI

Many people rely on Social Security Disability Insurance (SSDI) for financial stability when a medical condition prevents them from working. However, obtaining these benefits can be difficult when the Social Security Administration (SSA) denies a claim. They may do so for one of the reasons we discuss below.

Insufficient medical evidence  

The SSA relies heavily on medical documentation. Therefore, they may deny applications for: 

  • Missing medical records 
  • Incomplete treatment history 
  • Insufficient evidence demonstrating the severity of the disability 

Factors like a massive backlog prevent SSA workers from reaching out to applicants for more information or clarity. Instead, they may just deny the claim and move to the next case.

Failure to follow the treatment plan   

Applicants should participate actively in their prescribed treatment plan. Neglecting recommended care and procedures may raise questions about the legitimacy of the disability. 

Not meeting work requirements  

SSDI is for individuals with a work history who have recently paid into the Social Security system. Exceeding a specific income threshold due to part-time work or not having enough work credits may result in disqualification. 

Submitting multiple applications   

Applicants who submit multiple SSDI applications instead of filing for an appeal may be denied again. Generally, applicants have 60 days after receiving the notice of decision. There are four levels of appeal: reconsideration, hearing by an administrative law judge, review by the Appeals Council and a Federal Court review.

Residual functional capacity (RFC)  

The SSA assesses an applicant’s ability to perform specific work-related tasks. If the evaluation concludes that the individual can perform some form of work, even with limitations, the SSA may not consider the applicant fully disabled for SSDI purposes. 

Misconceptions about SSDI  

Some people might believe that any medical condition qualifies for benefits or that the program is solely for severe disabilities. Understanding the specific criteria and limitations of SSDI is crucial to avoid unrealistic expectations and potential denial. 

The SSDI application process can be complex. However, knowing the potential reasons for denial can help individuals prepare accordingly. Further, legal guidance can be valuable for those applying or filing an appeal after a denial.