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Common Reasons Social Security Disability Claims Are Denied

Person Hand With Pen Filling Social Security Disability FormAccording to data supplied by the Social Security Administration (SSA), individuals in North Carolina applying for Social Security Disability Insurance (SSDI) in 2020 were successful 39.2 percent of the time, down from 39.6 percent in 2019. In other words, if you apply for SSDI, there is a 60 percent chance you will be turned down.

There are various reasons, both medical and administrative, for SSDI denials. Some denials can be avoided with proper preparation when submitting the initial application and by responding quickly and appropriately when the SSA asks for further information.

Many denials are due to the applicant’s lack of knowledge of what it takes to qualify and inexperience in preparing the necessary documentation.

You can overcome these hurdles by working with an experienced Social Security disability attorney. If you’re located in or around Raleigh, North Carolina, or in the nearby communities of Roanoke Rapids, Fayetteville, and Greensboro, contact me at Lloyd King Law Firm PLLC.

After spending 8 years as a Social Security disability judge in Raleigh, I opened my own private practice to help others navigate the system and earn the disability benefits they deserve. I understand the process and what Social Security looks for in awarding disability benefits. I will fight for your rights every step of the way.

Qualifying for Disability Benefits

SSDI benefits are only for those who meet Social Security's definition of "disability." Under the legal definition, to show disability, you must:

  • Have a medically determinable physical or mental impairment that will last at least 12 months or lead to death, and

  • Show that this condition will prevent you from engaging in any “substantial gainful activity” (SGA), such as the work you were previously engaged in, and that your condition will not let you adjust to other types of work

You will also need to have earned enough work credits to qualify. Work credits are earned by paying into the Social Security system through your job or by self-employment taxes. Each credit is determined by your wages, and the amount needed changes on a yearly basis.

In short, you must have earned 40 work credits overall, with 20 of them in the past 10 years, to qualify. This means that you must have worked and paid into the system for five of the past 10 years. For workers under 31 who have had fewer chances to work, the requirements are lower.

Common Reasons for SSDI Denial

The forms you submitted are incomplete. There are a number of forms associated with applying for SSDI that can be confusing to the average person, especially if you’re already dealing with a disability. An experienced SSDI attorney can help you complete every form precisely and accurately.

You provided insufficient medical evidence. This goes along with the above error of submitting incomplete forms. You must be willing to release your complete medical history, along with any associated medical, treatment, and prescription records and receipts. Keep a log of every visit to a physician or specialist to document your condition, just to be safe.

You failed to comply with a consultative exam requirement. The SSA may ask you to be examined by a third-party medical expert. If you refuse, your application will likely be denied.

You failed to complete the process or cooperate with requests. The forms you submit are likely to be followed by requests from the SSA for other types of evidence, or as mentioned above, a third-party exam. If you fail to follow through, your claim will go nowhere.

You failed to prove your condition meets the legal definition. The disabling condition must last for at least 12 months or lead to death. It must also prevent you from engaging in any substantial gainful activity (SGA). You will need to prove this with thorough medical documentation and testimony.

Your impairment is not expected to last 12 months. SSDI does not cover short-term disability. If you cannot show that your condition will last at least a year or lead to death, it will not qualify under strict SSDI standards.

Your impairment is not listed by the SSA as a qualifying disability. The burden is on you to prove that your condition is totally disabling. If your condition is not shown on the agency’s list, you will need to go the extra distance to show that your condition meets the legal definition. According to the SSA, “If your condition is not on the list, we have to decide if it is as severe as a medical condition that is on the list.”

You are able to adjust to other types of work, even though you can no longer do the kind of work you were engaged in before your condition set in. If you are able to engage in other types of SGA than what you did before you became disabled, you won’t likely qualify for SSDI. You must show that your condition prevents any type of SGA.

You start working before your benefits are approved. If you return to work while your application is pending, that can show you are not in need of SSDI.

You earned too much. When you apply for SSDI, if you are earning above the SGA limit, you won’t be considered disabled. In 2021, the SGA limit is $1,310 a month for nonblind individuals. Income from investments does not count. Only income from work counts as it shows your ability to work.

You didn’t work long enough in recent years. Remember, you have to accumulate 20 work credits in the past 10 years to qualify unless you’re 31 years of age or younger. According to the SSA, in 2021, to earn one work credit, you must earn $1,470 (the figure changes yearly) in wages or self-employment income.

How Legal Counsel Can Help

It’s easy to trip yourself up as you apply to qualify for SSDI. I have two decades of experience being on the receiving and judging side of the process, and I know what the SSA is looking for. I can help you complete all of the documentation and comply with all agency requests to improve your chances of success.

I am also knowledgeable and experienced in the appeals process. If your application is denied, I can work with you to take everything to the next level and strive to get the denial overturned.

If you’re applying for SSDI or you’ve been denied, contact me immediately at Lloyd King Law Firm PLLC. I serve clients throughout Raleigh, North Carolina, and the neighboring communities of Roanoke Rapids, Fayetteville, and Greensboro.