Social Security Disability: 8 Reasons You May Be Denied Benefits

Will your claim for SSDI or SSI disability benefits be denied?

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 turn the perspective around and understand the reasons why you might be denied SSDI or SSI benefits. In some cases, the reasons are beyond your control.

In other instances, though, you may be able to avoid doing something that results in a denial. Here are some circumstances that may get you denied, and what you can do about them.

1. You Earn Too Much Income

SSDI is the benefit program for workers who have paid into the Social Security system over multiple years.

One of the most basic reasons you could be denied SSDI benefits is that, when you apply, you're earning above the limit that's considered "substantial gainful activity" (SGA). This means you earn 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 limit.

The SGA limit in 2024 is $1,550 per month (for nonblind people). The figure is adjusted annually. Income from investments doesn't count toward the SGA limit—only work income counts, as it shows your ability to work.

As to SSI, which is the disability benefit for low-income people, when you apply for SSI, you can't be making over the substantial gainful activity level. But after approval you can earn more money than that. The limit on all earned and unearned income for SSI is around $1,900 per month. And any time your income is over $85 per month, your SSI payment will start to be reduced, by a somewhat complicated formula. If you make more than about $1,900, your payment would be reduced to zero; in other words, you won't qualify for SSI.

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

To qualify for SSDI or SSI benefits, the Social Security Administration (SSA) must believe that your impairment is severe enough to last at least 12 months (or result in your death). The only exception to this duration requirement is for blind SSI applicants.

Many claims—like claims for bone fractures resulting from acute trauma, such as automobile or motorcycle accidents—are denied because they're not likely to cause disability for 12 months. (Almost all bone fractures heal in less than a year.) However, if you have severe bone fractures that aren't healed after six months, the SSA is then likely to think your impairment will last a year. Each case is evaluated on an individual basis.

In addition, your medical condition must cause you severe limitations to qualify for SSDI or SSI. Most claims are denied simply because the SSA didn't consider the applicant's impairment to be severe enough to prevent all types of work (for more information, see Nolo's article Social Security Disability: How Claims Are Decided).

3. The SSA Can't Find You

Social Security and Disability Determination Services (DDS)—the state agency that determines your medical eligibility for benefits—must be able to communicate with you regarding your application. If these agencies can't reach you to schedule examinations or communicate with you about critical matters, they're likely to deny you benefits.

If you name a representative (such as an attorney) to handle your paperwork, you might not need to get in touch with the SSA, but be sure to stay in touch with your representative or attorney.

If you move while your application is being considered, make sure the SSA knows how to contact you. Claimants (those who are applying for Social Security disability) get denied every day because the SSA can't find them.

4. You Refuse to Cooperate

Your medical records are vital to granting your disability. If you refuse to release those records to the SSA, your claim will be denied.

Similarly, the SSA may need additional information about your impairments, either because your treating doctor's medical records are incomplete or because you have no regular treating doctor. In these instances, the SSA will request that you be examined by an SSA doctor, during a "consultative examination" (CE), at government expense. In some cases, the SSA will require you to attend more than one CE.

If you refuse to attend a CE, or request that the SSA make a determination based on the medical records already in your file, you can be denied disability because of inadequate medical information or failure to attend the CE.

If you can't make it to a scheduled CE because of the time or location, talk to your DDS claims examiner so the DDS can schedule a CE at a time or place that is convenient for you. If you repeatedly fail to show up for a CE, your claim will most likely be denied.

5. You Fail to Follow Prescribed Therapy

If you're being treated by a doctor, but fail to follow the doctor's prescribed therapy when you have the ability to do so, you can be denied disability benefits. However, the SSA recognizes certain legitimate excuses for failing to follow the doctor's orders (which can be for taking medicine, going to therapy appointments, or undergoing surgery).

Acceptable medical excuses. Failure to follow prescribed therapy can be excused for reasons beyond your control. Some examples follow.

  • You have a mental illness so severe that you can't comply with prescribed therapy.
  • You have a fear of surgery so intense that surgery wouldn't be appropriate. Your treating doctor must confirm the severity of your fear to the DDS consulting doctor.
  • You physically can't follow prescribed therapy without assistance—for example, because of paralysis of the arms or cataracts caused by diabetes.

Acceptable nonmedical excuses. It is possible that you can't follow a prescribed therapy for a reason that has nothing to do with your medical condition. Acceptable nonmedical excuses for failing to follow prescribed therapy follow.

  • 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.

Additionally, for the SSA to deny your claim for failing to follow therapy, the therapy that you fail to follow must be one that is clearly expected to restore your ability to do substantial gainful activity. If your treating doctor tells Social Security that the prescribed therapy is not likely to result in your ability to work, the SSA won't fault you if you don't follow such therapy.

For more information, see Nolo's article on the impact of failing to follow prescribed treatment.

6. Your Disability Is Based on Drug Addiction or Alcoholism

Social Security will deny benefits to applicants whose drug addiction or alcoholism (DAA) contributes to their disability. The key factor a DDS medical consultant considers when making a "DAA determination" is whether or not the SSA would still find you disabled if you stopped using drugs or alcohol.

For more information, see Nolo's article on when drugs or alcohol will prevent you from getting disability.

7. You've Been Convicted of a Crime

Certain conditions related to conviction of a crime or imprisonment will prevent you from receiving Social Security disability insurance benefits. Here are the circumstances where you'll be denied benefits:

  • 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.

However, it's worthwhile to apply for SSDI benefits even if one of the above situations apply to you, because even if you can't get cash benefits, you may be granted a period of benefit-free disability that will "freeze" your earnings record, keeping your eventual disability, retirement, or dependents benefits from decreasing.

Note these situations don't prevent you from receiving SSI disability benefits, although being incarcerated does keep you from collecting SSI benefits.

    8. You Commit Fraud

    If you obtain disability benefits by dishonest means, the SSA can terminate your benefits and prosecute you for fraud. If you obtained benefits through fraud on the part of someone working for the SSA, your benefits can also be terminated.

    For More Information

    If your claim has been denied for one of the above reasons, see Nolo's article Social Security Disability: Deciding Whether to Appeal a Denied Claim. Or, for more information in general about Social Security disability in general—including tips on applying for benefits, appealing a denial of benefits, and understanding detailed medical listings—see Nolo's Guide to Social Security Disability: Getting & Keeping Your Benefits, by David A. Morton III, M.D. (Nolo).

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