How Likely are You to Win Your Disability Case?

The likelihood of winning a disability case depends on several factors, such as--

1) Your medical history. If you can document the severity and ongoing nature of your disability through medical records, preferably from your treating physician, you are more likely to win benefits.

2) Your age, level of education, and work history. In general, those who are under 55, possess marketable work skills, or a higher level of education are less likely to be awarded Social Security Disability (SSD) or SSI disability benefits.

The logic behind this, at least from the Social Security Administration's point of view, is that younger, more educated people with a variety of job skills and/or work experience are better able to switch to a different job or be trained in another line of work.

However, having said this...many cases involving younger individuals are won, particularly at the hearing level, because a claimant's representative will be able to prove that the individual has the types of exertional limitations (e.g., lifting, carrying, pushing, pulling) and nonexertional limitations (e.g., restrictions in reaching, grasping, bending, seeing, hearing, concentrating, remembering, etc) that make it impossible for them to A) go back to their past work and B) do any other type of work.

Obviously, this is where knowledge of the disability system and the regulations and medical vocational rules guiding decisions comes into play. A good representative will have strong familiarity with medical impairments and the types of functional limitations that SSA is looking for, the meaning of vocational skill levels, specific rulings and regulations to support a case, and how to build a successful argument for winning the case.

3) Persistence. Statistically most initial applications for SSD and SSI are denied (the denial rate nationwide is about 77%). If your application for disability is denied, you should take it in stride, realizing that very few applications are immediately approved. After a disability application is denied, the next step is to file a social security appeal, called a request for reconsideration.

Reconsideration appeals are even more likely to be denied than initial applications, probably due in large part to the fact that the same agency that denied the initial application (the state disability determination services agency, or DDS) is in charge of evaluating all first appeals. If you have no new pertinent medical evidence to add to the record, your first appeal doesn't stand much chance of being approved.

So why persist in pursuing your disability case if the odds of approval are so slim? Because, if your reconsideration appeal is unsuccessful, you can and should file a second appeal. This second appeal will be reviewed by a federal administrative law judge (ALJ), and typically ALJs are more likely to award disability benefits than the claims examiners at DDS.

Note: More than half of all claims previously denied by DDS are later approved for disability by an administrative law judge (see Tips for Getting Disability Approved When you File with Social Security). That amounts to a stunning reversal based on A) how long a person decides to stick with their case and B) whether or not their case has been properly prepared for a judge to review.

The very worst thing a claimant can do is to give up on their claim for two very profound reasons.

The first reason: it is a historically established fact that when claimants continue to pursue their claims through the appeals process, the likelihood is that they will win their disability benefits, especially if the right evidence has been gathered and submitted

This is because at the second appeal level, the disability hearing, the rules actually do change. Administrative law judges regard the opinions of a person's treating physician differently and this practice is supported by Social Security rulings, whereas at the lower levels, the opinion of your doctor is likely to receive very little consideration.

Also at the hearing level, when consideration is given to what jobs may still be available to a person based on their age, education, functional limitations, and work skills (this is where Social Security may attempt to deny you based on the idea that you can do "other work"), only the jobs available in the claimant's geographical location are considered---whereas at the disability application and reconsideration appeal levels, a disability examiner will cite other jobs you can do, even if those jobs barely exist and are located as far away as Hawaii or Alaska...

Which, logically, means that you really can't do them because A) you can't find them and B) you can't get to them.

The second reason: many individuals will give up on a claim by not appealing a denial. They will let the case lapse. Then, months or years later, they will try again by filing a new claim. They will, in effect, start with a new filing date. And that means potentially sacrificing not only months of time (that were consumed on the original disability application) but also thousands (or even tens of thousands) of dollars in back pay.

In summation: a claimant is far less likely to win a disability case when they initially apply. However, the odds go up substantially when they follow the appeals process, do not miss filing deadlines, and make sure that the case is supported by the right evidence and is presented in a way that illustrates that they do not have the capability to do their past work, or switch to form of other work.

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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