Reasons why SSDI claims are denied

On Behalf of | Jul 7, 2022 | social security disability

The Social Security Disability Insurance program can provide people with much-needed benefits after they become unable to work due to injury, illness or underlying condition. Unfortunately for many applicants, the eligibility requirements can be quite strict. Most applicants are turned down the first time they apply for benefits.

How SSDI works

Workers contribute to Social Security Disability Insurance through payments every payday. If they have a disability that is severe and has long-term impact, SSDI will provide financial assistance, health insurance and back to work assistance. But the Social Security Administration’s eligibility requirements can be stringent.

Less than 40% of the approximately 2 million people who seek SSDI each year will receive benefits, according to data from the Social Security Office of Retirement and Disability. The SSA denies approximately 67% of initial SSDI applications.

Only 8% of former workers will receive benefit approval during their first appeal or reconsideration. After a hearing, only 2% of claimants will succeed with appealing the denial of benefits.

Work history

If a worker has sufficiently paid into the SSDI system through their paychecks, they are technically eligible for Social Security Disability benefits, but only if their condition meets the SSA’s definition of a disability. A disability is defined as a physical or mental impairment that prevents them from being able to perform substantial gainful activity for 12 months or having a terminal diagnosis.

Substantial gainful employment involves work for pay or profit. The monthly benefit for 2022, after qualification, is $1,350 a month.

Applicants must have engaged in work for at least 5 of the last 10 years. This requirement may be different for younger workers. Applicants must also be at least 21 and did not reach their full age of retirement before they became disabled.

Documentation

It is essential to gather detailed medical information supporting a disability and its impact on the worker’s ability to engage in substantial gainful activity. The information should include diagnosis, medical test results, history of treatment, drugs, surgeries, and hospital and doctor visits. This information needs to demonstrate that the worker has a problem that is receiving ongoing medical treatment.

Medical information explaining the disability’s impact on daily living is particularly important for workers having a mental disorder, neurological condition, cognitive dysfunction, or other invisible disability caused by an injury or disease. Ongoing monthly treatment and drug therapies with specialists and mental health practitioners may be a significant part of a claim.

Representation

SSA does not inform initial applicants that they have the right to have someone represent them early in the application process. Only 30% of applicants have a representative assist them, but those who do have representation are 23% more likely to have their application approved. Representation can also help assure that applicants receive their benefitsmore quickly.