Why SSDI denials are so common and what to do if you’re denied

By Whitney Vandiver | NerdWallet

When Marlinda Cesar-Wiley’s 4-year-old son with autism was diagnosed with epilepsy in 2023, she thought he’d finally qualify for Social Security Disability Insurance. But he was denied for the fourth time a few months later.

“It’s been very, very frustrating because I don’t know what I’m doing wrong at this point,” says Cesar-Wiley.

Her son is nonverbal, making it difficult for him to communicate about his epilepsy. He has a Medicaid-sponsored nurse, goes to occupational and speech therapy and receives transportation assistance for appointments. But he has received a string of denials for SSDI benefits.

Cesar-Wiley’s experience is common. Only 31% of SSDI claims were approved, on average, by the Social Security Administration between 2010 and 2019. Here’s why denials happen and what you can do about them.

Stringent requirements

SSDI spells out clear requirements for working credits needed and a monthly income limit for adult applicants or parents applying on behalf of a child, but the SSDI criteria for eligible disabilities can be vague.

Some impairments, such as chronic heart failure, have published eligibility metrics, but conditions that vary in their symptoms and severity leave applicants to prove they are extremely limited in certain abilities.

And denials are becoming more pervasive. According to the most recent data, between 1999 and 2021, the Social Security Administration increased the rate of SSDI denials for applicants who were deemed to not qualify for benefits.

“We built a system that is more focused on denying people than it is on getting people the benefits that they need,” says Rebecca Vallas, secretary of the board of directors of the National Academy of Social Insurance. “People often say people are falling between the cracks, and that isn’t what’s happening here. The system is working the way it was designed.”

Complicated appeals process

When Christy Vaal applied for SSDI, she had three conditions that affected her work as a therapist: severe asthma, rheumatoid arthritis and chronic lymphocytic leukemia.

“It was kind of the cumulative effect of all three of those that led to an impact to my daily functioning, my occupational functioning, and impaired my ability to do the things that we normally do, that healthy people do,” Vaal says.

Despite medical records showing three diagnoses for severe conditions, the SSA denied Vaal’s first two applications. On her third attempt, during a hearing with a judge, she was finally approved for benefits.

The SSA took 16 months to approve Vaal’s application, but that time frame isn’t abnormal. The average wait for an appeal decision in October 2020 was one year, according to the U.S. Government Accountability Office.

The burden of medical proof

Part of the problem is that applicants must prove they meet the criteria for being disabled.

“Eligibility doesn’t equal access,” says Vallas.

As a lawyer, Vallas previously represented SSDI applicants pro bono and advised them to expect a denial with their first applications, though some had already been denied several times before seeking her assistance. “And these were folks who were clearly eligible under the law, but who hadn’t been able to make it through all of the red tape.”

SSDI applicants must prove their impairments are so severe that they are unable to earn above a certain income. Often the SSA requires a lot of evidence, such as lab results, treatment history and psychological records. With conditions that present differently in patients, proving a disability is severe can create a lot of work.

“It takes mounds of paperwork. It takes extensive medical evidence,” says Vallas.

But evidence of severe medical conditions doesn’t guarantee approval; it’s a matter of how those conditions affect applicants. Vaal believes that working with a therapist influenced her SSDI hearing. She was able to prove that her physical health had affected her mental health to the point that she was unable to work.

“It wasn’t necessarily one particular medical condition, but I think the cumulative effect that it had on my mental health,” Vaal says.

‘Not knowing what I’m doing wrong’

Determining what needs to change for denied applicants to qualify can be surprisingly difficult.

Cesar-Wiley’s son’s initial denial said her family made too much money. When her son was diagnosed with epilepsy, she took medical leave to care for him and reapplied for SSDI, but her son was denied again due to family income requirements. Trying to get clarification on denials and how to qualify has been frustrating for her.

“I think the most draining is not knowing what I’m doing wrong,” says Cesar-Wiley. “These notices are very general.”

Every time her son is denied, Cesar-Wiley calls the SSA, but lengthy hold times, lack of appointment availability and messages that aren’t returned leave her in limbo.

But Cesar-Wiley says she’ll keep applying until her son is approved. “I’m very resilient for my son,” she says. “I have to advocate. I have to speak.”

NerdWallet contacted the SSA by email to inquire about Cesar-Wiley’s SSDI denials. A representative from the SSA press office responded by saying that “privacy laws preclude [it] from discussing individual cases,” but said the office would contact Cesar-Wiley directly.

What to do if you’re denied SSDI benefits

Talk to a disability lawyer

A disability lawyer can create a strategy for appealing your denial and help manage your records. Disability attorneys aren’t paid unless you are awarded benefits. Their cost comes out of your overdue benefits, and they’re limited in how much they can charge.

“I got one right away,” Vaal says. “It just made the whole process so much easier, infinitely easier.”

Organizations like the National Organization of Social Security Claimants’ Representatives can help you find a disability attorney.

Appeal

When you appeal an SSDI denial, the SSA must reconsider your application. You’ll likely need to appeal within 60 days of a denial, so start the process as soon as you receive your denial notice. It’s a good idea to appeal if you can, rather than filing a new claim; if you file a new claim for the same case, it’s more likely to be denied. If you’re working with a lawyer, they can guide you through this process.

Know that it’s a long process, no matter the stage

Be aware that it will likely take several months, if not over a year, for the SSA to decide on your case.

“I think it’s important to be prepared to wait. You have to be patient,” Vaal says.

You can still look for additional support while you are waiting for your SSDI application to be approved. Programs like Supplemental Security Income can assist you with affording necessities like food and shelter.

The article Why SSDI Denials Are So Common and What to Do if You’re Denied originally appeared on NerdWallet.