Reasons You May Be Denied Social Security Benefits

How to tell whether your claim for SSDI or SSI disability benefits will be denied or approved.

By , M.D.
Updated by Diana Chaikin, Attorney · Seattle University School of Law

When applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), most people naturally think about the reasons why they should be granted benefits. You may find it useful, however, to shift perspective and understand the reasons why you might be denied SSDI or SSI benefits.

Spotting weaknesses in your disability application doesn't have to be a bad thing. Once you're aware of potential pitfalls that could disqualify you from receiving disability benefits, you can work on addressing them and strengthening your claim. Sometimes, the reasons for a denial are beyond your control, and there isn't much you can do about them. But often you can avoid doing something that hurts your chances of approval.

Signs That You Will Be Denied or Disqualified for Disability

Below are some of the most common reasons why disability applications are denied.

You Earn Too Much Income to Qualify for SSDI or SSI

Most people use SSDI and SSI interchangeably, but they're two separate benefits. SSDI is the benefit program for workers who have paid into the Social Security system over multiple years, while SSI which is the needs-based benefit for people below a low-income threshold. Each program has preliminary eligibility requirements that you must establish before you're legally allowed to receive the benefit.

One of the eligibility requirements is that you're not earning above the limit that's considered substantial gainful activity (SGA) when you apply for disability. Earning above this amount means you make too much money to be considered disabled. You're allowed to work a small amount when you're applying for and collecting SSDI, but not over the SGA amount.

The SGA limit in 2024 is $1,550 per month ($2,590 for blind people), adjusted annually. Only wages you receive from work count towards the limit—investment income isn't included. Even if you earn the entire SGA amount in one week and are bedridden for the rest of the month, Social Security can't consider you disabled at that level of work income.

Keep in mind that, in some cases, you can earn above SGA after you've already been approved for disability. SSDI recipients can dip their toes back into the labor pool without risking losing their benefits during a trial work period. And people receiving SSI can make more than SGA up to a certain point (about $1,900 per month) and still get benefits—however, the monthly benefit amount will be reduced based on any earnings above the federal benefit rate.

Your Disability Won't Last Long Enough or Isn't Severe Enough

The Social Security Administration (SSA) doesn't pay benefits for short-term or temporary disabilities. You'll need to show that your medical condition is severe enough to last at least 12 months or result in death before the agency will approve your application. The only exception to this durational requirement is for blind SSI applicants.

Many claims—like those for bone fractures resulting from acute trauma, such as automobile or motorcycle accidents—are denied because you're likely to fully heal in less than a year. But if complications from treatment significantly extend your recovery period, the SSA is more likely to think that your impairment will last a year or more.

In addition to the durational requirement, your condition must have "more than a minimal impact" on your activities of daily living to qualify for disability. If you have a condition such as athlete's foot, tennis elbow, or a topical rash that—while annoying—can be easily handled with basic medical treatment, your claim is likely to be denied (unless you have another, more severe disorder). Your combined impairments have to keep you from performing any full-time job.

The SSA Can't Find You

When you first apply for disability, the state agency that determines your medical eligibility for benefits—Disability Determination Services (DDS)—must be able to communicate with you regarding your application. DDS helps process applications for Social Security disability at the initial and reconsideration levels. If the SSA or DDS can't reach you to schedule examinations or communicate with you about critical matters, they're likely to deny you benefits.

Disability claimants get denied every day because the SSA can't find them. You can name a representative (or hire an attorney) to handle your paperwork and communicate with the SSA and DDS, but you'll need to maintain contact with your representative. Lawyers are allowed to "fire" clients who don't keep in touch with them.

Because the disability determination process can take several years to complete, many people move while their applications are under review. Make sure the SSA knows how to contact you by keeping your address up to date. Current contact information is especially important at the hearing level, where your claim will be assigned to a disability judge at a hearing office near you.

You Refuse to Cooperate

Supportive medical records are the foundation of a successful disability application. If you don't release those records to Social Security, your claim will be denied.

Likewise, if you don't attend a consultative examination (CE) that Social Security schedules for you, your application may be denied. The agency can send you to a CE when they need additional information about your impairments, either because your treating doctor's records are incomplete or because you have no regular treating doctor. CEs are provided at government expense and transportation costs are often covered, so you'll need to have a good excuse as to why you couldn't attend a CE that you missed.

If you know in advance that you can't make it to a scheduled CE, speak with your claims examiner at DDS to reschedule your examination for a time or place that is convenient for you. Repeatedly failing to show up for a CE means your claim will almost certainly be denied.

You Fail to Follow Prescribed Therapy

When reviewing your application, Social Security needs to see that you're following "doctor's orders" by taking your medication as prescribed and engaging in recommended therapy. This is because if you don't follow your doctor's advice, the agency has no way of knowing whether your medical condition would improve to the point that you could work—and can deny your claim.

Even so, the SSA recognizes certain justifications for failing to follow your doctor's orders. These reasons can involve medical "contraindication" (a situation where a medication, procedure, or surgery could cause harm to the patient) or other specific financial, religious, or personal reasons. Some acceptable justifications include:

  • You have a mental illness severe enough to keep you from engaging in prescribed therapy.
  • You have a very intense fear of surgery as confirmed by your treating doctor.
  • You physically can't follow prescribed therapy without assistance (for example, you have neuropathy or cataracts caused by diabetes).
  • You don't have the money to pay for treatment.
  • Your religious beliefs prohibit you from receiving medical therapy.
  • Your doctor prescribes treatment that another doctor disagrees with.

