If You Get Denied For Disability Should You appeal Or file A New Claim?

I think most would agree that it is much more to a disability applicant's advantage to file an appeal of their disability denial than it is to file another new initial disability claim. If you consider that about sixty to sixty-five percent of all initial disability claims are denied (depending on the state in which you live: despite the fact that Social Security Disability and SSI are federal programs, approval and denial rates differ from state to state), that should tell you a lot about your chances if you continue to file new initial disability claims.

It would stand to reason, that your chances of being approved on a new initial disability claim are not any better than your first initial disability claim. Your new disability claim will go to the same state disability agency and it will most likely receive the same decision, the only difference being that the decision will be made by a different disability examiner.

Your chances of winning your disability benefits are not much better on your reconsideration appeal (the request for reconsideration is the first appeal in the SSA appeal system). About eighty-five percent of all reconsideration appeals are denied; basically for the same reason that new initial disability claims are denied.

The reason being: state disability examiners make the decisions on both initial disability claims and reconsideration appeals, and they are bound by very strict rules set forth in the blue book, officially titled "Disability Evaluation Under Social Security". Disability examiners use this disability handbook, along with vocational guidelines to make all of their medical decisions, and they have very little leeway in making their medical determinations.

So now you may be thinking "Well why is the appeal process better than filing a new claim since only about fifteen percent of all disability applicants are approved at the reconsideration appeal level?". Well, reconsideration appeals are just the next step on the path to an administrative law judge hearing.

If your claim is denied at the disability application level, your goal should really be to get your case heard by a federal administrative law judge at a social security hearing. However, ALJ hearings can only be requested and scheduled after a claimant has gone through the first appeal step (the request for reconsideration).

Why are judges at hearings more likely to approve claims? Administrative law judges approve more than sixty percent of all cases that they adjudicate when the claimant is represented by either a disability attorney or a non-attorney disability representative (the ALJ approval rate falls to about forty percent for unrepresented claimants). Therefore, it stands on its face that the hearing level is the most favorable as compared to the initial claim and reconsideration levels.

As to why judges are more likely to approve claims, however, there are several explanations.

To begin with, administrative law judges have much more freedom than disability examiners when making their medical determinations. Although both administrative law judges and disability examiners use all the same disability tools to make their determinations, judges are able to use their own judgment when deciding cases without interference.

In stark contrast to this, disability examiners must not only confer with physicians and psychologists in their case processing units, but must often yield their judgement to their unit supervisors (who often try to hold down the number of approvals being issued because approved claims are more likely to be reviewed by an external quality control branch known as DQB, which stands for the disability quality branch).

In short, disability judges make decisions as they see fit, based on the medical evidence before them and the arguments presented by the claimant or the claimant's disability attorney; whereas disability examiners are influenced by the agency in which they work to hold down the number of disability claim approvals.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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