Disability claimants often believe that filing for Social Security Disability Insurance (SSDI) disability benefits is similar to filing for SSA retirement: You simply file your application and a few weeks later, payments are sent to you. Unfortunately, the Social Security Administration (SSA) estimates that up to 60 to 70 percent of first-time disability applicants are denied disability benefits.
So before you start what can be a baffling, agonizing and frustrating process for many disability applicants, it is important to understand how you can improve your chances of winning SSDI the first time you apply.
To qualify for SSDI benefits, a claimant must have a severe mental or physical health condition that will last for at least 12 continuous months and that does not allow the claimant to perform substantial gainful activity. Claimants must also have sufficient work credits to be considered "insured" for SSDI. Below, we will discuss the most common reasons why claimants may be denied SSDI benefits.
1. Insufficient Medical Evidence to Prove Disability
The SSA will rely entirely on a claimant’s medical records to determine the severity of their condition, the duration of their condition, and whether the condition limits the claimant’s functional ability to work.
Unfortunately, regardless of the severity of your condition, if you do not have medical records that clearly outline your diagnosis, your prognosis and your limitations to work, you are likely to be denied SSDI benefits by the SSA.
What if you cannot pay to see a doctor? If the SSA does not have enough medical evidence to make a disability determination, and assuming that you meet the nonmedical requirements for SSDI, they will send you to a SSA disability examiner. Unfortunately, SSA disability examiners are notorious for performing cursory evaluations that generally do not help a claimant’s case. It is always better to see your own doctor.
2. Insufficient Work Credits to Be Insured for SSDI
The second reason why many SSDI claimants are denied SSDI benefits is because they have not worked or earned sufficient work credits to be "insured" for SSDI. In 2017, a worker will earn one credit for each $1,300 of wages or self-employment income. A maximum of four work credits can be earned by generating $5,200 in wages.
Workers who have not worked, or who work but do not pay payroll taxes, will not generate work credits for SSDI benefits. Work credits must be earned by the disability applicant and cannot be bought or borrowed. Workers who apply for SSDI benefits without sufficient work credits will automatically be denied SSDI, regardless of the severity of their mental or physical health condition.
3. Condition Is Not Severe or Long-Term
Another common reason why claimants are denied SSDI benefits is because the SSA has determined that they do not have a severe condition that will last at least 12 continuous months. Claimants may be able to file an appeal and challenge this notion, but winning at the appeal level will require the claimant to get better medical evidence for their claim.
For instance, the claimant may need to return to their medical doctor and have them complete a residual functional capacity assessment. This document outlines the claimant’s prognosis, diagnosis, symptoms and treatment. More importantly, however, it states the claimant’s physical limitations. For instance, how many hours per day can the claimant sit and stand? How much weight can the claimant lift and carry? Can the patient bend, squat and kneel? How much pain does the claimant have?
The functional assessment becomes especially critical to winning benefits if the claimant’s condition does not meet or exceed a listing on the SSA Listing of Impairments, and the SSA needs evidence that the claimant cannot retrain for some type of new work.
For example, if you have been a roofer for the last 20 years and you have been in a car accident, and can no longer perform that type of work for eight hours per day, the SSA will first determine if your condition meets a listing on the SSA Listing of Impairments. If it does not meet a listing, they will perform a medical vocational assessment to determine if you can retrain for new work. Information on the functional assessment form is critical to this assessment.
4. Working Too Many Hours or Making Too Much Money
Finally, claimants can be denied SSDI benefits if they are performing substantial gainful activity. The SSA defines "gainful" work in 2017 as making $1,170 per month or more. However, claimants can also be considered not disabled if they are working too many hours, regardless of the amount of income generated.
For example, activities such as attending school, self-employment (even if you aren't making money), illegal activities and voluntary work may be considered substantial even if they are not gainful. The assumption by the SSA is that if you are able to perform these activities for a substantial amount of time each week, then you also have the mental and physical capacity to perform gainful work, and they will deny your SSDI claim.