If you or a loved one is planning to apply for Social Security Disability Insurance (SSDI) benefits, then it is important to understand the claims process and be prepared for a potential denial. According to statistics published by the Social Security Administration (SSA), the average acceptance rate of initial SSDI benefit applications is only 22 percent. This means approximately 78 percent of SSDI applications will be denied by the SSA. Such a high denial rate can be downright shocking for many applicants, especially when an applicant has been told by their doctor that they are medically disabled.
It is important to understand that, in order for an individual to qualify for SSDI benefits, they must be considered disabled. The SSA has a specific set of requirements that must be met before a disability benefits claim will be approved. The rigid set of requirements may come as a surprise to some applicants, especially when they’ve been told by their doctor that they are disabled. Unfortunately, being told you’re disabled will likely not be enough to get your disability benefits application to the finish line. You need to meet the applicable threshold and prerequisites set by the SSA to improve your odds of securing SSDI benefits
Eligibility Requirements for SSDI Benefits
Typically, the SSA will conduct a multi-step assessment to determine whether or not you are eligible to receive SSDI benefits. The steps in this assessment include the following:
- Work Status. Generally speaking, SSDI applicants will not qualify for benefits if they are engaged in substantial gainful activity (SGA). For 2025, any individual earning more than $1,620 a month will likely be considered to be engaged in SGA.
- Severity Assessment. To qualify for SSDI benefits, your impairment(s) must be sufficiently severe to completely interfere with basic work-related activities. In addition, your impairment(s) must last, or be expected to last, at least 12 months.
- Disabling Conditions. The SSA has established an extensive list of medical conditions, also known as the listing of impairments, which are considered to meet the standard for an applicant to be deemed disabled. If your medical ailment is found in the listing of impairments, it will typically qualify for SSDI benefits.
- Previous Relevant Employment. The next step in the assessment typically involves determining your ability to perform past relevant work, which may entail residual functional capacity (RFC). Determining RFC involves an analysis of your medical records to discover which work-related tasks you may still be able to perform. If you are found to be incapable of doing the lightest possible work you have performed previously, then your claim will likely move forward in the assessment process.
- Performing Other Work. The SSA will take into consideration your education, work experience, and age when determining your ability to perform other types of work. This step may involve consulting a vocational expert to determine the jobs that a claimant may be capable of performing.
In light of the statistical odds indicating you may receive an initial denial of your SSDI benefits application, it is recommended you develop a general understanding for why benefit applications may not be approved. Having this understanding can assist you during the application process, particularly when it comes to avoiding pitfalls and common issues that arise with SSDI benefit claims.
Common Reasons Social Security Disability Applications Are Denied
Below are some common reasons why SSDI claims may be denied by the SSA. Please note that simply because an SSDI benefits claim is denied does not mean that you are ineligible for SSDI benefits. In fact, many legitimate SSDI benefit claims are not initially approved by the SSA. The list of frequently-cited grounds for denying SSDI benefit claims include:
- Insufficient medical evidence. An applicant must have strong medical evidence documenting his disability and how this prevents him from working. Many applications are denied for lack of sufficient medical documentation of the disability.
- Failure to follow treatment advice. If an individual does not follow his doctor’s advice on treatments for his disability or there are gaps in medical care, his application will most likely be denied. The SSA examiner would argue that it is not possible to determine whether the person is disabled if he is not receiving needed medical treatment.
- Prior SSDI benefit denials. Some people make the mistake of just filing a new application if their initial one is denied rather than filing an appeal. Unfortunately, this approach increases the likelihood that an application will not be approved.
- Excessive earnings. SSDI benefits are for people who are unable to work. If an applicant continues to work and earns too much money, this would make him ineligible for benefits. In 2025, the limit is $1,620 in monthly income. If you make more than that per month, you will be denied based on your income.
Even if none of these is true in your case, Social Security does not automatically have to credit the opinions of your doctor. Instead, SSA evaluates the opinion based on its own perceived consistency with the record and persuasive value of the opinion. Adjudicators may choose to rely on Social Security’s own medical reviewers instead of the opinions of your treating doctor if the adjudicator decides that evidence is more persuasive. If your SSDI benefits application is denied, you generally have the right to file an appeal.
Overview of the Appeals Process for a Social Security Disability Denial
Generally speaking, there are four levels of appeal that you may need to go through in order to try and secure SSDI benefits. Those levels include:
- Reconsideration
- Hearing by an administrative law judge (ALJ)
- Review by the SSA Appeals Council
- Federal Court review (lawsuit)
If your initial application for disability benefits was denied, then your next step is to request “Reconsideration” of your claim. When you request Reconsideration, you are asking for Social Security to take another look at its decision. As part of this process, you will need to provide any new information that you have that might change the government’s decision.
Timeframe to File an Appeal Challenging the Denial of Your Social Security Disability Benefits Application
It is important to note that there are specific timeframes that apply when you appeal a denial of your SSDI benefits application. Generally speaking, at each level of the process, you must file your appeal within 65 days, commencing from the date on the denial letter to file an appeal or request for reconsideration.
For example, after you receive an initial denial from the SSA, you have 65 days from the date on the letter to file a request for reconsideration. If you receive an unfavorable decision at this stage, then you are afforded another 65 days from the date of that notice to request a hearing before an administrative law judge (ALJ). The ALJ will make a decision in your case, and the SSA will send you a letter notifying you of the decision.
You will then have 65 days to ask for a review by the SSA Appeals Council. The Appeals Council may deny your request for review, send your case back to the ALJ, or make a decision. Whatever action they take, the SSA will send you a letter and a copy of the order.
If you receive an unfavorable decision, you have the right to file a lawsuit against the SSA in federal court. As with the other levels of review, you are afforded 65 days from the date of the notice to file a complaint in court.
Have Questions About What To Do Following a Social Security Disability Benefit Denial? Contact Bross Frankel PA
Getting your Social Security benefits application denied can be a frustrating experience, especially when you have a well-established and documented disability that hinders your ability to maintain gainful employment. Paperwork errors or even a lack of medical documentation are common reasons why the Social Security Administration may opt to deny your disability benefits application. While there are several levels of appeal, it can be difficult to appeal your case on your own. This is where Bross Frankel PA can help. Our disability benefits law firm has helped numerous individuals in all aspects of Social Security disability claims, from initial applications to final appeals.
Our skilled and experienced legal team has handled thousands of Social Security disability cases and possesses the knowledge and capabilities to help you achieve an optimal outcome for your disability benefits application. To learn more or to schedule a no-obligation claim review, fill out our online contact form or call our law office at (856) 795-8880.