Common Reasons Social Security Disability Claims Are Denied

How to Appeal When Your Application for Benefits Is Rejected

You’ve suffered an injury or illness that prevents you from being gainfully employed. It seems clear that you meet all the requirements to collect social security disability insurance benefits. You’ve applied, but your claim has been denied. You’re not alone. According to data collected by the Social Security Administration, less than one of every four initial applications for benefits are approved. What are the common reasons an SSDI claim is rejected? What is the process for appealing a wrongful denial of benefits?

Why Are So Many Social Security Disability Claims Initially Denied?

While every SSDI claim has unique facts and circumstances, there are some common causes for the initial rejection of what seems to be a valid claim:

• You provided the Social Security Administration with insufficient evidence of your injury or illness—The injury may be readily apparent to you, but the Social Security Administration won’t simply take your word for it. You must provide strong and compelling medical evidence that you have a qualified disability and that the disability interferes with your ability to perform your job. It’s critical that your medical providers accurately and thoroughly document your medical condition.
• You make too much money—You can have some income and still be eligible for SSDI benefits, but if your income exceeds permissible levels, your claim will be denied. Currently, you can earn up to $1,550 per month and still qualify for SSDI. If you are blind, that amount increases to $2,590 per month.
• You failed to follow medical advice—Your claim is likely to be rejected if there’s evidence your doctor recommended a form of treatment, or advised you to refrain from doing something, and that you ignored your doctor’s recommendations. The examiner may contend that, unless you obtain the necessary medical treatment, or follow doctor’s orders, it’s impossible to confirm that you are actually disabled.
• You failed to cooperate with the examiner or other personnel at the Social Security Administration—If you have been asked to provide additional information but failed to do so, or if you’ve been uncooperative in any way with SSA officials, your claim can be dismissed.
• You already have a claim that has been denied—Far too often, a person simply files a new claim, rather than using the appeals process to challenge a denial of benefits. If you have an open claim that has been rejected, a new claim for the same injury or illness will not be allowed.

What Is the Appeals Process When Your SSDI Claim Has Been Denied?

Under the laws governing social security disability insurance benefits, there are four levels of appeal when a claim is initially rejected:

• Reconsideration—After the initial denial of an SSDI claim, you have 60 days to submit a written request for reconsideration. The request may be made online, by mail, or by fax. If your request is granted, your claim will be reviewed by an SSA examiner who was not involved in the denial of your claim. You may submit new evidence.
• Hearing before an administrative law judge—If you receive an unfavorable ruling in the reconsideration, you can ask for a hearing with an administrative law judge. This may also be done online or by mail or fax. The request must be filed within 60 days of your receipt of the notice of reconsideration determination. The judge may ask questions. You can introduce new evidence and may call witnesses on your behalf. You can also ask the judge to review the evidence without holding a hearing.
• Review by the Appeals Council—If you disagree with the ruling of the administrative law judge, you can file a request with the Appeals Council, either online or by mail or fax. You must do so within 60 days of receipt of the unfavorable ruling by the administrative law judge. To qualify for review by the Appeals Counsel, you must have new evidence, and there must be a reasonable likelihood that the new evidence will change the ruling in your case.
• Review by the federal courts—If your claim is denied by the Appeals Council, you have 60 days to file a lawsuit in a U.S. district court. The court will review all evidence and may either render a decision or send the case back to the Social Security Administration for determination.

Let Bailey & Galyen Help You Maximize Your Chances of Getting SSDI Benefits

At the law offices of Bailey & Galyen, we have fought for the rights of people in Texas and nationwide for more than 40 years. We have a comprehensive understanding of the social security disability insurance program, and we know how to give you the best chance of getting the benefits you need in a timely manner. To learn more about how we can help you qualify for SSDI benefits, contact us by e-mail or call our offices at one of the convenient locations listed below. Our phones are answered 24 hours a day, seven days a week.