Top Reasons Your Social Security Disability Claim Gets Denied and How to Overcome Them
- The Forsythe Firm
- 2 days ago
- 5 min read
Applying for Social Security Disability Insurance (SSDI) can feel like navigating a maze. The denial rate for new disability claims is around 15 percent, so most applicants will face initial rejection. Understanding the main reasons behind these denials can help you prepare a stronger case and improve your chances of approval on appeal. This post breaks down the most common causes of denial and offers practical advice on how to overcome them.
Lack of Sufficient Medical Evidence
One of the leading reasons for SSDI claim denial is insufficient medical evidence. The Social Security Administration (SSA) requires detailed documentation proving that your condition severely limits your ability to work.
What Counts as Strong Medical Evidence?
Comprehensive medical records from your doctors, specialists, and hospitals
Diagnostic test results such as MRIs, X-rays, or blood tests
Treatment history showing ongoing care and management of your condition
Statements from healthcare providers explaining in specific detail how your disability affects your daily functioning (Not a general statement that you "cannot work" or that your are "totally disabled." Social Security does not accept these generalized conclusions.
How to Avoid This Pitfall
Keep thorough records of all medical visits and treatments
Ask your doctor to provide detailed notes about your limitations
Submit all relevant test results and reports with your claim
Follow up with your healthcare providers to ensure your records are up to date
List all your medical providers on your SSDI application.
Without clear medical proof, the SSA may conclude that your condition does not meet their strict criteria for disability.
Failure to Follow Medical Advice
The SSA expects claimants to follow prescribed treatments unless there is a valid reason not to. Ignoring medical advice can signal that your condition is not as severe as claimed.
Examples That Can Hurt Your Claim
Skipping physical therapy sessions without explanation
Refusing recommended surgeries or medications
Not attending follow-up appointments
How to Address This Issue
Communicate openly with your doctors about any difficulties with treatment
Document reasons for not following advice, such as side effects or financial barriers
Show efforts to comply with medical recommendations whenever possible
See your doctor(s) regularly
Demonstrating your commitment to treatment helps prove your disability is genuine and ongoing.
Working at Substantial Gainful Activity (SGA) Level
If you are currently working and earning above the SSA’s Substantial Gainful Activity (SGA) threshold, your claim will likely be denied. The SSA uses SGA as a benchmark to determine if you can engage in meaningful work.
What Is SGA?
For 2025, the monthly SGA limit is $1,620 per month (gross) for non-blind individuals and $2,460 for blind individuals (those who are legally blind)
Earnings above these amounts suggest you are capable of work and are working
What to Do If You Are Working
Report your earnings accurately on your application
If your work is part-time or temporary, explain the circumstances
Provide evidence that your work does not reflect your full capacity due to your disability
Submit W-2 forms, 1099 forms or other proof of your recent gross wages
If you are working above the SGA level, the SSA will conclude at Step 1 that you are not disabled under their rules. Your medical evidence will not be considered if you are working at the SGA level.
Insufficient Work Credits for SSDI Coverage
SSDI eligibility depends on having earned enough work credits through paying Social Security taxes [called FICA]. If you have not worked long enough or recently enough, your claim may be denied because you are "not insured" under the Social Security disability system. This may occur no matter how sick or "disabled" you are. You must be "insured" to collect benefits.
Understanding Work Credits
You earn up to 4 credits per year based on your income and FICA withholding
The number of credits needed depends on your age at the time of disability
Generally, you need 20 credits in the last 10 years, but younger workers (below age 31 when disabled) may qualify with fewer
What to Do If You Lack Credits
Check your Social Security statement to verify your work history
Consider applying for Supplemental Security Income (SSI), which has different eligibility rules and requires no work credits; however SSI does require very low assets and income
Consult a disability lawyer, such as Charles W. Forsythe in Huntsville, to explore other options, including appeals.
Without sufficient work credits, SSDI benefits are not available, but other programs might help.
Not Proving Inability to Work Any Job
The SSA requires proof that you cannot perform any substantial work, including unskilled sedentary jobs. Simply showing you cannot do your previous job is not enough, especially if you are under age 50.
What the SSA Looks For
Medical evidence showing limitations in physical and mental abilities
Vocational assessments considering your age, education, and past work
Documentation that you cannot adjust to other types of work
How to Strengthen Your Claim
Provide detailed medical records describing your functional limitations
Ask your doctor to provide a Residual Functional Capacity opinion (form)
Include statements from vocational experts if possible
Highlight difficulties with basic tasks like sitting, standing, or concentrating
Showing total disability across all job types is critical for approval.
The Importance of the Appeals Process
Many initial SSDI claims are denied, but the best chance for approval often comes during the appeals process. The hearing before an Administrative Law Judge (ALJ) is a key stage where many claimants succeed.
What Happens at the Hearing?
You present your case in person or via video
You can bring witnesses, including doctors or vocational experts
The ALJ reviews all evidence and asks questions
Tips for a Successful Appeal
Prepare thoroughly with all updated medical records
Practice explaining how your disability affects your work ability
Prepare to explain how your disability restricts activities of daily living
Consider legal representation to guide you through the complicated process
How a Disability Lawyer Can Improve Your Chances
Having a qualified disability lawyer can increase your approval odds by about 300 percent. Lawyers like Charles W Forsythe in Huntsville specialize in SSDI claims and appeals.
Benefits of Hiring a Lawyer
They understand SSA rules and procedures
They help gather and organize medical evidence
They represent you at hearings and communicate with SSA on your behalf
They solve problems before the hearing and help put your best foot forward
Lawyers know how to cross examine adverse testimony from experts at the hearing
They work on a contingency fee basis, meaning no upfront cost
What to Expect
No initial fees for consultation or claim filing
Fees are only charged after you receive past due or retroactive benefits
The fee must be approved by the SSA in advance
A skilled lawyer can make a significant difference in navigating the complex SSDI system.Te US Government Accountability Office (GAO) did a study and concluded that claimants with a lawyer are 3 and-one-half times (350%) more likely to be approved than claimants with no lawyer.
Taking Action After a Denial
If you have been denied SSDI benefits within the past 60 days, it is crucial to appeal quickly. The appeal window is limited (60 days) and acting promptly preserves your chance for approval.
Steps to Take
File a Request for Reconsideration immediately
Gather additional medical evidence or documentation
Consider consulting a disability lawyer for guidance in your appeals
Appealing increases your chances of success and can lead to receiving the benefits you deserve.
Contact The Forsyhe Firm at (256) 799-0297 for help with application, appeal or hearing representation. Free consultations available.
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