WHY DISABILITY CLAIMS GET DENIED

There are many reasons for denials of SSDI or SSI claims. Some common reasons are:

1. THE DISABILITY WON'T LAST LONG ENOUGH. There is no short term disability benefit with Social Security. Only disabilities which last at least 12 straight months are considered.

2. THE DISABILITY ISN'T SEVERE ENOUGH. A medical or psychological impairment must be severe enough to prevent any full-time work. For younger claimants (under age 50) the disability must prohibit all types of full-time work, even sedentary or light unskilled jobs. For older individuals the disability must be severe enough to prohibit any full-time which they have performed during the past 15 year period. This is called "past relevant work."

3. THERE ISN'T ENOUGH MEDICAL EVIDENCE. The duration and severity of impairments must be proven with objective medical evidence. If there isn't sufficient hard evidence in the medical files, Social Security will find that "You are not disabled according to our rules," or that "we do not have enough evidence to approve your claim."

4. THE CLAIMANT IS WORKING AT 'SUBSTANTIAL GAINFUL ACTIVITY (SGA).' In 2020, if an individual is earning at least $1,260 from employment or self-employment, he or she is considered gainfully employed and cannot be paid a disability benefit.

5. THE DATE LAST INSURED (DLI) HAS EXPIRED. This means the claimant has not worked and paid into Social Security recently enough to support a claim. Generally, Social Security looks at the most recent ten-year period. A claimant must have worked and paid Social Security tax (FICA) at least 5 out of the 10 years. For most workers, SSDI coverage will expire about 5 years after they stop working (for any reason). Another program called Supplemental Security Income or SSI does not require any work historyi but it has lower benefits and imposes severe income and financial resource restrictions.

6. THE DISABILITY IS DIRECTLY RELATED TO DRUG OR ALCOHOL ABUSE. If substance abuse is a material cause of disability, benefits will not be paid. Three questions generally determine whether alcoholism or drug abuse is material to the disability:

a) Did the substance abuse occur during the period that benefits would be payable?

b) Did the abuse cause or contribute in a material way to the disability?

c) If the claimant stopped the alcohol or drug abuse now, would he/she still be disabled?

7. THE CLAIMANT WAS INCARCERATED. The law prohibits Social Security from paying disability benefits to individuals who are incarcerated during the time they claim benefits. They may, however, apply for benefits after being released.

There are many other reasons a claim may be denied. Social Security initially denies over 70 percent of new applications for benefits. Some of those can be paid later after an appeal overturns the denial.

About 60 percent of claimants who are represented by attorneys or experienced advocates eventually get approved. Only about 33 percent of unrepresented claimants get approved.

Social Security disability is a complicated process involving several state and federal agencies. An attorney/advocate is a valuable professional assistant as you navigate the difficult process of getting disability benefits.