Why a Disability Claim Gets Denied
Understanding why a disability claim gets denied by the Social Security Administration (SSA) can help you better position your initial claim, in addition to helping you decide whether you should appeal a denial. Some denials are related to application errors or insufficient evidence, while others are reversed in the appeals process or simply do not meet the criteria. The SSA also denies claims that appear fraudulent.
Believe it or not, about two-thirds of all initial claims for disability benefits are denied, even seemingly credible ones. An even higher rate of claims is denied upon the first appeal, or reconsideration (see "Basics of Social Security Disability Appeals" for more information). So don't give up if your initial claim or request for reconsideration are declined.
Each Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) claim is unique, but the following reasons why a disability claim gets denied should help you gain a general understanding.
See our main Social Security Disability index for more articles about the SSA's disability benefits programs.
Your Disability is Based on Drug or Alcohol Abuse
While the SSA does approve benefits for claimants suffering from physical or mental impairments that resulted from past drug or alcohol abuse, such substances may not be a continuing contributing factor to these ailments. In other words, you will be denied benefits if the SSA determines that you would not be considered disabled with the removal of the alcohol or drug abuse in question.
You Earn Too Much Money
SSDI benefits are based on amounts paid into Social Security as part of one's payroll taxes. If your employment income is higher than the substantial gainful activity (SGA) level established by the SSA, you will not be considered disabled to the point where you need assistance.
SSI benefits, on the other hand, are for low-income individuals and are not based on payroll taxes. Your eligibility for benefits (and monthly amount) is established by an income-based formula developed by the SSA.
You Will be Disabled for Less Than One Year
You must be able to prove that your disability will last for at least for one year (or be a terminal condition) in order to be eligible for SSDI or SSI benefits, unless you are blind. The SSA will consider each claim on its own merits.
You Didn't Follow Doctor's Orders
With some exceptions, the SSA will deny your claim if you fail to adhere to the therapy prescribed for your disability.
Examples of medical and non-medical excuses:
- Your mental illness is so severe you were unable to follow directions or remember to take your medication
- You have been unable to obtain the assistance you need to comply with your therapy
- Your doctor did not prescribe an appropriate therapy
- You can't afford the prescribed therapy
The SSA is Unable to Contact You
While this may sound obvious, claims are regularly denied because the SSA is unable to get into contact with a claimant for questions or to schedule exams. If you are homeless, between moves, or otherwise difficult to find, make sure you have some way for the SSA to get a hold of you.
You Didn't Follow Directions
You must release medical records when indicated; answer questions posed by the SSA; attend examinations when asked; and otherwise cooperate with the agency. Otherwise, your claim may be denied.
Your Claim Lacks Sufficient Treatment Records
Treatments for physical disabilities tend to be more clearly defined and documented, but often this is lacking (or insufficient) for mental ailments. For example, sometimes a general practitioner prescribes antidepressants but the patient does not see a psychiatrist for a follow-up. Sometimes this is true for claimants who are unemployed and can't afford to see a doctor.
Your Disability is Linked to a Criminal Conviction
Your claim will be denied under the following circumstances:
- You are imprisoned after a felony conviction (unless you are enrolled in a court-approved vocational rehabilitation program)
- You have a disabling injury that was sustained or worsened while in prison (but you often may collect benefits upon your release)
- You sustained a disabling injury while committing a felony and were convicted (you may not collect benefits in the future on the basis of such an injury)
Still Confused Why Your Claim was Denied? Get Professional Legal Help
If none of the above explanations for a Social Security claim denial match your situation, you may have a valid reason to appeal. This process can be complicated, but the stakes are high for those who need the coverage. Get in touch with a Social Security Disability Insurance attorney near you today.
Contact a qualified social security lawyer to assist in your social security disability matter.