Why Disability Claims are Denied

The Social Security Administration (SSA) receives millions of disability claims each year and denies a significant percentage of them. The exact number of denied claims varies from year to year, but data from the SSA shows that the denial rate has generally been around 60% in recent years. For example, in 2020, the SSA received approximately 3.1 million disability claims and denied about 1.9 million of them, for a denial rate of about 61%. In 2019, the SSA received about 3.4 million disability claims and denied about 2.1 million of them, for a denial rate of about 62%. It is important to note that these figures include initial claims as well as appeals of denied claims. The SSA has a multi-level appeals process, and many claimants who are initially denied may eventually be approved for benefits after going through the appeals process.

There are several reasons why a disability claim may be denied by the SSA. Some common reasons include:

1.       The claimant is not considered “disabled” under SSA rules: In order to qualify for disability benefits, an individual must be unable to engage in any “substantial gainful activity” due to a medically determinable physical or mental impairment that has lasted or is expected to last at least one year or result in death. The SSA has a strict definition of what counts as a disability and a rigorous process for evaluating claims. If the SSA determines that an individual’s impairment is not severe enough or does not meet the criteria for a disability, the claim will be denied.

2.       The claimant does not have sufficient medical evidence: The SSA will carefully review an individual’s medical records to determine the severity and duration of their impairment. If the SSA determines that there is not enough medical evidence to support the claim, the claim may be denied. It is important for claimants to have thorough medical documentation relevant to the period of disability they are requesting and that they provide SSA with with complete information about their medical records when applying for disability benefits.

3.       The claimant is actually performing substantial gainful activity.  The claim will be denied if the person’s work activity is substantial and gainful.  However, part-time work with relatively low wages may be considered as not substantial and gainful.

4.       The claimant is not following prescribed treatment: The SSA may deny a claim if an individual is not following prescribed treatment for their impairment. This can include failing to take prescribed medications or not following through with recommended therapy or rehabilitation.

5.       The claimant does not respond to SSA’s requests for information.  If SSA asks for documentation, and the claimant fails to provide it, SSA may deny the claim based on insufficient information.

6.       The claimant does not meet the non-medical requirements for disability insurance benefits (has not worked enough or recently enough in Social Security covered employment) or has resources or income that exceeds the limits to qualify for Supplemental Security Income.  If a claimant does not qualify for either program based in work history or financial status, the claimant’s application(s) will be denied.

It is important to note that a denied claim does not necessarily mean that an individual is not eligible for disability benefits. Claimants have the right to appeal a denied claim and can request a reconsideration or a hearing with an administrative law judge. Consulting an attorney is helpful in identifying and addressing the reasons for the denial.

The Roose & Ressler Team is located in Lorain, Toledo, and Wooster, Ohio. You can count on us as your local disability specialist to analyze your case thoroughly to determine what is necessary for you to receive benefits. We assess the best methods on how to prove the crucial facts of your case and gather the necessary evidence. Having 40+ years of experience serving Northern Ohioans, we know the ins and outs of the local disability process.

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Guide to Preparing and Applying for
Social Security Disability

For something this important, trust the team that knows.

We know our way around the process. We know what works and what doesn’t. We know specifically how to handle cases in northern Ohio and have four locations to serve you.

Hiring Roose & Ressler can alleviate the feeling of being alone throughout the process. We act as your point person and will be here to answer all your questions. We’ll make sure you meet the necessary deadlines and requirements for the appeals process.

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