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Mental Disability Benefits

Denials for Disability

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What Social Security considers disabling

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Appealing a Social Security Disability or SSI Denial with a Disability Hearing Before an ALJ (Administrative Law Judge)




 
Though denial rates differ by state, on average about seventy percent of all applications for disability will be denied by SSA (the social security administration). An even higher percentage of first appeals (this is the request for reconsideration) will be denied as well: up to eighty-seven percent according to recent statistics.

Even so, most claimants who have been denied on their SSD or SSI case would be well-advised to file an appeal instead of simply giving up and letting their claim lapse. This is because at the second level of appeal, the disability hearing (where the decision-maker is not a disability examiner, but, instead, a federal administrative law judge who specializes in adjudicating disability claims), more than 60 percent of all cases will be approved for benefits.

Why are disability hearings more effective than the first two levels for allowing claimants to win their benefits? There are several reasons for this:

1. The disability hearing allows both the claimant and their chosen representative, such as a disability lawyer, to offer a presentation of facts of the case, the medical evidence involved, as well as a theory of the case (i.e. an argument as to why the facts merit an approval). At the lower levels of the system, there is no such involvement of the claimant or their attorney.

2. The hearing process is non-adversarial. The claimant may appear with their representative; however, the social security administration does not have opposing council and the judge does not represent the interests of SSA. This fact alone may go far in answering why it is that most cases that have been denied by disability examiners are later approved by administrative law judges who are not required to answer to any level of management at the social security administration.

3. Administrative law judges give proper consideration to the opinions of treating physicians. A treating physician is social security's term for a doctor who has a history of providing medical treatment to a claimant. As such, the doctor is expected to have some familiarity with the claimant's condition and response to treatment, thus making them capable of offering an opinion on the claimant's prognosis and current functional abilities as well as functional limitations.

As disability judges see things, the opinion of the treating physician holds enough weight that an approval can be made on the basis of it. And this is a logical position since a treating physician has actually provided medical treatment to the claimant. At the lower levels of the system, however, the opinion of the treating physician is not given the proper consideration.

And, in fact, even when claimants submit detailed letters from their doctors to a disability examiner working on their disability application or reconsideration appeal, it will very often be overlooked. This may be because the disability examiner works, in his or her processing unit, with a unit medical consultant (an M.D.) whose job is to review the disability examiner's assessment of the case and provide their own opinion of the claimant's functional limitations.

Administrative law judges at disability hearings, however, do not place the opinion of a doctor who has never treated or even seen the claimant (the disability examiner's unit medical consultant) above that of the doctor who does have a history of providing medical treatment to the claimant (the treating physician). And this fact, probably more than any other, is what sets the disability hearing appeal far apart from the earlier levels of the system where the great majority of claims are denied by disability examiners.















Return to:  Social Security Disability Resource Center, or read answers to Questions





























Related pages:

How to Appeal a disability claim denial from Social Security
Common Mistakes after Receiving a Denial of Social Security Disability or SSI Benefits
What is a Social Security Disability Denial based on?
Are there ways to avoid being denied for SSI or social security disability?
What does a Disability Denial Letter from Social Security say?
Reconsideration of a Social Security Disability denial- what does it involve?
What to do if you receive notification of a Social Security Disability or SSI claim denial
If you receive a Social Security Disability Denial quickly does that mean the case is weak?
What happens if my SSI or Social Security Disability Application is denied?
Social Security Disability Denied The Reasons Why (medical denials)



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