Overview of Disability
Disability Back Pay
Disability Advice Tips
How long do cases take?
How to win Disability
SSD Mistakes to avoid
Disability for Mental
What if you get denied?
How to file Appeals
Disability through SSA
SSI Disability Benefits
Disability for Children
How do I qualify for it?
Working and Disability
Disability Award Notice
Disability Lawyer Q&A
Disability Conditions List
What is a disability?
Your Medical Evidence
Filing for your Disability
SSD SSI Definitions
SSDRC authored by
SSDRC Disability Blog
What is a Social Security Disability Denial based on?
There are plenty of misconceptions as to why denials on social security disability and SSI claims happen. To some extent, this may be due to the wording of notices of denial, which are largely template-assembled letters (meaning that if you lined up ten "notices of disapproved claim" from ten separate claimants, the letters would tend to look very much the same).
Claimants will often assume that one of a variety of factors may have been responsible for why they were denied on their disability application or appeal for disability benefits.
But, in every single case, a denial happens because the claimant, through the information presented in their medical records, has failed to prove that they have an inability to work at a substantial and gainful level and that this inability will last for at least one full year.
This is basically the social security administration definition of disability: that, to qualify for disability, a condition, or set of conditions (which may be physical, mental, or a combination of either) must be all of the following:
B) Severe enough to make it impossible for the claimant to engage in work activity at what is considered to be a substantial and gainful level
C) Severe enough to last at least a year.
Translation: to meet the Social security definition of disability, a claimant's overall condition must result in enough physical and/or mental limitations that they cannot be able to work for a full year while earning a substantial and gainful income (which is defined here: SGA, substantial activity level).
This includes, of course, the job that they last did, any work that they have done previously in the last fifteen years (their relevant past work), as well as any job that their skills and training might qualify them for and which their age and various restrictions might not disqualify them for.
Denials on disability applications and denials on disability appeals, therefore, occur because either--
1. The claimant's rated limitations, or residual functional capacity (measured on something known as a residual functional capacity form, which is completed by a disability examiner and the examiner's unit medical consultant at DDS, or disability determination services) is not enough to rule out their ability to go back to their former job or to do some type of other work. OR
2. The claimant has managed to return to work activity for which they earn a substantial and gainful wage while their disability application or disability appeal was pending.
Most claimants and potential claimants will assume that the outcome of a disability case will simply boil down to the information that may be found in the medical records. However, claims are as much focused on the claimant's work history as on the medical history.
Therefore, the claimant's ability to engage in work activity, as well as the perception of the ability to engage in (or return to) work activity (while earning a substantial and gainful income) can determine whether or not a disability claim is approved or denied.
Return to: Social Security Disability Resource Center, or read answers to Questions
How to Appeal a disability claim denial from Social Security
Common Mistakes after Receiving a Denial of Social Security Disability or SSI Benefits
What is a Social Security Disability Denial based on?
Are there ways to avoid being denied for SSI or social security disability?
What does a Disability Denial Letter from Social Security say?
Reconsideration of a Social Security Disability denial- what does it involve?
What to do if you receive notification of a Social Security Disability or SSI claim denial
If you receive a Social Security Disability Denial quickly does that mean the case is weak?
What happens if my SSI or Social Security Disability Application is denied?
Social Security Disability Denied — The Reasons Why (medical denials)
Letter showing why I was denied for disability
How long does it take to get SSI Disability Benefits?
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 - Eligibility Requirements and Qualifications Criteria