If you are applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) payments, you may be wondering what are common reasons for denial of an SSDI or SSI claim.
What Is SSDI?
SSDI is a program administered by the Social Security Administration (SSA). It pays disability benefits to those who cannot work due to a medical condition that is expected to last at least one year or result in death. SSDI does not give money to people with a partial disability or short-term disability.
To apply successfully for SSDI, a person must meet the SSA’s disability criteria. SSA defines disability as a condition that significantly limits a person’s ability to do basic work-related activities for at least 12 months.
In addition, the applicant (or their spouse or parent) must have worked a certain amount of time within a recent timeframe and in a job where they paid into the Social Security system.
If approved, an applicant’s monthly SSDI payment amount will be based on their lifetime average earnings covered by Social Security. The SSDI payment may be reduced if the applicant receives workers’ compensation payments or other public disability benefits, such as state and civil service disability benefits. Under some circumstances, your children may also receive a monthly benefit.
What Is SSI?
SSI is a program administered by the Social Security Administration (SSA). It pays disability benefits to those who cannot work due to a medical condition that is expected to last at least one year or result in death. SSDI does not give money to people with a partial disability or short-term disability. It is meant primarily for individuals who do not have a work record to claim SSDI on.
To apply successfully for SSI, a person must meet the SSA’s disability criteria. SSA defines disability as a condition that significantly limits a person’s ability to do basic work-related activities for at least 12 months. In addition, the individual needs to meet strict asset (less than $2,000) and income limitations.
Common Reasons for Denial
Although millions of people apply for SSDI yearly, only a small percentage get approved. For example, in 2022, approximately 3 million people applied, but SSA only made 543,445 SSDI awards.
So, why do such a large percentage of claims get denied? Here are five common reasons.
1. Insufficient Medical Evidence
A common reason SSDI or SSI claims are denied is that the SSA disagrees that an applicant meets its disability criteria. This is usually because the application lacks adequate medical evidence supporting the person’s claim they are disabled and unable to work.
Medical records need to document not only the existence of a disability, but also that this condition has interfered with a person’s ability to work. Medical records that do not have a clear diagnosis, are sparse, or do not have any doctor’s notes on how a specific condition has limited your work abilities will not support an SSDI or SSI claim.
For example, if you have not been seeking medical attention for your condition or have inconsistent or insufficient medical information in your records, you may face a denial of your claim. It is essential to try to seek medical care as soon as possible and discuss with your physician how your disability is affecting your work life.
You may also be able to supplement your medical file and SSDI or SSI application with any doctor’s notes that excused you from work activities or asked your employer to limit your activities, or any records of the time you had to take off from work. So, do not throw these records away.
2. Multiple Applications and Failure to Pursue the Appeal Process
Another common issue is when a person submits another application instead of appealing a denial. If the SSA reviewer sees you were previously denied benefits based on a similar application, you may find yourself being denied once again.
SSDI and SSI applications are frequently denied because they don’t have enough information to enable the SSA to award you SSDI or SSI benefits. It is better to appeal a denial first before submitting a new application. An appeal comprises multiple levels, so you can correct or supplement your application through this process.
The first level, called reconsideration, is where you ask the SSA to take another look at your request. It is not uncommon for an applicant to be denied again at this stage. The next step, where you appeal before an administrative law judge, is where you may have more success. You can testify about your disability and how it affects your life and ability to work.
Beyond this, there are two further stages of appeal – requesting a review from the SSA’s Appeals Council and filing an action with the federal district court. None of these stages should be undertaken alone. You should seek the counsel of your attorney with any appeal.
3. You Earn Too Much
If you are working and making more than a certain threshold that qualifies as “substantial gainful activity” (SGA), your claim for SSDI or SSI may be denied. The SSA typically will not approve an SSDI or SSI benefits award if your earnings are more than $1,470 monthly (in 2023).
4. Your Condition Is Not a Qualifying Medical Condition
Even if your condition is severe and limits your ability to work, the SSA may still find that you can do other work and engage in SGA.
The SSA maintains a list of medical conditions that are serious enough that a person cannot engage in SGA. However, an applicant’s medical issue may not neatly fit into one of these impairment categories. In that case, the SSA has to decide if the person’s condition is comparable to one of the conditions on the list.
Often, the person evaluating your request will determine your condition is not comparable and that you can engage in other types of work that can lead to SGA. If they come to this conclusion, your claim will likely be denied.
If you disagree with the SSA’s determination that your medical condition is not a qualifying one, you may need to take up an appeal. You should speak with your attorney as early in the process as possible, or you may be unnecessarily prejudiced.
5. Your Employment History Is Not Long or Recent Enough to Qualify for SSDI (SSDI only)
In addition to qualifying as disabled per SSA guidelines, an applicant must have worked long enough and recently enough to be eligible for SSDI benefits. An applicant needs a certain amount of “work credits,” earned from reported yearly wages or self-employment income (on which they paid taxes). Work credits are earned for each quarter of the year a person works as long as they make a certain amount of income. The dollar amount of earnings that qualify for one work credit varies from year to year.
In addition, the amount of work credits a person needs to qualify for SSDI depends on the age they became disabled. The general rule of thumb is that a person needs 40 credits, and 20 of these must have been earned in the last 10 years. However, younger applicants may need fewer work credits.
If a person does not have enough work credits, their SSDI claim can be denied, even if they qualify as disabled.
Applying for SSDI is a challenging task. The process can be long and arduous, with the average time for an initial decision being seven months. SSI applications are sometimes administered faster.
Investing in working with an attorney can significantly improve the outcome of your case. Federal law allows applicants to access attorneys without paying attorney’s fees upfront. Under this law, an attorney who helps you file for SSDI benefits can be paid up to 25 percent of the disability back pay award (capped at $7,200, effective November 30, 2022) in exchange for their legal services. If your claim is not approved, you have no financial responsibility for the attorney’s fees.