Understanding the Prevalence of SSDI Denials and Steps to Take if Your Claim is Rejected

A Mother’s Fight for Her Son's Rights

In 2023, a flicker of hope sparked in Marlinda Cesar-Wiley's heart when her 4-year-old son, who has autism, was diagnosed with epilepsy. She believed this might finally qualify him for Social Security Disability Insurance (SSDI). Yet, within months, her hopes were dashed as the application faced yet another rejection—this was the fourth denial.

The Struggles of Communication

“I feel lost and frustrated—I just can’t figure out where I’m going wrong,” Cesar-Wiley confides, reflecting the struggles faced by many. Her son’s nonverbal condition complicates the communication of his epilepsy symptoms. With the support of a Medicaid nurse, occupational therapists, and speech therapy, he still finds himself caught in a cycle of denials that seems never-ending.

The Stark Reality of SSDI Approvals

Cesar-Wiley’s experience is not unique. Data from the Social Security Administration shows that only 31% of SSDI claims from 2010 to 2019 were granted approval. The convoluted and stringent requirements set forth by SSDI—such as proof of work credits and strict income limits for both adults and minors—often contribute to the frustrations many families face in their applications.

The Challenges of Proving Limitations

While some medical conditions, like chronic heart failure, have eligibility metrics outlined, others— like epilepsy—leave applicants in murky waters, grappling to prove severe limitations in daily activities. The problem is exacerbated as denial rates have increased from 1999 to 2021, indicating a system that often seems more concerned with denying assistance than providing necessary benefits.

Voices of Encouragement Amidst the Struggles

Rebecca Vallas, an advocate and secretary of the National Academy of Social Insurance, asserts, “Our system appears designed to reject people rather than to assist them.” This unchecked process is echoed in the experiences of Christy Vaal, a former therapist dealing with severe health issues—her applications for SSDI faced rejection twice, despite clear medical documentation. It wasn’t until a hearing that she finally gained approval after 16 months of waiting.

The Burden of Red Tape

Successfully navigating the SSDI system involves enduring mountains of paperwork and presenting extensive medical evidence. It’s an arduous process where meeting the criteria doesn’t guarantee access. Vaal noted the significant impact of her therapist during her hearing as she demonstrated how her physical ailments intertwined with her mental health, making her unable to work.

A Struggle for Clarity

Cesar-Wiley's battle intensifies with vague rejection notices from the SSA. Her son’s initial denial cited family income as an issue. After her son’s epilepsy diagnosis, she applied again while on medical leave, only to be turned down once more due to the same income concerns. “The lack of clarity is draining. These notices do little to explain the reasons,” she emphasizes, expressing her exasperation with the system.

The Resilience of a Loving Mother

Despite the continuous setbacks, Cesar-Wiley is determined to persevere. "I refuse to give up on my son," she passionately declares, fully committed to advocating for him. In her pursuit for answers, she frequently reaches out to the SSA, only to be met with long hold times and unreturned messages.

Seeking Support in the Fight for Benefits

After reaching out to the SSA regarding her denials, she was informed that privacy laws prevent any detailed discussion about individual cases. However, immediate assistance from a disability attorney could streamline this cumbersome process, as they work on a contingency basis and are paid only if benefits are awarded, limiting their fees.

Tips for Navigating the SSDI Process

Those with denials have the option to appeal, with the necessity to do so within 60 days of receiving rejection. However, patience is essential, as reviews can take months or even longer. Vaal emphasizes the necessity of being prepared for the waiting game, a crucial reminder for anyone set to face this daunting process.