When you apply for Social Security Disability Insurance (SSDI), you can be denied for either medical or technical (non-medical reasons). However, you can appeal either type.
Technical reasons for denial
In order to qualify for SSDI, you must be fully disabled from working due to a medical condition that is expected to last at least a year or result in your death.
Moreover, you must have earned a certain number of work credits within the last 10 years. (This year, the number is 20, which translates to about $28,200.)
The Social Security Administration (SSA) will examine your work history to ensure you have earned enough work credits to qualify. If you do not qualify for SSDI based on your work history, you may still qualify for Supplemental Security Income (SSI).
Medical reasons for denial
When determining your eligibility for SSDI, the SSA will ask several questions. Your answer to these questions could lead to a denial:
Are you working? If you are earning more than about $1,220 per month, you are not considered disabled and won’t qualify for SSDI.
Is your condition “severe”? In order to qualify as disabled, your condition must interfere with basic work-related activity. If it doesn’t, you may not qualify. Similarly, your condition must be one that will be long-term — at least a year — or result in your death.
Does your impairment meet or equal one that is described in SSA’s listing of impairments? This would be quite hard to determine without an experienced attorney. The listing of impairments is a complex document, but if your disability is on it, you have a good chance of qualifying for SSDI.
Can you perform the work you once did? If you can, you generally won’t be considered disabled and won’t get SSDI.
Can you perform other work? Again, this goes to the definition and severity of your disability. The SSA will look at your education and experience and see if there are jobs you could still perform in your geographic area.
Common specific reasons for denied SSDI claims
As you go through the process, there can be many pitfalls that could get your SSDI claim denied. Have you considered:
- Are your claim forms completed properly?
- Have you given the SSA accurate contact information so they can reach you?
- Have you responded to any requests for additional information?
- Have you gotten any consultative exams requested by the SSA? (These are examinations by independent doctors that may be requested)
- Have you granted the SSA access to your medical records?
If you have filled out your claim form correctly and have responded to any requests for additional information, your claim could still be denied, however.
Probably the main reason for a claim being denied at this point is that you have failed to produce sufficient medical evidence to prove your legitimate disability. If this is the reason for your denied claim, you should sit down with an experienced Social Security Disability attorney for help.
In some other cases, you can be denied if you refuse to follow your doctor’s treatment advice.
Finally, SSDI is not available to people whose disability is primarily based on drug or alcohol addiction. If you are suffering from addiction, however, this does not necessarily mean you do not qualify for SSDI. You should work with an attorney to demonstrate that your disability is not primarily the result of your addiction.
If you have a legitimate disability but your claim was denied, the SSA will tell you the reason for your denial. You have the right to get help from an attorney at any point in the process, and an attorney may be able to polish your application or include additional information so that it will be approved on reconsideration or appeal.