SSDI Denial Letters: Understanding “Why” and Deciding What's Next

While over 10 million Americans receive Social Security Disability Insurance (SSDI) most applicants know that getting benefits isn’t an easy journey. From the time you apply, it usually takes about three to five months to find out whether you’ve been accepted or denied. 

If you’re reading this, there’s a good chance you’ve learned that already. Whether you have an SSDI denial letter or anticipate one soon, it’s time to take action. In this article, you’ll learn how to navigate your SSDI denial letter and how to chart your next steps.

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Don’t assume your denial is final

Don’t worry! Just because you received a denial letter doesn’t mean that you don’t qualify for SSDI. And having your initial application rejected is more common than you’d think. Most people that apply for SSDI get rejected.

As of 2019, the average acceptance rate was only 24.6% after the initial application for benefits. The biggest mistake people make at this point is giving up, or reapplying, rather than appealing (more on that below). By the hearing stage, almost half of applicants are approved.

Decoding your denial

If you receive notice that you are denied disability, the Social Security Administration (SSA) must send you a letter detailing why you didn’t qualify. Your claim number, important contact information, and eligibility for other benefits will be clearly stated on the first page when you get your letter. Here’s an example of what it will look like.

However, the most important part of the letter is the reason for the denial. Understanding why you were denied is essential, as this helps you and your lawyer formulate your appeal. Let’s look at some potential scenarios.

Why was I denied?

Your SSDI denial letter will explain whether your rejection was based on non-medical or medical criteria.

Non-medical denials

If you receive a denial for a technical or logistical reason, you did not meet the criteria based on working hours, employment history, or income requirements. If you work too many hours or make too much money, your chances of being denied are high. Occasionally, more nuanced problems like tax discrepancies or an abundance of assets could cause a denial. If you receive a non-medical denial, you have fewer options. If you’re working too many hours, you can work fewer. If you haven’t sufficiently paid into the SSDI program, you can ensure your taxes are correct. If you didn’t cooperate with the SSA’s requests for more paperwork, or an exam, you may also be non-medically denied.

Some common rejection letter language that may indicate a non-medical denial:

• The individual is found not disabled because he/she is engaging in substantial gainful activity.

• The individual is found not disabled because of failure to cooperate with a request for evidence or action, or a request to attend a consultative examination when that evidence is necessary for the determination.

Medical denials 

Lack of sufficient medical evidence is the most common reason the SSA rejections applications. A documented disability must meet precise criteria and be supported by documentation or test results showing that you physically cannot work due to the medical condition. If you receive a medical denial, there are many things you can do to strengthen your case. You often have better chances of approval once you can speak directly to a judge, and appealing is your best next step.

Some rejection letter language that may indicate a medical denial:

• The individual is found not disabled on medical considerations alone because the impairment is not severe.

• The impairment is severe but not disabling because it does not cause marked and severe functional limitations.

• The individual has a severe impairment(s) but is found not disabled because he or she has the functional and vocational capacity to engage in substantial gainful activity in relevant past work.

• The individual willfully, without justifiable cause, fails to follow therapy prescribed by the treatment source for a disabling impairment.

What rights do I have to appeal?

It’s 100 percent within your right to appeal the SSA’s decision within 60 days of receiving a notice of denial. This process is called “filing for reconsideration,” no matter whether you have a medical or non-medical determination. Here’s a description of each level of appeal:

• Reconsideration. This is where someone who wasn’t involved in making the initial eligibility decision reviews your appeal. To start the reconsideration process, you must create an account on the SSA’s website. Most reconsiderations are also rejected.

• Hearing with an Administrative Law Judge. You can request a disability hearing with an administrative law judge (ALJ) if you get denied post-reconsideration. This is a higher-level review that will require significant preparation with a disability lawyer.

• Review from the Appeals Council. If a judge doesn’t grant you SSDI, you can accelerate the decision to the Appeals Council. Here, the ALJ’s decision is reconsidered. After this, the Council can either hand the request back to an ALJ, issue a new decision on your case, or deny the request altogether.

• Federal Court Review. Accelerating an appeal to the Federal level is the highest attempt to resolve a discrepancy and is the last step in the appeals process.

How can a lawyer help me? 

You don’t have to go through the appeals process alone. Working with a lawyer is the best way to navigate getting the most accurate SSDI decision, despite the potential for repeated rejections. It’s not uncommon for you to get denied multiple times for different reasons. With legal help, however, your chances of reversing that denial are significantly higher than doing it yourself.

At Atticus, we’ll pair you with a lawyer who will understand and be well-versed in the specifics of your case — for free! Reach out to us today to get started on your appeal.