The Social Security Administration (SSA) denies more than two-thirds of initial applications for Social Security Disability Insurance (SSDI) each year. In 2023, 61% of applicants were denied on their first attempt. At Walker Firm PC, DBA Casa de la Justicia, if a client is denied, we review the case thoroughly and at the Hearing Level are winning more than 70% of our claims. The difference is that we review each application thoroughly to ensure information is accurate and that both the technical and medical criteria truly indicate the client is no longer able to work.

Some reasons why claims are denied include:

Technical denial

Work credits are essential for SSDI eligibility, which requires a recent work history of at least 10 years of tax-paying work. Applicants who don’t meet the SSA’s technical requirements, such as not working long or recently enough, are denied before their medical condition is assessed. In 2021, about 43% of initial applications were technically denied.

At Walker Firm PC, DBA Casa de la Justicia, we review the claimant’s work history to make sure that they became disabled during the time they were working, as SSA only awards when the disabling condition occurred during the insured period. Applicants who make more than the “substantial gainful activity” (SGA) amount are likely to be denied. In 2024, the SGA is $1,550 per month, or $2,590 for blind individuals.

Medical condition

Work credits are essential for SSDI eligibility, which requires a recent work history of at least 10 years of tax-paying work. Applicants who don’t meet the SSA’s technical requirements, such as not working long or recently enough, are denied before their medical condition is assessed. In 2021, about 43% of initial applications were technically denied.

SSDI benefits are intended for people with long-term or life-threatening impairments that significantly limit their ability to work. The SSA needs clear evidence that shows how the condition of the applicants limits their ability to work. This means every application needs to include recent and accurate information from doctors and specialists, so SSA can request that information and confirm the claimant is actually suffering from the condition(s) claimed.

It’s common for people applying on their own to miss categories of information that SSA needs to award a claim, i.e. some people think they’re disabled because of headaches, but the headaches are caused by a back condition that affects their ability to walk. Omitting that information could result in a denial because the information is not directing SSA to look in the right area for medical records.

Treatment gaps are fine – but SSA likes to see a long history of consistent treatment. It is very important that the claimant see their doctors as much as is helpful for their treatment. During these visits, it’s essential the client shares with the Doctor specific details about why they are not able to work, so the medical records support the claim.

SSA also has a very specific (and outdated) way of determining whether people can perform past work or other jobs (which is the standard for applying for disability, in general).  At Walker Firm PC, DBA Casa de la Justicia, we provide our clients with forms for the treating doctors to fill out so that the limitations that the clients’ doctors are providing are the records SSA can use to make a decision.

The SSA also expects claimants to follow the doctor’s prescribed treatments to try to improve their limiting condition. At Walker Firm PC, DBA Casa de la Justicia, we sometimes hear that our clients are not following the prescribed treatments due to side effects or the cost.  In these cases we first recommend that they talk to their doctors about alternative medications or other options.  Second, we make sure to describe specifically the barriers to treatment, and include this information in the application.