How Often Does Social Security Approve Disability The First Time You Apply?

How many people are approved for disability the first time they apply? Statistics indicate that the national average for approval on initial disability claims is about thirty to thirty-five percent. The exact percentage varies by year and by state; however, this range has been fairly consistent for the last twenty years.

Reconsideration appeals also vary by year and state with some states (typically those in the southern U.S.) having some of the highest rates of denial at this level. In general, the reconsideration appeal always has a much lower rate of approval: averaging roughly fifteen percent, and ranging between 10 to 20 percent depending on the state in question.

The Social Security Disability process, it goes without saying, is a long and difficult one and it does not always end in an approval of disability benefits. In fact, in all levels of the disability process, other than the administrative law judge hearing level, there is a greater likelihood of a disability claim denial than an approval. That is not to say that certain cases will not be approved the first time an individual applies for disability, but the simple truth is that most claimants will end up having to appeal.

Social Security Disability examiners use a disability handbook that contains impairment listings for every body system. If an individual has a condition that meets or equals the criteria of any of the impairment listings, they will be medically approved for benefits.

Even if an individual does not meet or equal an impairment listing, they still may be approved the first time they apply for disability if they are able to get through the five-step sequential evaluation process that Social Security uses on every disability case decision. The five-step sequential evaluation process is as follows:

1. Determine if the disability applicant is working at an SGA level (a monthly earnings level that Social Security has determined to be self supportive). If an applicant is working and earning an SGA income, their disability claim will be denied no matter what disabling condition or conditions they have.

2. Determine if the individual has a medically determinable physical or mental condition, or conditions. This must be documented by objective medical evidence from an acceptable medical source (certified or licensed physicians, psychologists, speech and language therapist, etc.).

3. Determine the severity of the disabling condition or conditions by evaluating medical evidence, functional questionnaires provided by the disability applicant and their third party contact person (the person named as the third party contact on the disability application), or even their treating physician.

Don't get a generic statement from a doctor

Just a reminder, a generic "my patient is totally disabled" statement will carry no weight. If your treating physician provides a statement, they should address your limitations, diagnosis, prognosis, and your response to treatment.

Additionally, the objective medical evidence in your record should support the physician's statement. At this point, if the individual does not meet or equal an impairment listing they must go through the next two steps that deal with an individual's ability to perform work activity considering the limitations of their disabling condition or conditions.

4. The fourth step is an evaluation of the individual's ability to perform any of their past work. If they are found able to perform their past work, their claim will denied at this point.

5. The last step of the sequential evaluation process is to determine if an individual is able to perform other work in the general economy when you consider their age, education, residual functional capacity, and past work activity.

It is at this point that an individual can be found disabled by Social Security if they are unable to meet or equal an impairment listing and they are not able to do any of their past work or do other work due to the restrictions caused by their disabling condition or conditions.

After seeing the sequential evaluation process, it may make more sense there would not be a lot of Social Security Disability approvals the first time someone files for disability. Reconsideration appeals have an even less likelihood of resulting in an approved disability claim, because this appeal level only involves a review by another disability examiner at the same state disability processing agency.

Unless there was an error on the part of the disability examiner who made the initial disability decision, or there has been some new medical evidence that supports a finding of disability, it would be unlikely for the second examiner to arrive at a different decision.

However, for those who persist and file their second appeal (a request for a disability hearing), the rate of approval can be higher than sixty percent for those who have experienced representation to handle their claim and present their case to a federal administrative law judge.

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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