Denial Rate for Disability Claims

The denial rate for disability claims is notably high. According to the Social Security Administration, approximately 70% of initial disability claims are denied. This means that for every 10 people who apply for disability benefits, 7 will not be approved at the first attempt.

However, it’s important to note that a denial does not mean the end of the road. You have the right to appeal the decision, and many individuals eventually succeed in obtaining benefits after going through the appeals process.

Reasons for Disability Claim Denials

There are several reasons why so many disability claims are denied. Some of the most common reasons include:

• Insufficient Medical Evidence
  One of the most frequent causes of a claim denial is the lack of sufficient medical evidence to prove that the applicant’s disability is severe enough to prevent them from working. The SSA requires thorough documentation, including doctor’s notes, medical test results, and other supporting records. Without strong medical evidence, your claim is likely to be denied.

• Not Meeting the SSA’s Definition of Disability
  The SSA has a strict definition of disability, which means your condition must be severe enough to prevent you from doing any substantial gainful activity (SGA) for at least 12 months or result in death. Some applicants may not fully meet these criteria, resulting in a denial.

• Income or Work Activity
  To qualify for disability benefits, your income must fall below a certain threshold, and you cannot be engaged in substantial work activity. If you are working or earning above the Substantial Gainful Activity (SGA) limit, the SSA may determine that you are not disabled.

• Failure to Follow Treatment
  The SSA requires you to follow prescribed treatments from your doctors. If you fail to comply with treatment recommendations without a valid reason, your disability claim can be denied. The SSA may interpret non-compliance as a sign that your condition is not as severe as claimed.

• Inaccurate or Incomplete Application
  Even small errors or missing information in your disability application can cause delays or denials. It’s crucial to be thorough and accurate when filling out the application and to submit all required documents.

What Happens After a Denial?

If your initial disability claim is denied, don’t be discouraged. Many applicants are approved after going through the appeals process, which typically includes the following stages:

• Request for Reconsideration: The first step is to ask for your claim to be reviewed again by a different SSA representative.
• Hearing Before an Administrative Law Judge (ALJ): If reconsideration is denied, you can request a hearing before an ALJ. This is often where the real chance of success occurs, as you can present your case in person and submit additional evidence.
• Appeals Council: If you lose at the ALJ hearing, you can request a review from the Appeals Council.
• Federal Court: If all previous appeals fail, you can take your case to federal court.