Why Social Security Denies SSDI Claims

Social Security denies most initial SSDI claims. The exact percentage varies by state and by the type of disability, but roughly seven out of ten first-time applicants receive a denial letter. This does not mean your claim was wrong or that you cannot succeed — it means Social Security found gaps in the medical evidence, or decided the evidence did not meet the threshold for disability under their rules.

The most common reason for denial is insufficient medical evidence. Social Security needs records that show what is wrong with you, when it started, what treatment you have had, and how it limits your ability to work. If your doctors have not documented these things in detail, or if there are gaps in your treatment history, Social Security will deny the claim. A second common reason is that Social Security concludes your condition does not meet the severity threshold — meaning you have a medical condition, but Social Security believes you can still do some kind of work.

A third reason is that Social Security determines your condition will not last long enough. SSDI requires that your condition last at least 12 months or result in death. If Social Security thinks you will recover within that time, they deny the claim. You will receive a written notice that explains which reason or reasons led to the denial.

Key Takeaways

  • You have 60 days from the date on your denial letter to file a request for reconsideration, which is a free second review by a different Social Security examiner.
  • Reconsideration is the first step in the appeal process and requires you to submit new medical evidence or explain why the first decision was wrong.
  • If reconsideration is also denied, you can request a hearing before an administrative law judge, which is the stage where most people who eventually win their cases succeed.
  • At every stage of appeal, you can represent yourself or hire a lawyer, and you do not pay a lawyer unless you win.
  • The entire appeal process from initial denial to a hearing decision typically takes one to three years.

Understanding Your Denial Letter

Your denial letter is a legal document that tells you three things: the reason Social Security denied your claim, what evidence they reviewed, and what you can do next. Read it carefully, because it tells you what you need to fix in order to win on appeal.

The letter will say something like "We found that you have [condition], but we do not find that your condition meets or equals the requirements in our rules" or "We do not have enough medical evidence to decide your case." These are two different problems with two different solutions. If Social Security says the condition does not meet the rules, you need medical evidence that shows greater severity — more recent treatment, test results that show worsening, or a doctor's statement that the condition is worse than the records show. If Social Security says there is not enough evidence, you need to get more records from your doctors and submit them.

The letter will also list the medical records Social Security reviewed. Check this list against your own records. If your doctor treated you for your condition but Social Security did not receive those records, that is a major problem you can fix on appeal. Keep the denial letter in a safe place — you will need it to file your appeal.

The Reconsideration Stage

Reconsideration is a free second review of your claim by a different Social Security examiner. You must request reconsideration within 60 days of the date on your denial letter. If you miss this important date, you lose the right to reconsider and must instead request a hearing, which takes longer.

To request reconsideration, you can visit your local Social Security office in person, call Social Security at 1-800-772-1213, or mail a written request to the address on your denial letter. You do not need a special form — a letter that says "I request reconsideration of my SSDI denial dated [date]" is enough. Include your Social Security number and the date of your denial.

When you request reconsideration, you should also submit new medical evidence. This is the key to winning at reconsideration. New evidence means records from your doctors that you did not submit with your original claim, or records that are more recent than what Social Security already has. Call your doctors' offices and ask them to send your complete medical records to Social Security. Include a cover letter that explains what new evidence you are submitting and why it shows your condition is disabling.

Social Security will review your case again and send you a decision letter within about 60 to 90 days. If they deny reconsideration, you can move to the next stage, which is a hearing before an administrative law judge.

Requesting a Hearing Before a Judge

If reconsideration is denied, you have 60 days to request a hearing before an administrative law judge (ALJ). This is the stage where most people who eventually win their SSDI cases succeed. A hearing is different from the paper reviews at reconsideration — you or your representative can present evidence and question Social Security's medical informed.

To request a hearing, you can visit your local Social Security office, call 1-800-772-1213, or mail a written request to the address on your reconsideration denial letter. Again, you do not need a special form. Write "I request a hearing before an administrative law judge" and include your Social Security number and the date of your reconsideration denial.

After you request a hearing, Social Security will send you a notice that tells you the date, time, and location of your hearing. This usually happens three to six months after you request the hearing, though the wait varies by region. You will receive this notice at least 20 days before the hearing date.

