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The way the Social Security disability system is supposed to work is that if you have a disability which prevents you from working, Social Security Disability Insurance (SSDI) is there for you as a financial “safety net.” For individuals who are disabled and have never been able to work or who have worked but haven’t earned enough recent work credits to qualify for SSDI benefits, Supplemental Security Income (SSI) is supposed to be a lifeline for them. Unfortunately, the system does not always work the way it should. Every year, many American workers apply for disability benefits and are denied. Nationally the initial denial rate is disheartening—about 60%. But what are the main reasons for denials and how can they be avoided?
Denial Reason #1: Insufficient Medical Evidence
To qualify for disability benefits, it is not enough to say you are disabled. It is not enough even for your doctor to say you are disabled. This may surprise you but, in reality, the term disabled doesn’t mean much to the Social Security Administration.
Cuddigan Law Attorney Kim Schram explains that “the SSA may judge that you have a disabling condition and grant disability benefits:
- If you are unable to go to work to perform your previous occupation full or part time and you do not earn more than the monthly amount of the substantial gainful activity limit.
- If you cannot adjust to other work--if your skill set cannot be applied to a different, easier job.
- If your medical condition has lasted or is expected to last for at least one year. If your condition will improve quickly, you will not qualify for Social Security disability benefits.”
SSA will not pay benefits without precise and up-to-date medical documentation like bloodwork panels; imaging studies like MRIs, CAT scans, and X-rays; physician examination and treatment notes; and mental health records. You will need up-to-date medical records to show the current state of your condition and you will also need a history of how the condition has progressed.
It is also critical to include a history of your treatments. SSA wants to know what treatments you have been given and how your condition(s) have responded to those medical treatments. In some cases, the SSA will deny your claim unless you submit a detailed treatment history. Therefore, it is critical that you see your doctors early and often. Keep in mind that the SSA will not consider lack of insurance or income as a valid reason for missing regular medical treatment because there are clinics which offer free or low-cost treatment for those with limited resources. “The bottom line here is: Complete medical records are crucial to winning disability benefits,” Schram points out.
Denial Reason #2: Your Condition Is Not a Qualifying Medical Condition
To determine if you are medically eligible for disability benefits Social Security has a set of procedures in place. These procedures are published in a handbook known as the “Blue Book,” and it includes a list of various disabling conditions known as “listings.”
However, most often an applicant’s medical conditions will not precisely meet the Blue Book’s technical requirements to qualify for disability payments. But there is a second way to qualify. You may be eligible for Social Security disability benefits if you can prove that, due to the limitations of your condition, you are unable to perform any job in the national economy, considering your age, education, and past work. This is where a skilled disability attorney is your best ally. He or she can work with you and your healthcare providers to build a convincing argument for why you should be awarded benefits.
Denial Reason #3: Your Employment History Is Not Long or Recent Enough to Qualify for SSDI
In addition to your medical evidence, Social Security will review your employment history and your Social Security work credit status. SSDI eligibility and the amount of benefits payable are based on how much you have worked in the ten years prior to your Social Security disability claim. Work credits are based on the amount of your earnings. In 2024, you receive one credit for each $1,730 of earnings, up to the maximum of four credits per year. Each year the amount of earnings needed for credits goes up slightly as average earnings levels increase. The number of work credits you need to qualify for disability benefits depends on what your age was when your disability began. The general rule of thumb is that a person needs 40 credits, and 20 of these must have been earned in the last 10 years. However, younger applicants may need fewer work credits.
If you do not have enough work credits, your SSDI claim can be denied, even if you qualify as disabled. But in this case, you may be eligible for Supplemental Security Income (SSI). SSI is based on financial need. The Social Security Administration says, “It is designed to help aged, blind, and disabled people, who have little or no income.” Because work credits and qualifying for SSI can get complicated, you may wish to seek the advice of a skilled disability attorney who can help you decipher the requirements.
What should you do now if your Social Security disability claim been denied?
First, you should always appeal a denial. Most disability claims that are denied are not appealed, even though many claims are approved after an appeal and hearing.
But it is critical that you appeal within the time allowed by the Social Security Administration. In most situations you have 60 days from the time you receive notice of denial of your initial claim or your reconsideration.
Delaying your appeal and being forced to file a new application is generally a waste of your time because you will be forced to go through the whole time-consuming process again. Your chances are much better with appealing the denial of the original claim.
Don’t give up! Consider hiring an attorney to represent you in the appeals process. Statistics show that if you are represented by an attorney, you are more likely to win your benefits case. Chose a lawyer who focuses exclusively on Social Security disability benefits.
If your disability claim is denied, contact the Social Security office as quickly as possible, or contact a lawyer to file an appeal. The sooner you appeal, the sooner Social Security will schedule a hearing, which gives you the best opportunity to explain your work limitations.
For a free evaluation of your case contact the disability law attorneys at Cuddigan Law.
