Do Most Social Security Disability Reconsiderations Get Turned Down?

Unfortunately, most people who apply for disability benefits are turned down. In fact, only about thirty five percent of those who apply for disability benefits are approved for disability, forcing those whose disability claims were denied to make a decision as to whether or not they want to continue to pursue disability benefits through the Social Security appeal process.

If an individual decides to appeal their initial determination, they must file a reconsideration appeal within the appeal period. The appeal period is sixty days plus five days for the mailing of the decisional notice (counted from the date of that same notice).

This literally means an individual's reconsideration appeal should be in their local Social Security office on the sixty-fifth day to be considered timely. Once the reconsideration appeal is received, it is sent to the same federally-mandated, state-level disability agency that made the initial disability denial decision (DDS, also known as the disability determination services agency).

The only difference this time around is that the individual's reconsideration appeal is given to a different disability examiner--usually a disability examiner who specializes in handling reconsiderations and reviews of existing claims--for a decision. Unless the disability examiner who made the initial disability determination was in error or the disability claimant has new medical evidence that could make an approval possible, the decision is going to be the same.

Why is this true? The answer is actually very simple. The disability examiner who makes the reconsideration appeal decision is bound by the same strict interpretation of the disability medical and vocational disability guidelines as the initial disability examiner. The reconsideration disability examiner is also held to whatever standards are used in his or particular DDS (disability determination services).

For example, there are different DDS agencies in North Carolina, Georgia, Michigan, Ohio, Texas, etc, etc. And decisions that come out of one of these agencies are likely to be a bit different from the decisions that come out of other agencies. This is why you can see (as documented by federal statistics) greatly differing rates of approval and denial between states like Mississippi and Massachusetts.

But within a particular DDS agency, say, for example, the North Carolina DDS, all disability examiners will tend to make the same sorts of decisions. And this is why, if a claimant is denied on a disability application by a disability examiner at a DDS, they are likely to be denied again by the reconsideration disability examiner---because they are both at the same DDS agency for that particular state.

This explains why the reconsideration appeal approval rate is so low. The average national approval rate for reconsideration appeals is about ten to fifteen percent.

Social Security Disability is full of turn downs and the reconsideration appeal has the honor of having the highest turn down rate of all the levels of the disability process. The only way to see any good in the reconsideration appeal for most people is to just look at it as one step closer to an administrative law judge hearing-- which, by the way, has the highest approval rate in the disability process.

Disability hearings, as opposed to disability applications and reconsideration appeals, result in approvals for most claimants. At least forty percent of those who go to hearings without the benefit of being represented are awarded SSD or SSI disability benefits. More than sixty percent of those who go to hearings with a disability attorney are awarded disability benefits.

Why are the outcomes so different? Administrative law judges have the benefit of meeting the claimants that they render decisions for. Administrative law judges also have the benefit of being independent. Unlike disability examiners, who have several layers of supervisors, judges have the autonomy and freedom to decide cases as they see fit. Very often, this means that judges can simply employ both common sense, as well as compassion, in their decision-making.

Because the decisions of disability judges and the decisions of disability examiners can be so widely different, individuals who give up the right to appeal a denial of their initial disability claim do themselves a grave disservice. The rule of commonsense, when it comes to disability claims that are filed with the social security administration, is to always appeal after a notice of denial has been received. At least as far as the hearing level where your claim will get a fair opportunity.

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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