Before your hearing, gather all medical records from the past year or two and organize them in order by date. Write down a list of your symptoms and how they affect your daily life and your ability to work. If you have a lawyer, they will help you prepare. If you do not, you can still represent yourself, though having a lawyer increases your chances of winning.

Hiring a Lawyer for Your Appeal

You can hire a lawyer at any stage of the appeal process. Most SSDI lawyers work on contingency, which means they do not charge you anything unless you win. If you win, the lawyer's fee comes out of your back pay — the money Social Security owes you from the date you became disabled. The fee is capped by law at 25 percent of your back pay or $7,200, whichever is less.

You do not need a lawyer to appeal, but statistics show that people with lawyers win more often than people without them. A lawyer knows what evidence Social Security needs, how to present it, and how to challenge Social Security's medical informed at the hearing. If you cannot afford a lawyer, you can also work with a non-lawyer representative called a disability advocate or advocate representative. These representatives charge lower fees and can represent you at reconsideration and at a hearing.

To find a lawyer or advocate, you can contact your state bar association, search the National Organization of Social Security Claimants' Representatives (NOSSCR) directory, or ask your local legal aid office. When you hire a representative, you must sign a form called an Authorization to Represent (Form SSA-1696). Social Security will not discuss your case with your representative without this form.

What to Do While You Wait for a Decision

The appeal process takes time. While you are waiting, keep doing three things: keep treating with your doctors, keep paying your bills, and keep gathering medical records.

Social Security looks at your medical records to decide if you are disabled. If you stop treating, Social Security will assume your condition improved. Even if you cannot afford much treatment, see your doctor regularly and tell them how your condition affects you. Ask your doctor to write down your symptoms, test results, and limitations in your medical records.

Keep copies of all medical records you submit to Social Security. Request records from every doctor, hospital, clinic, and mental health provider who has treated you. Medical records are free or low-cost to obtain — you have a legal right to them. If a doctor charges more than a reasonable copying fee, you can file a complaint with your state's health department.

If your condition gets worse, tell your doctors and make sure they document it. If you have new test results, imaging, or diagnoses, submit them to Social Security as soon as you get them. You can submit evidence at any stage of the appeal.

After a Hearing Decision

After your hearing, the administrative law judge will issue a written decision. This usually takes 20 to 60 days. The decision will say either that you are disabled and your claim is approved, or that you are not disabled and your claim is denied.

If the judge approves your claim, Social Security will start paying you benefits. You will receive back pay for the months from your process date to the date the judge approved your claim. If the judge denies your claim, you have 60 days to request review by the Appeals Council, which is the next level of appeal. The Appeals Council rarely overturns a judge's decision, but they will review your case if you show that the judge made a legal error or did not consider important evidence.

If the Appeals Council denies your request or if you do not request Appeals Council review, you can file a lawsuit in federal court. This is expensive and takes years, so most people only do this if they believe Social Security made a serious legal mistake. A lawyer can advise you on whether a lawsuit makes sense in your situation.

Frequently Asked Questions

Can I work while my appeal is pending?

Yes. Working does not hurt your appeal. However, if you earn more than about $1,550 per month (the amount changes each year), Social Security may decide you can do substantial work and deny your claim. Keep your earnings below this amount if you can, and tell your lawyer or representative how much you are earning.

What if I miss the 60-day important date to appeal?

If you miss the 60-day important date, you can still appeal, but you must show "good cause" — a good reason you missed the important date, such as serious illness, homelessness, or a language barrier. Contact your local Social Security office right away and explain why you missed the important date. Social Security will decide whether to let you appeal late.

Do I have to go to the hearing in person?

No. You can appear by phone or video if you request it. Tell Social Security when you request your hearing that you want to appear by phone or video, and they will send you instructions. Appearing in person is usually better because the judge can see you, but phone or video is allowed.

How much back pay will I receive if I win?

Back pay is the money Social Security owes you from the date you became disabled to the date your claim is approved. The exact amount depends on when you became disabled and when you filed your claim. Social Security will calculate it for you. If you have a lawyer, the lawyer's fee comes out of the back pay.

What if my condition improves while I am appealing?

Tell Social Security and your doctor. If your condition genuinely improves so that you can work, your claim may be denied. But if you improve temporarily and then get worse again, that does not hurt your case — Social Security looks at your overall condition over time, not just one moment.