November 06, 2025
Denied Disability Benefits? 3 Common Reasons And What To Do Next
Opening that denial letter feels like a punch to the gut. You’re already struggling with a disability that prevents you from working, and now the government or insurance company says you don’t qualify for benefits. The frustration is real, and so is the financial pressure mounting with each passing day.
Disability benefit denials happen frequently, but they’re not the end of the road. Our friends at Hickey & Turim, S.C. discuss how most initial applications get denied, and many of those denials get overturned on appeal. A social security disability lawyer handles different types of cases, but attorneys who focus on disability claims understand the system’s quirks and know how to build stronger cases the second time around.
Reason 1: Insufficient Medical Evidence
The most common reason for disability denials is lack of sufficient medical documentation. The Social Security Administration or private insurance company needs proof that your condition prevents you from working. Your word alone isn’t enough, no matter how severe your symptoms feel.
Disability examiners want to see consistent medical treatment with detailed records from your doctors. If you’ve only been to the doctor a few times, or if there are large gaps in your treatment history, they assume your condition isn’t as limiting as you claim.
According to the Social Security Administration, claims with comprehensive medical evidence have significantly higher approval rates than those with sparse documentation. The examiners reviewing your file aren’t medical professionals making independent judgments. They’re administrators following checklists and guidelines based on what doctors write in your records.
What Medical Records Need To Show
Your medical documentation should include regular office visits, diagnostic test results, treatment plans, medication lists, and most importantly, functional assessments from your doctors. A functional assessment explains how your condition limits your ability to sit, stand, walk, lift, concentrate, or perform other work-related activities.
Many doctors focus on diagnosing and treating conditions without documenting how those conditions affect daily functioning. A diagnosis of severe arthritis means something different if your records don’t specify that you can only stand for 10 minutes at a time or can’t grip objects with your hands.
If your claim was denied for insufficient medical evidence, you need to work with your doctors to create more detailed records. Ask them to complete functional capacity forms, document your symptoms at each visit, and explain specifically how your condition prevents substantial gainful activity.
Reason 2: Earnings Above Substantial Gainful Activity Level
Social Security disability benefits have strict income limits. If you’re earning above the substantial gainful activity threshold, you’re automatically disqualified regardless of your medical condition. For 2025, this threshold is $1,550 per month for non-blind individuals.
This trips up people who try to keep working part-time while pursuing disability benefits. You might only be working 10 hours per week because that’s all your body can handle, but if those hours pay enough to exceed the SGA limit, your claim gets denied.
Private disability insurance policies have different definitions, but they also focus on your ability to earn income. “Own occupation” policies pay if you can’t do your specific job, while “any occupation” policies only pay if you can’t do any work at all.
Understanding The Income Rules
The SGA limit applies to gross earnings from work, not passive income or benefits from other sources. Investment income, rental property income, or payments from other disability policies don’t count toward the threshold.
If your denial was based on earnings, you need to carefully evaluate whether you can actually sustain that level of work. Many people push themselves beyond what’s medically advisable because they need income. But continuing to work at an unsustainable pace weakens your disability claim and risks worsening your condition.
Consider whether reducing hours or stopping work entirely makes sense for your long-term health and financial situation. This isn’t an easy choice, but trying to work while claiming total disability creates a contradiction that’s hard to overcome.
Reason 3: Condition Doesn’t Meet Duration Requirements
Social Security requires that your disability last or be expected to last at least 12 continuous months, or result in death. If your medical records suggest your condition might improve within a year, your claim gets denied even if you’re currently unable to work.
This affects people with serious but potentially temporary conditions. You had surgery and recovery takes eight months. You’re completely disabled during that time, but it doesn’t meet the duration requirement. The same applies to many mental health conditions where treatment might show improvement within a year.
Private disability policies have their own elimination periods, often 90 to 180 days before benefits begin. You need to be continuously disabled through this waiting period and beyond to qualify for payments.
Proving Long-Term Disability
If your denial cited the duration requirement, your appeal needs medical evidence showing the condition is long-term. This might include:
- Doctor statements about expected duration of disability
- Evidence that treatments haven’t worked or have limited effectiveness
- Progressive conditions with documented worsening over time
- Chronic conditions with no cure, only symptom management
Sometimes the initial denial happens too early in your disability timeline. A condition that seemed possibly temporary six months ago now clearly won’t resolve within a year. Your appeal can include updated medical evidence showing the ongoing nature of your limitations.
The Appeals Process Timeline
Disability denials aren’t final decisions. You have the right to appeal, and the appeals process has multiple levels. For Social Security disability, the process includes reconsideration, administrative law judge hearing, appeals council review, and federal court if necessary.
You typically have 60 days from receiving your denial to file an appeal. Missing this deadline means starting over with a new application, losing months of potential back benefits. The denial letter includes specific instructions for requesting reconsideration or a hearing.
Most people who win disability benefits don’t win on their initial application. They win at the hearing level after appealing. Administrative law judges can review your case in person, ask questions, hear testimony from medical professionals, and make more nuanced decisions than the initial desk reviewers.
Private insurance denials also have appeal rights spelled out in the denial letter and in your policy documents. These might involve internal reviews, external reviews by independent medical professionals, or arbitration depending on your policy terms.
Strengthening Your Appeal
Simply resubmitting the same information that led to your initial denial won’t change the outcome. Your appeal needs new evidence, better documentation, or clearer explanations of how your condition meets the requirements.
Focus on filling gaps in your medical evidence. If you haven’t seen a doctor in months, schedule appointments and have them document your current condition. If your records lack functional assessments, ask your doctors to provide detailed statements about your limitations.
Consider getting evaluations from additional medical professionals. Sometimes a specialist’s opinion carries more weight than general practitioner notes. Consultative examinations arranged by Social Security can help or hurt depending on the examiner, but thorough evaluations from your own doctors provide stronger evidence.
Gather statements from people who observe your daily struggles. Spouses, family members, former coworkers, or friends can describe how your condition affects your ability to function. These aren’t as valuable as medical evidence, but they provide context that reinforces your claim.
Common Appeal Mistakes To Avoid
Don’t wait until the last minute to file your appeal. The 60-day deadline is strict, and gathering new medical evidence takes time. Start the process immediately after receiving your denial.
Don’t assume the appeal is just a formality that rubber-stamps the initial decision. Appeals actually get reviewed, and judges at hearing level overturn denials regularly. Taking the appeal seriously and presenting a stronger case makes a real difference.
Don’t give up after one denial. The system is designed with multiple appeal levels because initial denials happen frequently. Persistence matters, and many successful claimants went through several rounds before approval.
When To Get Legal Help
You can handle appeals yourself, but representation improves your chances significantly. Disability attorneys work on contingency, meaning they only get paid if you win benefits. Their fees come from your back pay and are capped by law.
Attorneys know what evidence convinces judges, how to obtain proper medical documentation, and how to present your case effectively. They’ve seen thousands of cases and understand which medical conditions qualify under which criteria.
If you’ve been denied once and are considering giving up, or if you’re preparing for a hearing before an administrative law judge, legal representation can make the difference between approval and another denial. Understanding why your claim was denied is the first step toward fixing the problems and building a case that meets the requirements for benefits you need and deserve.
