Applying for and being awarded Social Security Disability Insurance (“SSDI” or “disability benefits”) benefits is never an easy or fast process. But for those who are disabled, getting awarded disability benefits can be critical.
Which is why being denied those benefits can often feel devastating.
Unfortunately, statistics overwhelmingly show that the Social Security Administration (“SSA”) denies more first-time applications than it approves. Of the millions of SSDI applications each year, only about 30% of them are approved at the initial application level by the SSA. Put another way, SSDI applications have a 70% denial rate during the initial evaluation stage. This fact alone often makes people wonder whether the SSA simply denies all first-time applications.
Of course not.
Nevertheless, the fact remains that most applications are denied at the initial stages.
Well, there could be any number of reasons.
Let us take a brief look at some of the reasons why the SSA would deny a valid claim for disability benefits.
A Denial Does Not Mean You Are Not Disabled
Before we get into the specifics of denials, the first thing to understand is that having your SSDI application denied does not mean you are not disabled.
It might mean you are not disabled within the SSDI’s definition of disabled, or it could be for a number of other reasons. Be aware that not all of the SSA’s reasons for denying SSDI benefits are related to a person’s medical condition.
For example, there could be technical reasons your application was denied. You may not have sufficient work credits to qualify for SSDI.
Or, your application may be missing important information.
The second thing to understand is that a denial at the initial claims level is not the “end.”
Don’t give up.
Benefits are often awarded upon reconsideration or at the various appeal levels. That is why it is important to work with an experienced social security disability attorney.
Why Would the Social Security Administration Deny a Valid Claim?
So why would the SSA deny a valid claim?
Well, as mentioned above, there could be any number of reasons. But there are a few common ones that come up time and time again.
There are the basic qualification reasons, of course—that you did not work long enough to qualify or that your condition does not meet the SSA’s strict definition of “disabled,”— but there are other common reasons as well.
Insufficient Medical Records
One main reason for a denial is the lack of medical evidence to support the claim. Sometimes individuals applying for SSDI benefits without the assistance of a disability attorney think that the SSA will gather the medical evidence for them by, for example, sending them to doctors for examinations. Not so. Unless your application is fully supported with solid medical evidence within the relevant time frames and in the correct form, your application will be denied.
You are “Substantially Gainfully Employed”
Another common reason for denial of a valid claim is you are working at a level that constitutes “Substantial Gainful Activity.”
According to the SSA, in 2022, if you are able to work long enough to earn $1,350.00 a month (for non-blind individuals), you will not be awarded disability benefits.
Because in order to be eligible for disability benefits, you must not be able to engage in substantial gainful activity.
You Missed a Deadline or Important Phone Call
Sometimes the SSA will deny a valid claim because you missed important deadlines.
For example, if the SSA office or the Disability Determination Services Office (“DDS” or “Disability Office”) called you and you did not return the call or did not return it in time, your application may be denied.
The SSA has strict deadlines that must be met when making a medical determination, and if you miss those deadlines, your claim will be denied.
You Did Not Follow Doctor’s Orders or Did Not Follow Up
Finally, another reason for denial is the failure to follow up with medical treatment prescribed by your doctor.
The SSA looks closely at all medical records. If your records show a significant number of missed appointments or that you did not follow doctor’s instructions, the SSA will deny your claim. The reasoning behind this is that if you are not willing to cooperate with treatment, that tends to support either that your condition cannot be so disabling, or that you yourself are preventing your own recovery.
Or, it could be that the medical examiner could not accurately assess your condition because the medical records were not complete enough.
Any Other Reason
The foregoing are just some of the reasons why a valid disability claim might be denied by the SSA. There are others.
While being awarded SSDI benefits may not be predictable, one thing is certain: if you do not work with an experienced disability attorney, chances are that the process will be long and frustrating and you will not be awarded disability benefits at any level in the process.
Disability Attorney in North Central Florida
Our First Coast Social Security disability attorneys are here to help disabled individuals apply for disability benefits. We can help you determine what you must prove to the Social Security Administration and the best way to present the facts of your claim. Reach out to us here or simply call our firm at: 777-JOHN. We serve clients throughout Florida. Our main office is in Orange Park, but we have consulting offices in Palatka, Middleburg, Keystone, Starke, Gainesville, and Ocala.