Overview of Disability
Disability Back Pay
Requirements for Disability
Applications for disability
Tips and Advice for Disability Claims
How long does Disability take?
Winning Disability Benefits
Common Mistakes after a Denial
Mental Disability Benefits
Denials for Disability
Appeals for denied claims
Disability Benefits from SSA
Child Disability Benefits
Qualifications and How to Qualify
Working and Disability
Disability Awards and Notices
Disability Lawyers, Hiring Attorneys
Social Security List of Conditions
What Social Security considers disabling
Medical Evidence and Disability
Filing for Disability Benefits
Eligibility for Disability Benefits
SSD SSI Definitions
SSDRC authored by Tim Moore
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What kind of Final Decision can I receive on my Disability Application?
Disability Decisions at the Initial Claim and First Appeal Levels
If you have a pending application for disability, or you are waiting on a decision for a request for reconsideration appeal, the decision you receive can only be a disability approval or a disability denial.
In either case, after your medical records and "other evidence" is reviewed (for an adult, this would be information regarding one's work history and normal daily activities, and for a child this would constitute information that substantiates the child's ability or in ability to engage in age-appropriate activities, typically meaning academic, IQ, and achievement records), you will receive written notification of the decision.
If an approval occurs, you will be informed of the amount of your ongoing monthly benefit payments, how much you may receive in back pay, and when your benefits may commence. If a denial of benefits occurs, you will receive some explanation (generally brief) as to why the claim was denied, as well as an explanation of your appeal rights.
How often do approvals and denials occur on disability claims? National statistics have been fairly consistent with regard to approval and denial rates over the past decade. On average, about 30 percent of all disability claims are approved at the disability application level. At the reconsideration level (the first appeal that can be filed, which is also decided by a disability examiner at DDS, or disability determination services), only about 13-15 percent of claims receive an approval.
It goes without saying, of course, that a person who has been denied should immediately file their next available appeal. The social security administration will allow 60 days for the filing of a disability appeal (plus an additional five days added to this for mailing the appeal paperwork); however, it is always best to get an appeal submitted as quickly as possible to eliminate processing time and also to allow a "cushion" in case it is later learned that the appeal paperwork that was submitted was not received by SSA.
Disability Decisions at the Social Security Hearing Level
Decisions on cases that occur at the disability hearing level allow for more variation. If a claimant has had a hearing and the administrative law judge has decided to deny the claim, the claimant will receive an Unfavorable Notice of Decision. This decision will synopsize the evidence that was presented at the hearing and explain the basis for the decision of the judge. If the claim is approved, it may come in the form of a Partially Favorable Decision or a Fully Favorable Decision.
If the disability decision made by a judge is "fully favorable", this will mean that A) the judge has determined that the claimant, via their medical and vocational evidence, has satisfied the social security administration definition of disability (meaning that their condition is severe enough to prevent substantial, gainful work activity for 12 months or longer, or may even result in death) and B) the available medical evidence supports the onset date that has been alleged by the claimant.
The alleged onset date, or AOD, of course, is the date stated by the claimant as to when their condition became severe enough to be disabling. A fully favorable decision by a judge simply means that the judge has concluded that the claimant is, in fact, disabled, and is disabled as of when they claimed on their application for disability (meaning the AOD).
If the decision that is delivered by the judge is "partially favorable", this will mean that the judge has found the claimant to be fully disabled, but that the claimant's condition did not become disabling at the time the claimant has alleged or contended. In such cases, the judge will determine that the claimant's EOD, or established onset date, is later than was claimed.
This will usually make no difference as to when monthly disability benefits will be received; however, a less than fully favorable (i.e. partially favorable) onset date can make a difference in the amount of back pay received. It can also make a difference as to when medicare coverage begins. And this is exactly why, in some cases, a disability attorney may decide to appeal the judge's decision if it has been partially favorable (though, in most cases, it will usually be safer for the claimant to accept the decision as it has been rendered by the judge).
Return to: Social Security Disability Resource Center, or read answers to Questions
How to apply for disability and where to apply Filing an Application for Disability Benefits under SSD or SSI - Step by Step
Tips on how to file for disability
What is the Application Process for Social Security Disability and SSI?
What happens after I file my disability claim with Social Security? What happens after a Social Security Disability or SSI Claim has been taken and is Pending
If you get denied on a disability application do you have to file a new application?
How the Decision on a Disability Application or Appeal Under SSDI or SSI is Made Getting SSDI but making too much money
Would I eligible for SSD if I file now since I was disabled at the time I stopped working?
Information on the following topics can be found here: Social Security Disability Questions and in these subsections:
Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI
These pages answer some of the most basic questions for individuals who are considering filing a claim.
Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria