Social Security Disability Insurance: 10 Reasons Your Claim Will Be Denied

1. You Don’t Have Enough “Work Credits” To Qualify.

There is a minimum amount of time you must have worked in the past to qualify for Social Security Disability Insurance (SSDI) benefits. The Social Security Administration (SSA) calculates your credits based on your age, the number of years you’ve worked (and therefore paid taxes into the system), and when you became disabled. How many credits you need for disability benefits depends on how old you are when you become disabled:

If you become disabled before age 24, you generally need 1½ years of work (six quarters, or “credits”) in the three years before you became disabled.

If you are age 24 through 30, you generally need credits for half of the time between age 21 and the time you became disabled.

If you are disabled at age 31 or older, you generally need at least 20 credits in the 10 years immediately before you became disabled.

In 2020, you earn one credit for each $1,410 of earnings, with a maximum of four credits per year. The number of credits that you earn remains on your Social Security record regardless of your current work status.

The older you are and the more you’ve worked in recent years, the better likelihood you have of getting approved.

2. You Presently Earn Too Much Money.

You can generally work part-time while you apply for SSDI as long as your earnings don’t exceed a certain amount set by Social Security each year. If you earn more than this amount, called the “substantial gainful activity” (SGA) limit, SSA assumes you can do a substantial amount of work, and you won’t be eligible for disability benefits. In 2020, the SGA limit is $1,260 per month.

In addition to the amount of money you make, Social Security may look at the number of hours you’re able to work. For example, if you don’t earn more than $1,260 per month but you’re able to work 32 hours a week, it will be harder to convince the SSA you’re disabled.

SSA differentiates “earned” income from “unearned income. In regards to SSDI, most forms of income that are not made directly from work wages or under‑the‑table work are not included in substantial gainful activity. This includes investments, interest, a spouse’s income, or other assets.

Situations vary greatly from person to person. Depending on the nature of your disability and the nature of your income, you may still qualify for SSDI.

Do not let these numbers prevent you from applying altogether — it is always better to apply and not qualify than not apply at all.

3. Your Condition Isn’t Considered A “Disability” Under The SSA’s Strict Guidelines.

To qualify for disability benefits your conditions have to be severe: The impairment must have lasted (or be expected to last) at least 12 months, or be dire enough that it is expected to result in death.

Additionally, your condition must be on the SSA’s Listing Of Impairments. (Although you are not automatically disqualified from receiving benefits if your condition isn’t listed; that just means you’ll have to provide more medical evidence for the SSA to evaluate your particular impairment.)

If you haven’t received treatment for your condition or if the SSA needs more information than what you provided, they may request that you get a Consultative Exam at the SSA’s expense.

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4. The SSA Determines That You Are Fit To Do A Different But Related Job.

Generally, SSA will find you disabled if you can’t sustain full‑time work on a regular basis.

If SSA determines you are still able to do some sort of work ‑‑ even if it’s not the same work you did before, and even if it’s at a lesser strength level ‑‑ your application will be rejected. An examiner will make a determination about your ability to work. During the application process, it’s up to you to establish how your disability leaves you with no options ‑‑ that because of the severity of your disability you are unable to do any kind of work‑related activities, even sedentary entry-level type of work. Much attention is given to an applicant’s employment history and details about the scope of their work. Because this part of the application process plays such a large role in determining your eligibility, do the up‑front work of gathering work records before you apply.

5. You Didn’t Have The Right Documents On Hand.

A good filing system is a savior in situations like this. That’s because you’re going to need to produce documents about your income, work history, applications for other disability benefits, your medical history, and more. These include:

• A list of jobs you had (including dates of employment) during the 15 years prior to your disability.
• Pay stubs, award letters, settlement agreements, and anything else that offers proof of temporary or permanent workers’ compensation benefits.
• An accounting of workers’ compensation, state or local government disability insurance, or military disability benefits ‑‑ not including Veterans’ Administration (VA) benefits ‑‑ you have or intend to file for.
• Details of your injury or medical condition (including names, addresses, dates of treatment, patient IDs) for all doctors, hospitals and clinics you’ve visited.
• Dates, test results, and information about the doctor who sent you for any medical tests you’ve had.
• Names of medicines you take and the doctor who prescribed them.

