Why Are Social Security Disability Claims Denied?

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

• Insufficient Medical Evidence:
  If the Social Security Administration (SSA) determines that you haven’t provided enough medical evidence to support your claim, your application may be denied. The SSA needs clear and detailed medical documentation showing that your disability prevents you from working.
• Failure to Meet the Eligibility Criteria:
  To qualify for SSD, you must meet specific eligibility criteria, such as having enough work credits for SSDI or meeting the financial needs for SSI. If you don’t meet these criteria, your claim can be denied.
• Earning Above the Substantial Gainful Activity (SGA) Limit:
  If your income exceeds the Substantial Gainful Activity (SGA) limit, you may be considered able to work, which could result in a denial of your disability claim.
• Not Following Treatment Recommendations:
  If the SSA believes that your condition could improve with treatment but you haven’t followed your doctor’s recommendations, they may deny your claim.
• Incorrect or Incomplete Application:
  If there’s missing or inaccurate information in your application, it may lead to a denial. Providing all requested information and ensuring accuracy is crucial.

What to Do If You Get Denied for Social Security Disability

Receiving a denial notice from the SSA doesn’t mean your case is over. In fact, most initial disability claims are denied. If you get denied for Social Security Disability, you can appeal the decision. Here are the steps to take if you find yourself in this situation:

Steps to Appeal a Denied Social Security Disability Claim

If your Social Security Disability claim is denied, you have the right to appeal the decision. There are four levels of appeal, each with its own process and timeline:

Step 1: Reconsideration

• Request Reconsideration:
  After receiving your denial notice, the first step is to request reconsideration. This means the SSA will review your case again, taking into account any new evidence or information you provide. The SSA will assign a different examiner to review your case, and you may need to submit additional medical records or documentation.
• Timeline:
  The reconsideration process can take several months, and if the claim is denied again, you’ll move on to the next level of appeal.

Step 2: Hearing Before an Administrative Law Judge (ALJ)

• Request a Hearing:
  If your claim is denied during reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). This is one of the most important stages of the appeal process, as you will have the opportunity to present your case in person and answer questions about your condition and limitations.
• Prepare for the Hearing:
  At the hearing, you can present new evidence and have your doctor or vocational expert testify on your behalf. It’s essential to be well-prepared and have all necessary documentation and witnesses to support your claim.
• Timeline:
  Waiting for an ALJ hearing can take a year or more, depending on your location and the court’s caseload. However, this is your best chance for a favorable outcome.

Step 3: Appeals Council Review

• Request Appeals Council Review:
  If you disagree with the ALJ’s decision, you can request a review from the Appeals Council. The Appeals Council will review the ALJ’s decision and determine whether the law was applied correctly. It’s important to note that the Appeals Council does not conduct a new hearing or accept new evidence.
• Timeline:
  This stage can take several months to a year, and if the Appeals Council upholds the ALJ’s decision, your case may be closed.

Step 4: Federal Court Lawsuit

• File a Lawsuit in Federal Court:
  If the Appeals Council denies your appeal, the final option is to file a lawsuit in federal court. In this stage, you will argue that the SSA made a legal error in denying your claim. A federal judge will review your case and decide whether to send it back to the SSA or approve your benefits.
• Timeline:
  The timeline for this stage is highly variable and can take up to several years to resolve, depending on the complexity of your case.