Why is Almost Every Person Automatically Denied the First Time They File for Disability?

In actuality, this is not the case. However, when you consider the fact that more than 70 percent of all new disability claims are denied, and the fact that more than 80 percent of all first appeals are denied (this is the reconsideration appeal), then it becomes easy enough to understand why people believe this to be the case.

It becomes particularly difficult for people to understand the high rates of denial for SSD (Social Security Disability) and SSI (supplemental security income disability) cases when either their cases involve:

A) limitation of reflexes, strength, or movement,

B) pain,

C) a cognitive issue (such as memory loss),

D) a condition that involves exacerbation and remission--meaning it gets worse, then better, then worse again--such as fibromyalgia or lupus,


E) when they have a longstanding problem with an an affective disorder illness (e.g. bipolar disorder) or an anxiety-related disorder.

For the individual who has a condition that has either prevented them from working and earning a livable wage, or a condition that has worsened to this point, receiving a denial on a claim probably seems nonsensical.

Is every person automatically denied the first time they file for disability? No, but the odds are against you when you file a claim. And if you need to file your first appeal, the request for reconsideration, the rate of denial is so high that it might as well be automatic.

The actual question to ask is probably, "Why is it that the social security administration denies so many claims in the first place?". Some might think this question to be a relative waste of time. After all, not everyone can be approved for disability benefits, just as not everyone can be satisfactorily treated for a medical condition.

However, the question has merit because of this one fact: for those who are denied disability benefits and then choose to appeal all the way to the level of a disability hearing before an administrative law judge, the chances of approval are good. In fact, roughly 60 percent of these individuals, if they have able representation, will be approved by a judge despite the fact that they were previously denied at the initial claim and reconsideration levels.

So, why is it that a claim can be approved by a judge, but denied by a disability claims examiner at the lower levels of the system? There really isn't a single answer. However, let's point out how the levels are different from each other.

At the disability application and reconsideration appeal levels, claims are decided by disability examiners. These individuals are conceptually similar to insurance adjusters for insurance companies. They work in bureaucratic settings and follow the lead of their supervisors and agency managers. They make decisions on claims but have to answer to enough individuals that, truly, their decisions are not really independent in any sense. They also make decisions in a way that does not involve the significant participation of the claimant or even the claimant's disability representative.

At the disability hearing level, the administrative law judge is the single decision maker and, effectively, answers to no one. True, there is an appeal level, the appeals council, that reviews the decisions of disability judges, but it is debatable as to whether or not this body has any real effect on the adjudicative behavior of judges who work in the field.

Basically, judges, unlike disability examiners, make their own decisions without the influence of supervisors, managers, and without the bureaucratic leanings of an entire agency (such as the north carolina DDS, or disability determination services).

Furthermore, judges operate on a level that allows for far greater participation by both the claimant and the claimant's disability lawyer or non attorney representative. In fact, the judge's ability to reach a more developed opinion of a claimant's case is enhanced by the work that is done by a disability representative who may gather additional medical evidence from treatment sources, opinions from doctors, and additional information regarding a claimant's work history.

Added to that is the fact that at the hearing level the attorney will actually appear with the claimant before the decision-maker (the judge) and make a presentation of the case that includes advocacy for a favorable outcome which is supported by evidence in the claimant's file.

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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