SSDI Denials: Common Reasons and How to Appeal

Social Security Disability Insurance (SSDI) serves as a vital safety net for individuals who find themselves unable to work due to a disabling condition. The program offers financial support and essential benefits to those facing physical or mental impairments that hinder their capacity to engage in substantial gainful activity.

According to USA Facts, based on actuarial estimates by the Social Security Administration (SSA), today’s young workers face a roughly one in three likelihood of experiencing disability or death before reaching retirement age. 

In June 2022, approximately 7.8 million disabled workers in the United States were receiving disability benefits. This accounts for approximately 4% of the adult population aged between 18 and 64. 

However, despite the program’s significance, the road to obtaining SSDI benefits can be challenging and wrought with obstacles, as many initial applications face denial. Understanding the reasons behind SSDI denials and the subsequent appeal process is crucial for individuals seeking the assistance they rightfully deserve. 

In this article, we delve into the common grounds for SSDI denials, shedding light on the complexities that applicants often encounter during their initial claim.

Common Reasons for SSDI Denials

There are several reasons why your social security disability insurance application may have been denied. Below are some of the most common reasons for denial:

• Lack of medical evidence: The SSA requires a lot of medical evidence to support an SSDI claim. This evidence can include doctor’s reports, medical records, and test results. If you do not have enough medical evidence, your claim is more likely to be denied.
• Prior denials: If you have been denied SSDI in the past, it is more likely that your current claim will also be denied. This is because the SSA will look at your prior denials as evidence that your disability is not severe enough to prevent you from working.
• Too much earnings: If you are earning too much money, you may not be eligible for SSDI. The SSA defines “substantial gainful activity” (SGA) as earning more than $1,310 per month in 2023. If you are earning more than SGA, your claim will be denied.
• Failure to follow treatment advice: If you are not following your doctor’s treatment advice, the SSA may consider this as evidence that you are not disabled. The SSA wants to see that you are taking steps to improve your health and become able to work again.
• Failure to cooperate: If you are not cooperating with the SSA, your claim may be denied. This could include things like not returning phone calls or failing to provide requested information.
• Not meeting the definition of disability: To be eligible for SSDI, you must meet the SSA’s definition of disability. This means that you must have a severe physical or mental impairment that prevents you from working for at least 12 months.
• Not working in a “substantial gainful activity” (SGA): If you are working in a “substantial gainful activity” (SGA), you are not eligible for SSDI. The SSA defines SGA as earning more than $1,310 per month in 2023.
• Living in a state with a high denial rate: The SSDI denial rate varies from state to state. If you live in a state with a high denial rate, your claim is more likely to be denied.

Furthermore, Legal Reader notes that in 2023, if you’re applying for federal disability benefits, chances are you’ll need to attend a hearing. The administrative law judge (ALJ) assigned to your case can significantly influence the outcome. 

In the previous year, judges from 168 Social Security hearing offices made approximately 322,000 decisions, with an overall approval rate of slightly over 54%. While many judges had an approval rate around this figure, 123 judges approved 75% or more of their cases. On the other hand, 39 judges had an approval rate of 25% or less in 2022.

How to Appeal an SSDI Denial?

To seek an appeal for your SSDI denial, you have the option to take the following steps:

• Request a reconsideration: If you have been denied SSDI, you can request a reconsideration of your claim within 60 days of the denial letter. This is a review of your claim by a different SSA employee. You will need to provide any new medical evidence or information that you have since your initial claim.
• Request a hearing before an administrative law judge (ALJ): in the case of the denial of the reconsideration, you can request a hearing before an administrative law judge (ALJ). This is a formal hearing where you will have the opportunity to present your case to a judge. You will need to bring all of your medical evidence and other supporting documents to the hearing.
• Appeal to the Social Security Appeals Council: If your hearing is denied, you can appeal to the Social Security Appeals Council. The Appeals Council will review your case and make a decision.
• File a civil lawsuit in federal court: If the Appeals Council also denies your appeal, you can file a civil lawsuit. This is a last resort, as it is a long and expensive process.

TruLaw notes that the time limits for appealing an SSDI denial are strict. If you miss the deadline, you may lose your right to appeal. It is, therefore, essential to contact an experienced disability lawyer as soon as possible if you have been denied SSDI. A lawyer can help you file the proper paperwork and meet the deadlines.

According to The Washington Post, over the past two fiscal years, data from agency statistics reveals that federal judges reviewing appeals for denied benefits found issues with nearly 6 in every 10 cases. 

Consequently, they sent these cases back to administrative law judges at Social Security for new hearings, marking the highest rate of rejections in years. Moreover, the trend indicates that court remands are likely to reach similar levels this year.

Here are some additional tips for appealing an SSDI denial:

• Get help from an experienced disability lawyer. A lawyer can help you gather medical evidence and file the proper paperwork. They can also represent you at your hearing and help you appeal the decision if your claim is denied.
• Gather as much medical evidence as possible. The more medical evidence you have, the stronger your case will be. Be sure to include all of your doctor’s reports, medical records, and test results.
• Be prepared to explain how your disability prevents you from working. The SSA wants to see that you cannot work due to your disability. Be prepared to discuss your limitations and how they affect your ability to earn a living.
• Be persistent and don’t give up. The SSDI appeals process can be long and frustrating, but it is essential to keep fighting for your benefits. If you are persistent, you will eventually get the help you need.

Conclusion

SSDI is not just about financial aid. It’s about gaining dignity and the necessary support to lead fulfilling lives despite challenges. Obtaining SSDI benefits may be tough, but with determination, reliable information, and support, people with disabilities can overcome obstacles and strive for a more financially stable future. 

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