Why are so many claims at the disability application level denied?
Someone recently posted that they had no idea that most claims are denied. When I read statements like that, sometimes for a split second I think "how could you not know that?". However, that only lasts for a fraction of a second. Because, logically, why would someone think that. After all, most individuals do not want to file for disability. And many put off doing so for years. They only finally take the step of applying for disability once it has become painfully clear to them that they have no other choice. Because of their mental or physical condition, they no longer have the ability to work and earn what SSA calls a substantial and gainful income.
So, to address the question, are most disability claims denied? Yes, the rates of approval and denial vary by state, but it has always been fairly accurate to say that, on a national basis, about seven out of 10 initial claims are denied.
Why are so many claims at the disability application level denied? There are many answers to this question. And you could go on for quite a while discussing the various reasons.
However, I like to focus on the fact that most claims are denied initially, an even higher percentage are denied at the first appeal level (the request for reconsideration appeal), and then, suddenly, at the disability hearing level, the odds tilt in the claimant's favor. And there are various reasons one could entertain as to why hearings are more successful, particularly for claimants who have representation provided by a disability attorney or non-attorney disability representative.
But...to some extent those reasons are rationalizations. The bald truth is that the disability system is biased and titled against claimants. Purposeful or not, it is set up in such a way that those who start the process have an unfavorable chance of winning, while those persist and file appeals see their chances for approval rise significantly.
And this is why my advice has always been this: if you have a physical condition or mental condition that impairs your ability to work, and your current earnings are below the SGA limit, apply for disability. If you get denied for disability, file an appeal. If you get denied on this first appeal, file a request for a hearing. And absolutely, by this time, make sure you have a disability lawyer or a disability representative assisting you so you can maximize your chances of winning benefits.
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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