Why Was My SSDI Claim Denied? Key Reasons

Receiving a denial letter from the Social Security Administration (SSA) can feel like a crushing blow, especially when you are unable to work due to a serious medical condition. You may have spent months gathering medical records, completing forms, and waiting for a decision, only to open an envelope that says your claim has been denied. If you are asking yourself, “Why was my SSDI claim denied?” you are not alone. The SSA denies approximately two-thirds of initial applications for Social Security Disability Insurance (SSDI). Understanding the specific reasons behind these denials is the first step toward building a stronger appeal and getting the benefits you deserve.

Most denials happen because the SSA determines that an applicant does not meet their strict definition of disability. However, the reasons can range from simple paperwork errors to complex medical evidence gaps. This article will walk you through the most common pitfalls, explain how the SSA evaluates claims, and show you how to correct these issues during the appeals process. Whether you are filing for the first time or preparing a reconsideration request, knowing these answers can dramatically improve your chances of success.

The SSA’s Five-Step Disability Evaluation Process

To understand why a claim was denied, you first need to understand how the SSA makes its decision. The agency uses a sequential five-step process to evaluate every SSDI application. If you fail at any single step, your claim is denied. Knowing where you stumbled can help you answer the question, “Why was my SSDI claim denied?” with precision.

Step one asks whether you are currently working and earning above the Substantial Gainful Activity (SGA) level. For 2026, the SGA threshold is $1,620 per month for non-blind individuals. If you are working and earning more than this amount, the SSA will deny your claim immediately, regardless of your medical condition. Step two examines whether your condition is severe enough to significantly limit your ability to perform basic work activities. Minor or temporary impairments usually do not pass this step.

Step three is where the SSA checks if your condition meets or equals a listing in its Blue Book, which is a manual of disabling impairments. If your condition matches a listing, you are automatically found disabled. Most denials happen because the medical evidence does not quite meet the listing criteria. Step four considers whether you can perform any of the jobs you held in the past 15 years. If the SSA decides you can still do your past work, your claim is denied. Finally, step five looks at whether you can adjust to other work that exists in significant numbers in the national economy. This step considers your age, education, work history, and residual functional capacity (RFC). A denial at step five often means the SSA found you capable of some other type of work.

Top Reasons Your SSDI Claim Was Denied

While the five-step process provides the framework, the real reasons for denial are usually more specific. Here are the most common issues that lead to rejected claims.

Insufficient Medical Evidence

The SSA requires objective medical evidence to support your disability claim. This means doctor’s notes, lab results, imaging studies, and treatment records. If your medical records are sparse, incomplete, or do not cover a long enough period, the SSA will likely deny your claim. Many applicants assume that simply being diagnosed with a condition is enough. However, the SSA needs evidence showing how your condition limits your ability to function on a daily basis. For example, a diagnosis of chronic back pain is not enough. You need MRI results, physical therapy notes, and a doctor’s opinion about your lifting, sitting, and standing limitations.

Another common problem is a gap in treatment. If you stopped seeing a doctor for several months or years, the SSA might assume your condition is not as severe as you claim. Consistent treatment records from a licensed medical provider are crucial. If you cannot afford regular care, document that fact and mention any free clinics or emergency room visits. The SSA must consider all evidence, but they will not fill in the blanks for you.

Failure to Follow Prescribed Treatment

If your doctor recommends a specific treatment or medication and you do not follow through, the SSA can deny your claim. They may argue that your condition would improve if you simply followed medical advice. This is a common denial reason for conditions like diabetes, hypertension, or mental health disorders where medication adherence is critical. However, there are exceptions. If you have a legitimate reason for not following treatment, such as severe side effects, financial barriers, or religious objections, you can explain this to the SSA. Make sure your medical records document these reasons.

Earning Above Substantial Gainful Activity (SGA)

As mentioned earlier, working and earning more than the SGA limit is an automatic denial. But even working part-time or earning below the limit can cause problems. The SSA looks at your average monthly earnings over a period of time. If you have a good month or two where you earn a significant amount, the SSA might consider that evidence that you can work. If you are trying to work while applying for SSDI, keep meticulous records of your earnings and be prepared to show that your work was unsuccessful or required significant accommodations.

Non-Compliance with SSA Requests

The SSA will send you requests for additional information, medical records, or forms. If you miss a deadline or fail to respond, your claim will be denied by default. This happens more often than you might think. Applicants move, change phone numbers, or simply overlook a letter. Always keep the SSA updated with your current contact information. If you receive a request for a consultative examination (a medical exam paid for by the SSA), you must attend. Missing this appointment is a guaranteed denial.

Your Condition is Not Expected to Last 12 Months

Social Security disability benefits are only available for conditions that are expected to last at least 12 months or result in death. If your condition is temporary, such as a broken bone that will heal within six months, your claim will be denied. This is a common issue for people with short-term injuries or those recovering from surgery. The SSA needs evidence that your impairment will last for a full year or is terminal.

