If your Supplemental Security Income disability claim has been denied on your first go-round, don’t worry. You’re not alone. Most disability claims are denied at first review. The comprehensive claims process, including appeals, can be long and draining. As an applicant, you have the responsibility of proving that you are disabled, according to the SSA’s strict definition of the term, and that you are also in financial need as a result of that disability.
This can be a daunting task. But knowledge is power, and if you know some of the most common reasons for SSI applications being denied, you can set yourself up for success from the very beginning.
4 Common SSI Denial Reasons
- Income
- Lack of Medical Evidence
- Incomplete Documentation
- Social Security Administration Mistake
When you begin the process of applying for SSI disability benefits, you should understand that you’re likely in this for the long haul. There’s a heavy burden of proof on the applicant to make a sufficient case for both the medical condition or disability in question and its impact on the applicant’s ability to work. Disability, as defined by the SSA, means that you are unable to do any kind of work – not only the kind of work you’ve previously done but also any kind of work the SSA believes your skills will transfer to or that you could feasibly be trained to do.
Only about 30% of SSI and SSDI claims are approved when first submitted; it takes a tremendous amount of exactly the right kind of documentation to show that a claimed disability would prevent you from being able to perform your work duties. But that doesn’t mean it’s impossible.
More than half of the applicants who appeal their decisions ultimately win their claims. If you didn’t engage with a disability lawyer when you began the claims process, a good time to engage one is when you first receive that denial notice. At that point, you’ll have a knowledgeable resource for navigating all the steps involved in the appeals process.
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1. Income
One of the most common reasons an initial claim is denied is that the applicant makes too much money already to qualify for benefits. SSA will look at how much money you have in the bank. For single people who apply for disability benefits, the cutoff amount is $2,000, and it is $3,000 for a married couple. And when it comes to considering your resources, the SSA will also take into account the assets you own. For example, you can own one home and one car and still potentially be approved for SSI benefits. But if you own substantial other assets, the SSA may initially reject your SSI claim. This sometimes happens when a married couple owns two cars.
2. Lack of Medical Evidence
Lack of medical evidence or documentation is the most common reason for a disability claim to be denied. And if your SSI benefits claim is denied for a medical reason, generally it’s because the SSA doesn’t believe you’ve provided enough official medical documentation and evidence to show that you meet its very specific definition of disability.
If this is the case, your denial notice will carefully outline all the medical documentation and resources the SSA used to come to its decision. You should see a list of every medical condition for which you were evaluated, and an official statement about how the SSA rules that your condition and limitations should affect your ability to work. The bottom line for this kind of SSI claim denial is usually that it’s too big a leap of faith based on the documentation you’ve provided for the SSA to feel confident that your condition is severe enough to prevent you from earning a living.
Sometimes, claimants may also submit medical documentation that shows conflicting results – diagnoses from different medical providers, for example. This simply creates confusion for the SSA reviewers and fails to make your case. If you have a documented history of failing to follow medically prescribed therapy for a particular condition, or if you deny the SSA access to your medical records, you can expect your initial claim to be denied.
The SSA may rule that you have a “non-severe” medical condition, which shows that the SSA is conceding that a medical issue is present, but not one that shows a documented effect on a person’s ability to earn a living. If your denial notice says that the SSA finds that your condition doesn’t meet an impairment listing, that simply means that the condition you’ve claimed doesn’t meet the requirements of the SSA’s existing list of Blue Book disabling conditions. This reason for denying a claim is quite common.
3. Incomplete Documentation
Incomplete documentation goes hand in hand with a lack of medical evidence. Remember that the burden of responsibility is on you to show conclusively that a medical condition exists and that it prevents you from being able to carry out your day-to-day work. You shouldn’t expect the SSA to take your word for anything; you must show them conclusively through your documentation that your condition is severe enough to keep you from working.
Many times, a denied claim will be rejected simply because the documentation isn’t sufficient, and it’s usually the medical evidence and documentation that’s missing.
