Typical Reasons for Denial of Benefits
More than half of all initial claims for disability benefits get denied. Understanding why the Social Security Administration (SSA) generally denies disability claims will prepare you for your initial claim and decide whether you should file an appeal if your claim is denied. Some denials are related to the technical errors made during the application process, while others are because your claim does not appear to meet the requirements for receiving disability benefits.
The following are the main reasons the SSA generally denies claims:
- Failure to timely respond to SSA: If the SSA is unable to reach you to ask questions or schedule an appointment, your claim may be denied. Make sure the SSA has a way to get in touch with you at all times.
- Failure to follow SSA directions: If you do not follow all the instructions and directions given by SSA, your claim may be denied.
- Failure to follow doctor’s orders: If you fail to take prescribed medications or attend prescribed therapy, your claim may be denied. There are some acceptable excuses, however, such as your doctor providing an inappropriate therapy, the inability to pay for the prescribed therapy, lack of assistance needed to comply with the therapy, or a mental disability so severe that you cannot comply.
- Failure to support claim: If you fail to provide sufficient medical records and documents for your claim, it may be denied.
- Failure to suffer from a disability expected to last 12 months: You must be able to prove that your disability will last for at least one year (or be a terminal condition) in order to be eligible for SSDI or SSI benefits, unless you are blind. The SSA will consider each claim on its own merits.
- Disability related to alcohol or drug abuse: While the SSA does approve benefits for claimants suffering from physical or mental impairments that resulted from past drug or alcohol abuse, substance abuse must not be an ongoing and contributing factor to disability. In other words, you will be denied benefits if the SSA determines that you would not be considered disabled if you stopped abusing alcohol or drugs.
Legal Editors: Anselmo Alegria and Wiliam E. Leavitt, February 2018
Changes may occur in this area of law. The information provided is brought to you as a public service with the help and assistance of volunteer legal editors, and is intended to help you better understand the law in general. It is not intended to be legal advice regarding your particular problem or to substitute for the advice of a lawyer.