Common Medical Conditions That Get Denied

Some conditions are notoriously difficult to prove to the SSA, even when they are genuinely disabling. Subjective conditions that rely heavily on patient-reported symptoms are often denied initially. These include chronic pain syndromes, fibromyalgia, chronic fatigue syndrome, and many mental health disorders like depression, anxiety, and bipolar disorder. The SSA looks for objective findings such as trigger points, abnormal lab values, or psychiatric evaluations. Without these, your claim may be denied.

Another challenging category is musculoskeletal conditions like back pain or arthritis. Even if you have clear imaging showing disc degeneration or joint damage, the SSA wants to see how that damage limits your range of motion, your ability to walk, or your ability to lift. They will often send you to a consultative examination to measure these limitations. If you downplay your pain during that exam, your claim will likely be denied. Be honest and show your true limitations.

How to Appeal a Denied SSDI Claim

A denial is not the end of the road. In fact, most successful SSDI claims are approved only after an appeal. The process has four levels, and you must generally follow them in order. The first level is reconsideration, where a different SSA reviewer looks at your claim and any new evidence you provide. Unfortunately, the approval rate at reconsideration is very low, often around 10 to 15 percent. The second level is a hearing before an administrative law judge (ALJ). This is where most claims are won. The judge will listen to your testimony, review your medical records, and question any vocational or medical experts present.

If you lose at the hearing level, you can appeal to the Appeals Council, which reviews the ALJ’s decision for legal errors. Finally, you can file a lawsuit in federal district court. The entire process can take one to three years, so patience is essential. For more detailed guidance on the timing and strategy of this process, read our article on when to appeal a denied Social Security disability claim.

Strengthening Your Appeal: What You Can Do

To win an appeal, you need to address the specific reason your claim was denied. Start by obtaining a copy of your entire claims file from the SSA. This will include the denial letter, the rationale, and all the evidence they considered. Review it carefully for errors. Many denial letters contain incorrect information about your work history or medical treatment.

Next, gather updated medical records. If your original claim lacked evidence, get more. Ask your doctor to write a detailed statement about your functional limitations. Specifically, ask them to comment on your ability to sit, stand, walk, lift, carry, and concentrate. A well-written doctor’s opinion can be very persuasive to an ALJ. Also, consider keeping a daily pain or symptom diary. This can provide powerful evidence of how your condition affects your quality of life. If you have not already done so, consider working with a disability attorney. Statistics show that claimants with legal representation are significantly more likely to be approved at the hearing level. An attorney can help you prepare your testimony, gather the right evidence, and argue your case effectively.

Sometimes a denial happens because the SSA made a mistake about your past work. They may have classified a job incorrectly or overstated your skills. An attorney or vocational expert can help you challenge this. For a broader look at what happens when a government benefits claim is denied, you might find our article on what happens when your Illinois bankruptcy petition is denied helpful, as it explains similar concepts of appeal and fresh starts, even though the subject matter differs.

Frequently Asked Questions

Can I reapply instead of appealing a denial?

You can, but it is usually not a good idea. Reapplying means starting the entire process over from scratch. You will lose your place in line and any back pay you might have been entitled to from your original filing date. Unless your condition has changed dramatically or you made a fatal error on the original application, an appeal is almost always the better route.

How long do I have to appeal a denial?

You have 60 days from the date you receive the denial letter to file your appeal. The SSA counts the date of receipt as five days after the letter is mailed. Missing this deadline means you lose your right to appeal and must start over with a new application. File your appeal immediately, even if you do not have all your evidence ready. You can always add evidence later.

What is a residual functional capacity (RFC) assessment?

An RFC assessment is a form the SSA uses to describe what you can still do despite your disability. It covers your ability to lift, stand, walk, sit, and perform mental tasks. The SSA uses your RFC to decide if you can do your past work or other jobs. If your RFC is too high, your claim will be denied. Your goal is to provide medical evidence that shows a very restricted RFC.

Will a lawyer help me get approved?

Statistics show that claimants with legal representation are approved at much higher rates, especially at the hearing level. A lawyer understands the SSA’s rules, knows how to gather the right evidence, and can present your case effectively. Most disability attorneys work on a contingency fee basis, meaning they only get paid if you win. The fee is capped by the SSA at 25 percent of your back pay, up to a maximum of $7,200.

Final Thoughts

Being denied SSDI benefits is frustrating, but it is a normal part of the process for most applicants. The key is to treat the denial as a roadmap. The SSA has told you what was missing from your claim. Your job is to fill those gaps. Whether you need more medical evidence, a better explanation of your limitations, or help from a qualified attorney, every step you take brings you closer to approval. Do not give up after one denial. Many people who are now receiving benefits were initially rejected. With persistence and the right strategy, you can overcome the denial and secure the financial support you need.

If you are ready to take the next step, consider reaching out to a legal professional who can evaluate your case. At LawyerCaseReview, we can connect you with experienced disability attorneys who understand the system. For personalized assistance, call us at (833) 227-7919 to discuss your options.