4. Social Security Administration Mistake
Mistakes do happen. If the SSA denies your claim but you don’t understand the reason, make sure to appeal quickly. Since the SSA processes a high volume of applications each day, it’s possible that your application was denied by mistake – especially if your denial letter doesn’t make clear the reasons for your initial denial.
If your denial letter is confusing or unclear, that may be a good sign that it’s time to request help from a qualified Social Security disability attorney.
How to Appeal an SSI Denial
If your claim is denied during its first review, the process is far from over. Once you enter the appeals process, it’s a good idea to work with a disability lawyer to guide you through the next series of steps. The disability denial letter you receive from the SSA should outline the reasons your initial claim was denied, along with the steps you should take to begin your appeal.
You have 60 days from the date of the notice to file your social security disability appeal. After that point, you lose your right to appeal the SSA’s decision. You should also note that appealing is different from refiling – just because you’re unhappy with the SSA’s ruling doesn’t mean that you start from scratch and resubmit everything for review. You simply enter a different stage of the process.
The appeals process for SSI disability benefits claims includes four different levels. At the first level, you submit a simple Request for Reconsideration, which formally notifies the SSA that you’d like your decision to be revisited. Your denied claim will then receive a second review from someone who was not part of the first review or the subsequent decision.
During reconsideration, this SSI reviewer will go back through all the original documentation you submitted with your initial claim, along with any new paperwork or medical evidence you’ve since provided. This is a good opportunity to go back through your original disability application and provide any missing paperwork or information, along with providing any additional medical evidence you have access to.
It’s important to note that only about 5% to 10% of appeals are granted at the reconsideration stage in the appeals process. If your request is approved at this stage, you will receive an acceptance letter, and you’ll begin receiving monthly benefits, including back pay.
If your Request for Reconsideration also is denied, you move to the next step in the appeals process, which is to appeal the decision and submit a Request for Hearing. During this stage, an administrative law judge who has had no part in the decision thus far will review your claim and all its supporting documentation. This may be the part of the process that takes the longest, as you will have to wait for a hearing date and time to be assigned. If you get to this point in the appeals process, it’s a very good idea to work with a disability lawyer who can help you make the most of your hearing.
Most people who win their claim on appeal win it at this stage. This is the first opportunity you’ll have to meet with people and fully explain your situation, and you can even bring witnesses who can testify on your behalf. Instead of just looking at your paperwork, the administrative law judge will have the opportunity to get to know you a bit and to ask specific questions that can help her make the best decision about your case. The judge may ask a medical expert or an expert in your vocation to also be present to answer questions and provide expert advice.
The administrative law judge who reviews your case has more wiggle room than anyone else involved in the process to make a ruling that’s favorable to you. But a win still isn’t a guarantee – and if the administrative law judge upholds the previous decision, you still have a couple of additional stages of your disability appeal.
First, you can send your claim to the Appeals Council, who will review all aspects of your case to determine whether it was decided in full accordance with Social Security law and applicable regulations. This council will be composed of other administrative law judges – they won’t accept any new documentation at this point, and you will not get an opportunity to talk or meet with them directly. At this point, they have the option of sending your claim back to the administrative law judge, they can decide a different ruling for themselves or they can confirm the decision of the original judge. You should note that it’s rare for a decision to be overturned at this point – it only happens 2% to 3% of the time.
The final step of the appeals process is a federal court review.
Common SSI Denial Reasons
If you receive a disability denial letter from the SSA regarding your Supplemental Security Income disability claim, don’t give up. You’re in good company, and many qualified and knowledgeable disability attorneys can help guide your case through the appeals process.
Understanding some of the most common reasons for disability application denial is a great first step toward making sure your claim is as strong and well-substantiated as you can make it. We’re confident that if you take note of the denial reasons presented here, you can avoid some of the most common claim mistakes and set yourself up for success in winning your disability claim.
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