5 Most Common Reasons Social Security Claims Are Denied

5 Most Common Reasons Social Security Claims Are Denied


Filing a Social Security Disability claim can be an intimidating process.  Even if you do everything right, your claim can still be denied.  Only about one third of initial claims are approved.  Knisley Law Offices wants you to know some of the most common reasons Social Security denies claims, what you can do to give your initial claim the best shot, and also how to fight a denial and win on appeal.

How Many Claims Are Denied?

“Initial awards,” or claims approved on the initial paperwork without any appeals process, are surprisingly low – and getting lower each year. According to the 2013 Annual Statistical Report on the Social Security Disability Insurance Program, only 21 percent of initial claims were approved in 2012. That is a statistic down from 28 percent in 2003. Additionally, only about 11 percent more are eventually awarded on appeal.

Why Are So Many Social Security Claims Denied?

There are two categories of Social Security denials: technical and medical. We will break down some of the ways you can be denied in each category.

Technical: Communication problems

If you fill out the contact information on your claim incorrectly, move without updating your claim, or do not respond to their letters, the Disability Determination Service will deny your claim.

Technical: Failing to provide records or missing appointments

Whether you personally refuse to send your medical records or your doctor does not send them, Social Security simply cannot evaluate your claim if they do not receive medical records Sometimes the government will request a consultative examination – a mandatory medical appointment where a Social Security doctor examines you to verify the information in your records. If you refuse or do not show up to these appointments, your claim will be denied.

Technical: Substantial gainful activity

If you are working part-time while disabled, you could be denied benefits. Social Security says you are capable of earning a living despite your disability if you are making more than $1,090 a month in 2015.

Medical: Lack of medical evidence or severity

Your claim could also be denied if you are not seeing a doctor about your disability. Examiners must use documented medical records. If there is no documentation of a severe enough disability from medical professionals, the SSA cannot and will not just take your word for it.

Medical: Residual function capacity

SSDI wants to know if you can perform any full time work, not just the work you were doing before the disability. The examiner will look at your physical and mental limitations. They will then decide if you can perform any of the work from the last 15 years of your job history. If not, they will use the “medical-vocational rules” to see if you can learn to do any other job.

What Is The Next Step If Your Claim Is Denied?

If your claim is denied, there are four levels of appeals you can work through:

* A reconsideration by the State Disability Determination Services office
* A hearing by an administrative law judge
* A review by the Appeals Council
* A federal court review

Once a claim reaches the hearing and review level, about 60 percent of medical appeals are approved. Many claimants give up after the initial denial or reconsideration level; however, it pays to keep fighting for your deserved benefits if you are able to demonstrate a medical disability.

You have worked hard to pay into the system, so do not let the first round or two knock you out. Contact us today to discuss your case. We will help you understand how to give your initial claim the best chance of success. If your initial claim was denied, we can also help you navigate through the complicated appeals process.