Keep in mind that for Social Security to deny your claim due to failure to follow recommended treatment, the treatment must have been expected to restore your ability to perform SGA. If your treating doctor doesn't think that the therapy would have resulted in your ability to return to work, the agency won't hold it against you if you don't comply.

Your Disability Is Solely Based on Drug Addiction or Alcoholism

Social Security isn't allowed to approve disability applications when the only impairment is drug or alcohol abuse (DAA). But that doesn't mean that any evidence of DAA is fatal to your claim. You'll need to show that substance abuse is "immaterial" to your claim—meaning that you'd still be disabled if you stopped using drugs or alcohol. This is usually accomplished by establishing a period of sobriety during which your medical records show that you still have disabling symptoms from an underlying medical condition.

You're Incarcerated After Being Convicted of a Felony

Generally, a felony conviction doesn't impact your eligibility for SSDI or SSI. However, you can be disqualified from receiving SSDI in certain circumstances:

  • You're in prison after being convicted of a felony, unless you're in a court-approved rehabilitation program that's likely to result in your getting a job when you get released, and your release is expected to occur within a reasonable amount of time.
  • You were injured while committing a felony and were convicted of the crime. The impairment—or the worsening of an existing impairment—that you suffered during the commission of a felony can't be used as a basis for applying for disability benefits.
  • You were injured while in prison. The impairment—or the worsening of an existing impairment—that you suffered while you were in prison can't be used to obtain benefits. But you can generally receive benefits after being released from prison.

It can still be worthwhile to apply for SSDI benefits in the above situations due to the "disability freeze." Under the freeze period, you won't be able to get cash benefits from SSDI, but you'll keep your eventual disability, retirement, or dependents benefits from decreasing.

SSI doesn't have a disability freeze and you can still receive SSI disability benefits if you have a felony conviction, although you won't be able to collect SSI during your incarceration.

You're Suspected of Fraud

Social Security can terminate your benefits and prosecute you for fraud if you obtain disability benefits by dishonest means. This includes obtaining benefits through fraud on the part of someone else, such as a doctor or somebody working for Social Security.

If you're suspected of fraud, you may be the subject of a cooperative disability investigation (CDI). During a CDI, an investigator will be asked to observe you and write a report based on what they find. The CDI report can include any discrepancies between what you've told Social Security about your disability and how you complete your daily routine. Investigators can also talk to your neighbors to learn more about you.

Signs That Your Disability Claim Will Be Approved

Below are some factors that can weigh heavily in your favor when determining whether your claim will be approved.

You Have One or More Supportive Notes from Doctors

The SSA values the opinions of the doctors you regularly see to treat your medical conditions. So if you have multiple medical source statements saying that you either meet a listing or have a significantly reduced functional capacity, it's likely that the SSA will take those opinions seriously when determining whether you're disabled.

You're At Least 50 Years Old

Getting disability benefits is easier the closer you get to full retirement age. Under a special set of rules known as the "medical-vocational grid," you can qualify for benefits if you can't do your past work and the SSA doesn't expect you to learn how to do another, less demanding job. This means that, unlike applicants under the age of 50, you may be able to get benefits even if you're physically capable of performing light or sedentary (sit-down) work.

For example, consider two applicants who are applying for disability due to degenerative disc disease. Both applicants worked heavy construction jobs, have high school diplomas, and are physically limited to sedentary work. The same DDS examiner is handling both their claims and, after consulting a job expert, determines that the applicants can't use their construction skills at sit-down jobs.

Because the first applicant is 52 years old, the DDS examiner applies grid rule 201.14, which directs a finding of disability given their age, education, work experience, and physical limitations. The 52-year-old's application is then approved. But because the second applicant is 42 years old, the grid rules don't apply, and the DDS examiner determines that the younger applicant can perform other work, such as small parts assembler. With other work available that they can perform, the 42-year-old's application is denied.

You Have Solid Medical Evidence

The easiest claims for Social Security to decide are the ones that have extensive medical evidence pointing to a disability. If you've had a lot of clinical notes, lab work, medical imaging (such as X-rays, MRIs, or CT scans), and physical examinations that establish how severe your impairment is, you'll have smoother sailing than somebody with sparse documentation.

Quality matters as much—if not more—than quantity, however. Having a lot of clinical notes all saying that nothing's wrong won't help your claim, and one or two lab results showing extensive organ failure may be persuasive to the SSA even without regular doctor's visits. Ideally, your disability file will contain both a steady history of medical treatment as well as objective testing that can back up your subjective symptoms.

Your Impairment Is on the Compassionate Allowances List

The Compassionate Allowances list consists of the most serious disorders that Social Security reviews. Because a diagnosis of these conditions can be potentially life-threatening, the Compassionate Allowance program lets the agency target the most clear-cut disability claims and quickly approve them for benefits.

If you have a condition on the Compassionate Allowance list, your claim will be flagged for expedited processing, and you may receive a decision in just a few weeks. You don't have to do anything special—DDS will check to see if you may qualify for a compassionate allowance after you submit your application.

Why Do I Keep Getting Denied for SSDI or SSI?

Your technical denial letter should tell you why you were denied for Social Security disability. Read it carefully. If you don't see one of the above reasons in your denial, consider getting help from an experienced disability attorney.

Most people are denied at the DDS stage. Unfortunately, a lot of people get so discouraged that they don't appeal the denial, meaning they miss out on their best shot at getting approved—appearing at a disability hearing before an administrative law judge. Having the opportunity to speak with a judge and address any issues with your claim is invaluable, so don't let the appeal deadline pass you by.

For more information about Social Security disability in general—including tips on applying for benefits, appealing a denial, and understanding complex medical listings—see Nolo's Guide to Social Security Disability: Getting & Keeping Your Benefits.

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