Overview of Disability
Disability Back Pay
Requirements for Disability
Applications for disability
Tips and Advice for Disability Claims
How long does Disability take?
Winning Disability Benefits
Common Mistakes after a Denial
Mental Disability Benefits
Denials for Disability
Appeals for denied claims
Disability Benefits from SSA
Child Disability Benefits
Qualifications and How to Qualify
Working and Disability
Disability Awards and Notices
Disability Lawyers, Hiring Attorneys
Social Security List of Conditions
What Social Security considers disabling
Medical Evidence and Disability
Filing for Disability Benefits
Eligibility for Disability Benefits
SSD SSI Definitions
SSDRC authored by Tim Moore
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What Are The Reasons For Social Security Disability Cases Being Denied?
Social Security Disability and SSI cases are primarily denied for one reason: a claimant's medical records will fail to prove that the individual has enough physical or mental limitations that will prevent them from being able to go back to work--either performing one of their past jobs (past relevant work potentially includes any job that was done in the last 15 years) or performing some other type of other work (that Social Security may claim you can do based on your age, education, medical limitations, and skills and training).
When Social Security finds that a person filing for disability benefits is disabled, this means they have determined that they have either A) met the requirements of a listing in the Social Security List of Impairments, or B) that they have successfully passed through the five-step evaluation process known as sequential evaluation.
Now, most individuals will not be approved on the basis of the approval criteria for a listing. This is because many medical condtitions are not included in the listing book. And when they are the criteria for approval is very high. The simple fact is that most of the time a claimant's medical records will not contain the information needed to prove that they qualify for disability under a listing.
When a person is approved it will be because they have gone through all five steps of the sequential evaluation process, meaning that:
1) They are not currently working and earning a substantial and gainful income,
2) They have a severe impairment,
3), They do not meet a listing in the listing book,
4) Their condition or conditions prevent them from being able to do their past work, and finally
5) Their condition or conditions are severe enough that they cannot do any other kind of work, work that, if they were not disabled, they might easily be able to switch to.
We can distill the way the entire disability system works by making this one statement:
Most claims are denied because an SSA adjudicator--a disability adjudicator or a judge--will decide that the person can still do some type of other work, even if they can no longer do their past work.
The trick to winning a disability claim, of course, is proving that your condition is so severe that you cannot do other work, in addition to being unable to do your past work. And we address that topic more in length on this page: How to Prove you are disabled and Win your Disability Benefits
Non Medical Reasons for being denied disability
There are a variety of reasons an individualís disability claim can be denied that do not involve their alleged disabling condition or conditions.
For instance, disability cases can be denied because they do not meet the non-disability criteria, or eligibility requirements, of Social Security Disability and/or SSI (Supplemental Security Income disability) program. If an individual has not worked, or has not worked in a long time, they may not be insured for Social Security disability.
Insured status is gained only through work activity and lasts a limited amount of time once an individual stops working. If an individual files a disability claim on the basis of need, their disability claim may be denied because A) the value of their resources is too high (currently, the income resource limit for an individual is two thousand dollars and the coupleís resource limit is three thousand dollars) or B) they have income that is over the income limit. Like all need-based social welfare programs, individuals who file for SSI must meet certain income and resource limits to be eligible for disability benefits.
Disability claims can be denied for other reasons as well. If an individual files a disability claim and they are working, their disability claim can be denied for the performance of substantial gainful activity (SGA) prior to their case being sent to a disability examiner (at disability determination services, the agency that makes case decisions for social security) for a medical decision.
SGA is a monthly earnings amount that the Social Security Administration has determined to be self-supporting. If an individual is earning over the SGA amount, if does not matter what their disabling condition is or how severe it is; their claim will be denied.
Social Security disability claims can also be denied either in the Social Security office, or at the state agency responsible for making disability determinations, for failure to cooperate. Failure to cooperate denials involve a failure on the part of the disability applicant to provide forms or information needed to process their disability claim.
Often, too, the state disability processing agency denies disability cases because they are unable to get in touch with the disability applicant. This is why it is so important for all disability claimants to provide Social Security with updated addresses and phone numbers if there are any changes during the processing of their disability cases.
The state disability agency (DDS) may also deny a disability case if a disability claimant fails to attend a scheduled consultative examination. If a disability applicant cannot attend their consultative examination for any reason, they should contact the disability examiner responsible for their disability case a reschedule examination rather than miss it.
Return to: Social Security Disability Resource Center, or read answers to Questions
If I Get Denied Twice For SSD or SSI Disability, What Do I Do?
What Are The Reasons For Social Security Disability Cases Being Denied?
What happens if you get denied for social security disability three times?
Why Will A Social Security Disability Application Get Denied?
How Many Times Will Social Security Disability Deny You before You Get Approved for Disability?
Can You Avoid Being Denied on a Social Security Disability or SSI Claim?
What happens if a reconsideration for Social Security Disability or SSI is denied?
What should be done if your disability is denied?
How do you appeal if you are denied for Social Security disability or SSI?
Should you get Help from a Disability Attorney before the Claim has been Denied?
Information on the following topics can be found here: Social Security Disability Questions and in these subsections:
Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI
These pages answer some of the most basic questions for individuals who are considering filing a claim.
Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI Approval and Qualifications Criteria