6. Incomplete Or Inaccurate Explanations.

Being thorough, honest, and consistent about your situation is key. Gathering medical records can be an onerous task, especially since it may involve various doctors, hospitals, and other healthcare providers. So, review, organize and provide a thorough accounting of your disability so that the SSA can process your claim efficiently.

If you don’t have these records the SSA will contact the medical sources you list. The SSA website says to go ahead and submit what you have (and provide the names/contact information for medical providers that they can contact) and they’ll obtain evidence for you. Just keep in mind that adds another layer of due diligence (and time) on their end, so if you can easily get the required documentation yourself, do so.

7. You Don’t Have Objective Evidence Of An Impairment In Your Records.

Our experience has been that Social Security judges are a lot more comfortable awarding claims where the medical problems can be identified by objective testing – tests such as an MRI, CT scan, myelogram, nerve conduction study, echocardiogram, doppler study, etc. Tests that allow doctors to see or measure a severe medical problem tend to get approved, while more subjective illnesses (such as Fibromyalgia, Chronic Fatigue, myofascial pain, mental conditions) tend to be discounted.

Obviously, there are exceptions and some subjective impairments will be approved but those claims face an uphill battle and must be strategically prepared.

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8. A Simple Technical Error.

Remember, a living, breathing person is going to review your application, and any examiner’s workload is mind-boggling. Mistakes happen. And you, also a living, breathing person, are fallible as well. Little things can slow down your application’s review. For example:

• Photocopies are acceptable for W‑2s, tax returns, and medical documents. But in some cases, the SSA requires that you mail (or bring into a local Social Security office) the original version of some documents, like your birth certificate. Originals will be returned to you.
• Any documents you mail must include your Social Security number. Provide that information on a separate sheet, because:
• The SSA rules stipulate that you should not write anything (including your Social Security number) on original documents or, obviously, alter them in any way.

What you want to avoid is waiting for someone from the SSA to contact you for clarification. This just prolongs the application process and delays the time it takes for you to be awarded benefits.

9. You Failed To Appeal Your Denial Within The 60 Day Deadline.

If Social Security denies your claim, you generally must appeal within sixty (60) days. This applies to all appeals: Your appeal of the initial claim denial, your appeal of the reconsideration denial, and your appeal of a hearing denial.

If you miss the deadline you will have to start over, which may result in thousands of dollars of lost benefits or, in a worst-case scenario, you may lose your rights to benefits altogether. Social Security does have a procedure whereby you can petition SSA to accept a late-filed appeal but acceptance is not guaranteed. Sixty days can go by quickly so don’t miss your appeal deadline.

10. You Decided To Just Give Up.

Patience is a requirement for anyone applying for disability benefits. Depending on the amount of verification, follow‑up, and additional exams the SSA and you have to go through, the process could take as long as 2 years or more to be approved (although certain Compassionate Conditions like advanced cancers, kidney diseases, and complex amputations, get expedited).

For most people, the process of applying is daunting enough. A large percentage of applications are routinely denied; after getting rejected, just giving up may seem preferable to enduring a multiple‑step rigmarole appeals process. But if that’s what it takes, that’s what you must do as you double‑ and triple‑check to make sure everything’s in order for the next go‑round. And, of course, submit the correct form to appeal that inevitable denial

In order to ensure that you have provided all the medical evidence and evaluations, built a strong evidentiary case, and not miss any deadlines, it is highly recommended that you retain representation from an experienced advocate. This will greatly increase your chances of success.

P.S.:

Hang in there, it’s worth it.

Don’t get discouraged. If you’re eligible for benefits, your patience will pay off and hopefully help ease the financial burden of being unable to work.

You can increase the odds of getting approved if you know the rules and are armed with the right information to make your case. If you don’t know the rules, and the required quagmire of procedures, get help immediately, particularly if you have already filed an application and been met with a denial.

Consult With A Social Security Attorney.

Social Security can be complicated and very intimidating. It is also vital that everything is completed correctly and a strong case is presented so that your chances of success are maximized.

Get assistance from a seasoned attorney to help you weave your way through the maze. Their expertise in filing paperwork and presenting cases makes all the difference.