What Is A Social Security Durational Denial?

How to prove you are disabled
and win disability benefits

A disability for social security purposes is any physical or mental condition that prevents an individual from performing work at a substantial gainful level for twelve months, or which can be expected to prevent an individual from working for twelve months. When a condition is disabling, even according to social security guidelines, but does not last for 12 months, or improves before a twelve month period elapses, the claim may be denied for duration.

Durational denials have been somewhat controversial for Social Security because they are based upon a forecast of recovery. Disability examiners evaluate a disability applicant’s medical information and determine if they feel the applicant will be unable to perform work at a substantial gainful activity level for at least twelve months.

If the disability examiner determines that a disability applicant’s medical condition is likely to improve within twelve months, they may deny the disability claim. This is a durational denial for disability benefits.

As stated, the problem with durational denials is that forecasts tend to be very subjective. Often, disability examiners give durational denials for disability cases that involve traumatic injuries, injuries sustained in an accident, surgical interventions, or other impairments that have some chance of improving to a “finding of not disabled” prior to the end of the twelve month durational period.

However, there have been times when disability examiners routinely denied disability claims on the basis of duration that involved severe mental impairments and other conditions that have very little chance of medical improvement.

Disability examiners with no formal medical training make Social Security disability determinations with input of their managers, case consultants and unit medical professionals. Each individual involved in deciding the disability claim is subject to their own biases with regard to an individual’s chance of medically improving. This is why durational denials tend to be some of the most subjective in nature.

If an individual receives a durational denial, they should appeal that decision all the way to an administrative law judge disability hearing if necessary, even beyond that to an Appeals Council review. The chances are they will win their disability case at an ALJ hearing; if they do not win, they have a choice to file another disability claim or appeal the ALJ decision to the Appeals Council.

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Topics and Questions

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Should I have to go to court or get a Lawyer to get approved for Social Security disability or SSI?

SSD and SSI are Federal Programs

The title II Social Security Disability and title 16 SSI Disability programs operate under federal guidelines and, therefore, the program requirements--medical and non-medical--apply to all states:

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

Recent approval and denial statistics for various states can be viewed here:

Social Security Disability, SSI Approval and Denial Statistics by state

Special Section: Disability Lawyers and unnecessary claim denials