Reasons Why Social Security Disability is Denied

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

• Failure to Meet Eligibility Requirements: You must meet the SSA’s strict work history and medical criteria. For SSDI, this includes having enough work credits. For SSI, it’s based on limited income and resources.
• Insufficient Medical Evidence: One of the most common reasons for denial is a lack of sufficient medical evidence proving that your disability meets the SSA’s criteria. You need to show that your condition significantly limits your ability to work.
• Failure to Follow Treatment: If the SSA sees that you haven’t been following your doctor’s prescribed treatment plan, they may assume your condition isn’t severe enough to qualify for disability benefits.
• Earning Above Substantial Gainful Activity (SGA) Limits: If you are working and earning above a certain amount, the SSA may determine that you are not disabled, as you are able to engage in substantial gainful activity.
• Your Condition Doesn’t Meet the SSA’s Listing of Impairments: The SSA has a list of impairments that automatically qualify for benefits. If your condition does not meet the criteria, your claim may be denied, although you may still be approved by showing that your condition is equal in severity to a listed impairment.

What to Do When Social Security Disability is Denied

If your Social Security Disability claim is denied, don’t lose hope. Many applicants are denied initially but ultimately win their benefits after going through the appeals process. Here’s what you can do:

Understand the Denial Reason

Carefully review the denial letter from the SSA to understand why your claim was denied. Knowing the specific reason will help you address the issue when filing an appeal. The denial letter will provide information about:

• The reasons for denial
• What medical evidence or other documentation was missing
• The next steps in the appeal process

File a Request for Reconsideration

The first step after a denial is to request reconsideration. This means that the SSA will review your case again, including any additional evidence you submit. You can file for reconsideration online, by phone, or at your local SSA office.

• Deadline: You typically have 60 days from the date of the denial letter to file for reconsideration.
• Provide Additional Evidence: If new medical records or other evidence are available, submit them with your reconsideration request to strengthen your case.

Request a Hearing Before an Administrative Law Judge (ALJ)

If your reconsideration request is denied, the next step is to request a hearing with an Administrative Law Judge (ALJ). This hearing gives you the opportunity to present your case in person, and it’s a critical stage in the appeals process.

• ALJ Hearings: These hearings typically take place in a local office, and you will have the opportunity to provide testimony and present medical evidence to support your case.
• Legal Representation: You have the right to be represented by an attorney during the hearing, and many people find it beneficial to have legal help at this stage.

Consider a Federal Court Appeal

If the ALJ denies your claim, you can appeal the decision to the Federal Court. This is the final step in the appeals process, and it’s typically reserved for situations where you believe that the law was not applied correctly during the hearing.

• Consider Legal Representation: At this stage, having an attorney can be critical to ensuring that your case is presented effectively in court.

Gather Additional Evidence

At each step of the appeals process, providing more medical evidence and other supporting documents is key to strengthening your case. The SSA will rely on your medical records, statements from your doctors, and other evidence to evaluate the severity of your condition and its impact on your ability to work.

• Updated Medical Records: Be sure to submit any new medical records or treatment documentation that show your condition has worsened or is preventing you from working.
• Statements from Doctors or Specialists: Letters from treating physicians or specialists outlining the limitations caused by your disability can be crucial in proving the severity of your condition.

Work with a Disability Lawyer

If your Social Security Disability claim is denied, consulting with a disability lawyer can greatly improve your chances of success during the appeal process. Lawyers who specialize in Social Security Disability are experienced in handling the complexities of the process and can help you:

• Review and understand the reasons for the denial
• Gather the right evidence to support your case
• Represent you at hearings or in federal court if necessary