In 2020 the Social Security Administration (SSA) awarded social security disability (SSD) benefits to 619,363 new workers, bringing the number of SSD recipients to more than 9.5 million Americans. But that number represents just a fraction of the workers who applied for disability benefits. In 2019, the most recent year for which data is available, 2,064,798 workers applied for disability benefits. Yet only 29% of those applications were approved, a number on par with the 10-year average approval rating of 31%.
There are many reasons the SSA may deny a worker’s disability application, from lack of information to support a claim of disability to a determination that the disability isn’t severe enough. Below are some of the most common reasons a disability application may be denied.
1. The disability is short-term
Workers who were involved in an accident or have a medical condition that makes them unable to work may be eligible for short-term disability benefits. These benefits can be paid through an employer-provided or private short-term disability insurance plan. The Social Security Administration does not provide benefits for short-term disability. Social security disability benefits are only paid to workers whose medical condition or disability has lasted, or is expected to last, at least 12 months or result in death. If the condition is one expected to resolve in less than 12 months – for example, you underwent surgery with a five-month recovery and rehabilitation period – the application will be denied.
2. Income is too high
Workers are only eligible to receive SSD benefits if their disability prevents them from participating in substantial gainful activity, or SGA. This amount changes annually. Although there are some exceptions, generally the SSA will deny a disability application if the applicant earns more than $1,350 ($2,260 if they are statutorily blind) per month. Denial of benefits due to income that exceeds SGA is a technical denial; that means the application was denied for reasons other than the applicant’s medical condition.
3. Ability to perform usual work
The fact that an applicant has a disability that is expected to last 12 months or longer does not mean automatic qualification for SSD benefits. Many people with a disability can continue working in their current job, either because regular treatment helps alleviate the symptoms or they are provided accommodations. For example, most Americans experience back pain at some point in their lives; but a combination of medication, physical therapy, chiropractic care, or other treatment makes the symptoms manageable and minimally interferes with their ability to work. For others, workplace accommodations allow them to keep working. An applicant who works as a cashier or in an assembly line, for example, where they are required to stand may be able to continue working if they are provided a chair or more frequent breaks. If there is any evidence an applicant can continue to work in their current job, the application will be denied.
4. Ability to perform other work
In 2019 the SSA denied 42% of disability applications because the applicant was able to perform other work. To qualify for benefits an applicant must be unable to perform not only their current job, but any other work as well, taking into consideration their age, experience, and education. For example, an applicant whose disability makes him unable to continue operating heavy machinery will not suddenly be expected to work as an attorney, architect, or other position that requires specialized skills or education he does not have. But if he used to teach classes on how to repair or operate that machinery, or if he has supervisory skills that don’t require him to operate the machinery, the SSA can deny the benefits application because the disability doesn’t prevent him from performing this other work.
5. Medical condition is not severe enough
The SSA denied 23.8% of SSD applications in 2019 because it determined that the applicant’s disability was not severe enough. What does this mean? As already discussed, it could mean that the disability is not expected to last more than 12 months. For example, a surgeon who breaks her arm would be unable to perform surgery while the bone heals, but in most cases, that condition won’t last more than 12 months.
Most likely this type of denial happens because the applicant’s disability does not meet the SSA’s definition of severe. SSA determinations of disability are guided by its Blue Book, which lists more than 100 disabling conditions that qualify applicants for SSD benefits. Each condition has criteria applicants must meet to be awarded benefits. Failure to meet these criteria, or to show how the medical condition equals or exceeds these criteria, will result in a finding that the disability isn’t severe enough and benefits will be denied.
6. Other factors
One-fifth, or 20.5%, of disability denials in 2019 were due to other factors, such as lack of medical evidence to support the claim of disability, or technical denials, which is when the application is denied for reasons other than the applicant’s medical condition. This could include failure to cooperate with the SSA, failure to follow the doctor’s prescribed course of treatment, or if the inability to work is due to misuse of drugs and/or alcohol.
If your disability application is denied, don’t panic. Denials can be appealed, and the chance of approval increases substantially. It is estimated that 50% of disability applications are approved following an administrative hearing, which is the second step in the appeals process. (Only 15% of applications are approved during the first phase of the appeals process).
If the SSA denied your disability benefits application, an experienced disability attorney can help you file an appeal and improve the chance that you are ultimately awarded benefits. The Good Law Group has more than 30 years’ experience handling social security disability cases at every level of the application process, and we receive no payment unless you are awarded benefits. Call us at (847) 577-4476 to schedule a free case evaluation.