Receiving a denial notice from the Social Security Administration (SSA) is frustrating. You might be surprised to learn that as of 2021, only 36% of initial determinations for Social Security disability applications resulted in an approval. After reconsideration (the first administrative appeal), the allowance (approval) rate is even slimmer, with only 13% of applications being approved at this level.
On first glance, these numbers can seem disheartening. But if you're facing a disability denial, it's helpful to know that the SSA can deny a claim for many reasons. If you know why your claim was denied, you can help make it stronger for a hearing in front of an administrative law judge (ALJ). At the hearing level, the allowance rate becomes much greater, with 54% of all decisions resulting in an approval.
Before you can get a hearing in front of an ALJ, however, you need to appeal the initial denial. In Social Security terms, this appeal is called reconsideration. The agency will give you 60 days to file the request for reconsideration unless you have a good excuse for missing the deadline, so you'll want to do this sooner rather than later.
When SSA denies your claim, the agency must let you know the reason for the denial. Generally speaking, Social Security denials fall under two categories:
Depending on the type of benefit you applied for, and the type of denial you received, you'll likely want to shore up your evidence for your next steps. Below are some common types of technical and medical denials.
SSDI (Social Security Disability Insurance) is a public disability insurance program. You pay into the program by way of payroll taxes that come out of your paycheck. It's similar to a private insurer in some ways—if you stop paying your insurance premiums (taxes), you'll stop getting insurance coverage. But SSDI is more forgiving than a private insurer, because it's based on your work history and payroll contributions. You can be insured under SSDI for years after you've stopped working. But this coverage does eventually lapse. The date that your coverage under SSDI ends is called your date last insured. You'll need to prove that your disability began before this date in order to qualify for SSDI. For example, if your date last insured was in 2018 and you didn't get treated for your condition until 2022, Social Security will issue a technical denial for your SSDI claim.
Not having enough work credits for insurance coverage is another reason the SSA might deny your claim. Social Security work credits are based on the amount of money you've earned in the past. For example, you might have worked for a long time, but you didn't earn enough for your payroll taxes to cover your SSDI "premiums." Broadly speaking, you'll need to show that you've spent at least half of the past 10 years earning above the substantial gainful activity level (between $1,000-$1,350/month). If you haven't met that minimum, Social Security will issue a technical denial.
Unlike SSDI, SSI (Supplemental Security Income) is available regardless of how much you've worked. But it's needs-based, meaning that you'll need to show that you have less than $2,000 in assets as an individual, or $3,000 as a couple. If Social Security finds that you have more assets than that, the agency will consider you to be "over-resourced."
When Social Security receives an application for disability benefits, the agency will calculate your assets, work credits, and date last insured. Sometimes the agency incorrectly considers how many assets you have. Or, if you've worked very recently, Social Security might not have updated your work credits or date last insured. If you think that Social Security has made a mistake about your income, job history, or total assets, you should let them know about this on appeal.
Even if you've worked enough to qualify for SSDI or don't have total assets above the SSI limit, Social Security could still deny your claim if the agency thinks that your medical conditions don't prevent you from working. Medical denials are less common than technical denials, but they're easier to overcome on appeal.
When you apply for disability benefits, one of the first questions Social Security asks you is to list the illnesses, injuries, or conditions that are preventing you from working. These can be physical conditions such as a heart attack, mental illnesses such as depression, or a combination of each. In Social Security lingo, your response to this question is called your allegation of impairments. This is the "why" you're disabled.
Social Security will look at what you've told them about why you're disabled and begin collecting medical records that can help them understand your impairments.
If they've issued you a medical denial, it means that they don't think there's enough information in the medical record to show you can't work. Common reasons for a medical denial include:
For more information on when Social Security denies claims for these reasons, see our article on the medical reasons Social Security might deny your disability claim.
You can help improve your chances that your application will be approved by making sure that you follow up regularly with your medical providers. Be sure to keep Social Security in the loop by letting them know when and where you get treatment from any new providers, including hospital visits. That way, even if you're denied at the reconsideration level, you'll have more evidence to present to an ALJ at a hearing.
The first thing you'll want to do is file a request for reconsideration. (It's better to appeal a denial than to keep filing initial claims.) This means that you're asking a different disability claims examiner to look at your application and decide if the first decision was correct.
Social Security doesn't often find that claims examiners have made mistakes at the initial stage. To increase your chances of getting awarded at reconsideration, it helps to provide the agency with information that addresses why you were initially denied. For example, if you received a technical denial because the agency found you were over the resource limit for SSI, you could submit a recent bank statement with your appeal. Or, if you were denied because Social Security didn't think you had enough medical evidence, try to set up an appointment with your doctor.
You can start your appeal in any of the following ways:
Social Security will give you 60 days to decide whether you want to appeal a denial. If you miss that deadline, and you don't have a good reason, you'll have to start your application from square one. However, if you have what Social Security has determined to be good cause, the agency will let you go ahead with the appeal despite missing the deadline. Make sure that you submit the request to waive the deadline in writing, and that your reason for missing the deadline is pretty serious. Simply forgetting to file the appeal won't cut it.
If you're not sure whether Social Security will consider your reason as good cause, or if you just want help with your reconsideration request, consider consulting with an experienced disability attorney. They'll be able to let you know whether you can continue with your appeal or will need to re-file a new application.
Updated April 22, 2022