Understanding Why Your Disability Claim Was Denied: Common Reasons & How to Address Them (Updated 2025 Guide)
Receiving a denial for your Social Security Disability (SSD) claim can feel like a devastating blow, especially when you’re grappling with a serious medical condition. But you are far from alone in this experience. According to data from the Social Security Administration (SSA), approximately 62% of all initial applications for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) were denied in 2024. This means that for every 10 people who apply, about 6 will receive a denial letter.
This guide is designed to empower you. We’ll help you understand why disability claims are denied and what concrete steps you can take to address the issues.
The SSDI/SSI Denial Letter: Your First Clue
When that denial letter arrives from the SSA, your first instinct might be to discard it in frustration. Don’t. This letter is far more than just bad news; it’s the roadmap for your appeal.
The denial letter outlines the reason(s) your claim was denied. Sometimes it points to a lack of sufficient medical evidence, other times it’s a technical issue, or perhaps your ability to work.
Crucially, you have a strict deadline: you must appeal within 60 days from the date you receive the denial letter. If you miss this 60-day window without demonstrating “good cause” for the delay, you may lose your right to appeal and could be forced to start the entire application process over from scratch.
Tip: The language in SSA letters can be complex and confusing. If you find it difficult to understand the specific reasons for your denial or the next steps, do not hesitate to consult with our team of experts: Tell Us Your Story.
Top 5 Common Reasons for Social Security Disability Claim Denial (and How to Fix Them)
Denials generally fall into two categories: non-medical (technical) and medical. Understanding which category your denial falls into is the key to building a successful appeal.
- Insufficient Medical Evidence
Why it leads to denial: Your disability claim may be denied if it lacks clear evidence that your medical condition prevents you from working. Sparse, outdated, or inconsistent medical records can lead the Social Security Administration (SSA) to find insufficient support for your claim.
How to address it:
- Gather All Relevant Medical Records: This includes every test result, imaging report (X-rays, MRIs, CT scans), and detailed treatment notes. Ensure they cover the entire period your disability has affected you.
- Regularly See Your Doctor(s): Consistent medical treatment from specialists provides ongoing documentation of your symptoms and limitations.
- Lack of Objective Medical Proof
Why it leads to denial: The SSA places significant weight on “objective medical findings.” These are measurable, verifiable results from tests such as MRIs, X-rays, nerve conduction studies, blood work, pathology reports, and clinical tests. If your file primarily relies on subjective complaints of pain or other symptoms without supporting objective evidence, the SSA may question the severity or even the existence of your medically determinable impairment.
How to address it:
- Undergo Recommended Tests: Follow through with any diagnostic tests your doctor recommends, even if they seem repetitive or costly.
- Seek Specialist Referrals: If you’ve primarily been seeing a primary care provider, ask for referrals to specialists who can conduct more specific tests and provide expert opinions relevant to your condition.
- Include All Lab and Imaging Results: Make sure all lab results, imaging reports (along with the actual images if possible), and neuropsychological test results are included in your application.
- Failure to Follow Prescribed Treatment
Why it leads to denial: The SSA expects applicants to follow treatment plans prescribed by their doctors. If you consistently fail to take prescribed medications, attend physical therapy sessions, or participate in recommended counseling (for mental health conditions), the SSA might assume that your condition isn’t as limiting as claimed or that it could improve with compliance.
How to address it:
- Adhere to All Medical Advice: Follow your doctor’s treatment plan diligently. This includes taking medications as prescribed, attending all appointments, and participating in therapies.
- Document Reasons for Non-Compliance: If you have a valid reason for not following a specific treatment, ensure they are clearly documented in your medical records.
- Engaging in Substantial Gainful Activity (SGA)
Why it leads to denial: The SSA has specific income thresholds that define “Substantial Gainful Activity” (SGA). If you are earning more than this monthly limit, the SSA generally considers you able to engage in substantial work, regardless of your medical condition, and your claim will be denied.
2025 SGA Limits:
- Non-Blind Individuals: $1,620 per month
- Blind Individuals: $2,700 per month
Note: These figures are typically adjusted annually. Always check the official SSA website for the most current limits.
