What Should You Do If Your Social Security Disability Claim Is Denied?
Key takeaways:
Social Security Disability Insurance (SSDI) is a federal program that provides disability benefits to qualified individuals.
If you are denied benefits, you have the right to appeal the denial of your claim.
Common reasons for denial include being able to work or the impairment is not severe.
Social Security Disability Insurance (SSDI) is a federal program that provides disability benefits. Approximately 85% of SSDI beneficiaries are disabled workers. In 2020, the average age of a disabled-worker beneficiary was 55.
Supplemental Security Income (SSI) is also available for disability. But the rules for qualifying for SSI and SSDI are strict. From 2010 to 2019, the SSA denied about 67% of applications for SSDI.
But you have the right to appeal a decision. While the process can be time-consuming, it is worth it.
Prescription Savings Are Just the Beginning
See what other benefits you qualify for—from cashback cards to cheaper insurance.
Below, we’ll take a look at why the SSA denies claims, how the appeals process works, and your chances for success.
How does Social Security disability work?
Social Security disability benefits provide financial support to individuals who have a qualifying disability. The disability must limit a person's ability to work.
If you think you qualify for Social Security disability benefits, you can apply for SSDI or SSI by phone, online, or in person.
Contact the National Social Security office by phone (1-800-772-1213)
Visit a local Social Security Administration office
Once you submit your application for SSDI, there is a minimum 5-month waiting period. This means you will not receive benefits until your sixth full month of disability. The exception is if you have amyotrophic lateral sclerosis (ALS).
Once you submit your application for SSI, you will get your first payment on the first full month after you applied or became eligible.
Who’s eligible for Social Security disability?
Both SSDI and SSI have the same definition for disability. It is a physical or mental impairment that either:
Must last for at least 12 months
Is expected to result in death
Read more like this
Explore these related articles, suggested for readers like you.
Generally, you need 40 credits, or 10 years’ work experience, to qualify for SSDI. You also have to earn 20 credits within the past 10 years. But there are exceptions to the requirements if you are young.
You must also meet one of these requirements for SSDI:
A worker who is blind or has low vision
Disabled worker under age 65. The family may also qualify for benefits.
Disabled widows or widowers who are age 50 or over — Additionally, the deceased spouse must have enough work credits
Adults disabled before age 22 may qualify under certain circumstances. If the parent is deceased, the disabled adult may qualify for benefits. They may also qualify for benefits if the parent starts receiving disability or retirement benefits.
For SSI, the program is needs-based. There are no work credit qualifications. SSA requires that you are either:
Disabled
65 or older
Blind
You will also need to meet these requirements:
Limited income: The SSA has a complex formula that calculates your benefits according to your income. Your income includes wages, self-employment earnings, and other benefits.
Limited resources: If you are a single adult or child, your assets must not exceed $2,000. For a couple, the limit is $3,000. This does not include your residence, car, and household items.
Why are Social Security claims denied?
The SSA provides the following reasons:
The impairment is not expected to last 12 months.
The impairment is not severe.
You can perform your work.
You can pursue other work.
The impairment is from drug addiction or alcoholism.
You did not provide sufficient medical evidence.
You did not follow medical treatments.
How does the Social Security disability appeals process work?
For SSDI and SSI, you have 60 days to appeal a denial of your claim.
There are four levels, and they must be followed in this order:
Reconsideration: The SSA conducts a complete review of the claim. You can submit new evidence for your case.
Hearing: This is a proceeding with an administrative judge from the SSA. The hearing is available online.
Review by the Appeals Council: The SSA can either deny the claim, make a ruling, or remand the decision to the administrative judge.
Federal court review: You can file a civil suit in federal district court. This is a complicated process, and you will want to seek help from qualified legal counsel.
Who’s most at risk of experiencing a Social Security denial?
Based on SSA data, the following conditions mean the highest chance of receiving a denial:
Your disability is not severe: 24.8%
You are unable to do other work: 41.8%
What are your chances of winning a Social Security appeal?
The success rate for reconsideration was 15.7% of applications in 2019 and 61.7% for a hearing, according to research from the SSA.
The data for the SSA Appeals Council shows the number of cases remanded for hearings. This means the case was sent back for another administrative law judge hearing. In 2020, the Appeals Council processed 191,734 cases, and 14.59% were remanded. This does not necessarily mean there was a favorable outcome.
Data is not available for federal court reviews of denials. There are likely few cases because of the high costs of litigation.
Can you always appeal a denied Social Security disability claim?
Yes, so long as it is within 60 days of the denial. When you receive the notification for the denial, there will be a statement about your right to appeal the decision and the process.
How many times can you appeal a denied claim?
There are four levels of appealing the decision.
The bottom line
The SSA has two programs for disability: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both programs have the same definition for disability but have different requirements to qualify for benefits.
If the SSA denies your claim, you have a right to appeal the decision. This includes four levels: reconsideration, hearing, review by the Appeals Council, and federal court review. You need to make sure you file your initial application within 60 days of the denial. If not, you might lose your right for the appeal.
Why trust our experts?
References
SSA.gov. (n.b.). Disability Benefits.
SSA.gov. (n.b.). AC Remands as a Percentage of all AC Dispositions.
SSA.gov. (n.b.). Annual Statistical Report on the Social Security Disability Insurance Program, 2020.
SSA.gov. (n.b.). Apply Online for Disability Benefits.
SSA.gov. (n.b.). What You Need to Know When You Get Supplemental Security Income (SSI).
SSA.gov. (n.b.). Red Book.
SSA.gov. (n.b.). Disability Benefits | How You Qualify.
SSA.gov. (2022). Understanding Supplemental Security Income SSI Eligibility Requirements -- 2022 Edition.
SSA.gov. (n.b.). Disability Benefits | Appeal A Decision.
