5 Reasons for Disability Denials and How to Appeal

Author

Mike Lewis

Attorney Mike Lewis is the founding partner of Lewis & Keller. He has been practicing law since the ’70s with a focus on personal injury law and eminent domain.

June 10, 2025

The Short Answer

The Social Security Administration offers two disability programs called Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). To qualify, you must show that you are unable to work due to a qualifying disability. While you may feel strongly that you’re entitled to benefits, it’s important to provide convincing evidence to prevent disability denials.

Key Takeaways

• To qualify for SSDI, you must have a disabling health condition that prevents you from working for at least 12 consecutive months.
• You must provide sufficient medical evidence and treatment records to avoid denial.
• The SSA looks at your income and ability to maintain employment. If you’re able to work, even part-time, your application could be denied.
• To qualify for SSDI, you must have sufficient work credits earned in the past 10 years. If you don’t have enough credits, you may still qualify for SSI.
• Disabilities related to drug or alcohol addiction are typically excluded, and individuals who are incarcerated are not eligible for benefits.
• Over 60% of initial disability applications are denied, but many applicants are approved upon appeal.

1. The Duration or Severity of Your Disability Is Not Sufficient

The SSA evaluates each case individually to determine whether your specific health impairment qualifies you for SSDI or SSI benefits. The agency considers the severity and duration of your condition as well as your education and training. SSDI is not intended for short-term disabilities. In general, the SSA states that your injury or disability must meet 3 conditions to qualify for benefits.

1. The condition must be severe enough to prevent you from maintaining gainful employment.
2. You must be unable to work your previous job or adjust to different employment due to your health.
3. The condition must be expected to last for at least 12 consecutive months or result in death.

2. Insufficient Medical Records or Gaps in Treatment

If you are applying for disability benefits but are not following your doctor’s instructions, the SSA may interpret this as a sign that your condition isn’t severe or disabling. The SSA recognizes 4 main non-medical excuses for failing to comply with your prescribed therapy.

• The treatment prescribed by your doctor is unlikely to restore your ability to work.
• Your doctor’s prescribed treatment conflicts with another doctor’s recommendations.
• You do not have enough money to pay for your therapy or treatment.
• The prescribed therapy goes against your religious beliefs.

You can reduce the chances of a denial by providing comprehensive medical evidence, following your doctor’s recommendations, reducing gaps in medical records, and submitting any missing documentation when appealing your disability denial.

3. Excessive Income or Insufficient Work History

Both insufficient or excessive income can result in a Social Security disability denial. First, you must have a sufficient number of work credits to receive SSDI. For most workers, this means having 40 work credits, and half of these credits must be earned in the 10 years before your disability began. For 2025, workers earn 1 quarterly credit for every $1,810 in income with a maximum of 4 credits per year. Earning thresholds and income limits are updated annually.

To qualify for SSDI or SSI, your health condition must prevent you from maintaining gainful employment. For 2025, the SSA considers any income above $1,620 per month to be a substantial gainful activity (SGA). 

For blind individuals, the monthly income limit is $2,700. If your application is approved, you must be careful to avoid earning more income than permitted during the Trial Work Period ($1,160 per month for 2025) or Period of Extended Eligibility (regular SGA limit applies). 

The good news is that only earned income or wages count toward this limit, so unearned income from investments, pensions, or rental properties is not considered.

4. You Were Convicted of a Felony

Depending on the circumstances surrounding your crime and conviction, you may not be able to receive SSDI benefits. The SSA may deny you disability benefits if the following situations apply to you.

• If you became disabled while committing a felony and were subsequently convicted, you cannot use your injury as a basis for applying for SSDI.
• Disability benefits are not available during incarceration. You may appeal or have your benefits reinstated after your release.
• If you violate the conditions of your parole or probation, your benefits may be denied or suspended.

5. Your Disability Is Related to Drugs or Alcohol

If the SSA finds that drug or alcohol use has contributed to or worsened your disability, you may be denied benefits. There are exceptions if you can show that your disability would persist independent of any substance abuse. 

For example, if you’re unable to work due to mental health disorders or cirrhosis of the liver, you may still qualify for disability benefits if your condition would persist after sobriety. If you have a history of drug or alcohol use, participation in rehab or recovery groups may strengthen your claim.

Steps for Appealing a Disability Denial

If your application for disability was denied, don’t panic. Denials are very common following initial applications. However, you may still have a good chance of being approved during the appeals process. It’s highly recommended to consult a disability denial attorney for help navigating the appeals process.

1. If your application is denied, you’ll receive a Notice of Disapproved Claim. Provide a copy of this letter to your disability attorney to determine why your claim was denied and what information you need to provide with your appeal.
2. You have 60 days to submit a Request for Reconsideration unless you qualify for an extension. You can submit this information online, by mail, or by visiting a local office in North Carolina. Your attorney can help you prepare the request and submit additional documentation.
3. While some requests for benefits may be approved on appeal, you may have to go through multiple stages, including reconsideration, an administrative hearing, and appeals council review. As a last resort, it’s also possible to file a federal lawsuit if the SSA made a procedural error.

Don’t hesitate to consult a disability denial attorney for help managing your case, meeting deadlines, and presenting evidence. At Lewis & Keller, our attorneys have over 125 years of combined experience representing clients in Greensboro, Winston-Salem, and North Carolina’s Piedmont region.

Social Security Disability Denial FAQs

Contact Our Social Security Disability Denial Lawyers

Determining whether someone is eligible for SSDI or SSI is a complex process. To ensure that you receive the medical and financial benefits you may deserve, contact Lewis & Keller in Greensboro or Winston-Salem to speak to a Social Security denial lawyer. Our team has years of experience handling complex disability applications and appeals. Complete the form below to request a free case review.