Why Can Your Disability Claim Be Denied?

There are several reasons why your disability claim may be denied. Some of the most common reasons include:

• Failure to Meet the SSA’s Definition of Disability: The SSA requires that your disability is severe enough to prevent you from performing substantial work and is expected to last at least 12 months or result in death. If the SSA determines that your condition doesn’t meet this threshold, your claim may be denied.
• Insufficient Medical Evidence: To qualify for disability benefits, you need to provide detailed medical documentation that proves your disability. If your medical records are incomplete or insufficient to demonstrate that you cannot work, the SSA may deny your claim.
• Not Following Treatment Recommendations: The SSA expects applicants to follow prescribed treatments, such as taking medications or attending therapy sessions. If you fail to comply with medical advice without a valid reason, it may be used as a reason to deny your claim.
• Earning Too Much Income (SSDI Only): If you are earning above the SSA’s threshold for substantial gainful activity (SGA), which is typically around $1,470 per month (as of 2025), you may be considered ineligible for SSDI benefits.
• Lack of Work History (SSDI Only): For SSDI, you must have a certain number of work credits from paying into the Social Security system. If you don’t have enough credits, you may not qualify for benefits.
• Failure to Meet Income and Resource Limits (SSI Only): For SSI, you must have limited income and resources. If you exceed the financial limits set by the SSA, your SSI claim could be denied.

What Happens if You Are Denied Disability Benefits?

If you are denied disability benefits, it can be discouraging, but it’s not the end of your claim. The SSA allows you to appeal a denied disability claim. Here’s what you can do:

• Request Reconsideration: The first step in the appeals process is requesting reconsideration, where the SSA reviews your case again. You’ll be able to submit additional evidence if necessary to strengthen your claim.
• Request a Hearing: If your reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ). This is a critical step in the process where you have the opportunity to present your case in person. Many claims are won at the hearing stage.
• Appeal to the Appeals Council: If you lose the hearing, you can appeal to the Appeals Council. They will review the case to determine if the judge made an error in their decision.
• File a Federal Court Lawsuit: If you lose your appeal, you can file a lawsuit in federal court. This is typically the last step, and many people don’t reach this stage.

How to Improve Your Chances of Winning Your Disability Claim

To avoid a denial and increase your chances of approval, here are some tips to follow when applying for disability benefits:

• Provide Detailed Medical Documentation: Make sure your medical records clearly show how your condition impacts your ability to work and function in daily life. Include all relevant medical reports, test results, and doctor’s opinions.
• Follow Your Doctor’s Advice: It’s important to follow the treatment plans prescribed by your doctor. Failing to do so may lead the SSA to believe that your condition isn’t as severe as you claim.
• Keep a Record of Your Condition: Keep a personal record of how your disability affects your life. This can help you explain your limitations during the application process or in a hearing.
• Consult a Disability Lawyer: Working with a disability lawyer can increase your chances of approval. A lawyer can help you navigate the complex disability application process, gather medical evidence, and represent you in hearings or appeals.

Can You Be Denied Disability for Mental Health Conditions?

Yes, it’s possible to be denied disability benefits for mental health conditions. Mental disorders such as depression, anxiety, bipolar disorder, and schizophrenia may qualify you for benefits if they are severe enough to prevent you from working. However, the SSA has strict criteria for evaluating mental health conditions, and many claims are initially denied due to insufficient medical evidence or the inability to meet the SSA’s mental health listing.

What Can a Disability Lawyer Do to Help You After a Denial?

If you’re denied disability benefits, hiring an experienced disability lawyer can help you:

• Review Your Denial: A lawyer can analyze the SSA’s reasons for denying your claim and identify any areas where additional evidence or clarification might be needed.
• File Appeals: A lawyer can assist you in filing a reconsideration request, preparing for a hearing, and ensuring that all deadlines are met throughout the process.
• Represent You at Hearings: If your case goes to a hearing, a lawyer can present your case in front of an Administrative Law Judge (ALJ), cross-examine witnesses, and argue on your behalf.
• Increase Your Chances of Approval: Having a lawyer on your side significantly improves your chances of winning your case, as they are familiar with the SSA’s rules and regulations and can ensure that your claim is as strong as possible.