How to address it:
- Maintain Accurate Earnings Records: Keep meticulous records of all your earnings, including any freelance, gig work, or self-employment income.
- Failure to Cooperate with the SSA
Why it leads to denial: The disability determination process requires active participation from the applicant. If you miss scheduled appointments, fail to return requested forms, or do not provide necessary documentation in a timely manner, the SSA may deny your claim automatically due to non-cooperation.
How to address it:
- Respond Promptly: Reply to all SSA communications, letters, phone calls, and requests for information as quickly as possible.
- Attend All Scheduled Exams: If the SSA schedules you for a Consultative Examination (CE) with one of their doctors or psychologists, it is vital that you attend. Missing a CE without a very good reason is almost a guaranteed denial.
- Communicate Immediately If There’s an Issue: If you miss an appointment or cannot submit something on time, call your local SSA office immediately, explain the situation, and request a reschedule or extension. Follow up in writing.
Your Next Steps After a Denial: Understanding the Appeal Process
A denial is not the end of your case. In fact, many applicants who are initially denied go on to win their benefits during the appeals process. The Social Security Administration (SSA) has a multi-step appeals process designed to give you several opportunities to present your case.
Here is a breakdown of the appeal stages, with data from the SSA’s Fiscal Year 2024 workload report:
- Reconsideration. This is the first appeal stage. During this step, a different examiner will review your case. The national approval rate at this stage is very low.
- FY 2024 Approval Rate: 16% (based on 495,700 decisions)
- Administrative Law Judge (ALJ) Hearing. This is often considered your best chance to win. The approval rates increase significantly at this stage. At a hearing, you can present your case in person, testify about your limitations, and have an attorney question witnesses.
- FY 2024 Approval Rate: 51% (based on 289,492 decisions)
- Wait Times: Be prepared for a potentially long wait for a hearing, which can range from several months to over a year, depending on your location.
- Appeals Council Review. If your claim is denied by an ALJ, the next step is to request a review by the Appeals Council. The council can deny your request, approve your case, or send it back for a new hearing. The approval rate at this stage is very low.
- FY 2024 Outcomes (based on 45,641 decisions):
- Remand (Case sent back for a new hearing): 16%
- Deny: 80%
- Allow: 1%
- Dismiss: 3%
- Federal Court. If the Appeals Council denies your case, the final step is to file a lawsuit in a U.S. Federal District Court. A federal judge will review your case. The most common outcome at this level is for the court to send the case back to the SSA for a new hearing.
- FY 2024 Outcomes (based on 15,753 decisions):
- Remand (Case sent back for a new hearing): 63%
- Deny: 32%
- Allow: 4%
- Dismiss: 1%
All workload data is from the Social Security Administration’s “FISCAL YEAR 2024 WORKLOAD DATA: DISABILITY DECISIONS” report, dated January 30, 2025.*
Don’t let a denial letter stop you from pursuing the benefits you are entitled to. The most effective way to address the reasons for your denial and build a winning appeal is to act quickly and with purpose.
Whether you choose to handle your appeal yourself or seek professional assistance, the key is to take immediate action. If your claim has been denied, get legal help to guide you through the appeals journey.
Our Disability Advocates will:
- Correct errors
- Gather new evidence
- Submit your appeal on time
- Represent you at hearings or any stage of appeal
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Frequently Asked Questions (FAQs):
Generally, it is not advisable to reapply if your claim has been denied, unless the denial was purely for a technical, non-medical reason (like not having enough work credits for SSDI) that you can now resolve. If the denial was based on medical evidence, reapplying means you lose your previous filing date and may lose potential back pay. Yes, whenever possible, you should submit new and updated medical evidence at each stage of the appeal. This is especially critical for the Reconsideration and ALJ Hearing levels, as it directly addresses the SSA's previous findings and shows the ongoing nature and severity of your condition. Back pay (or past-due benefits) refers to the money you are owed from the time you applied for disability benefits up to the point your claim is approved. The calculation of back pay can be complex and depends on factors like your "onset date" of disability and how long the approval process took.Can I reapply for disability benefits instead of appealing?
Do I need new medical evidence for every appeal stage?
What is "back pay" in a disability claim?