If you are denied for disability are you able to win social security or SSI benefits on appeal?

Yes, and it is more often the case that those who file for disability will win their benefits on a Social security appeal versus winning on an initial claim. Only about a third of all applicants will be awarded disability benefits after filing at the initial level. The remaining two-thirds will be denied.

Of those individuals, the ones who file their first available appeal (the request for reconsideration) will have only a minimal chance of being approved (historically, about 13-15 percent of recons are approved).

However, for those who persist and file their second appeal (a request for a social security hearing), the odds of approval will increase substantially.

Typically, more than half of all applicants who appear at a disability hearing will be awarded Social Security Disability or SSI benefits. The rate of approval differs by state, and is also affected by whether or not a person is represented by a disability lawyer, a non-attorney disability representative, or has chosen to represent themselves.

Without a doubt, this is the worst possible option since it can assumed that nearly all applicants will have no idea of how to properly and completely prepare a case to be heard by an administrative law judge, or even how to interpret the information that is in their own file.

The disability hearing, obviously, represents the best opportunity for being approved if one is represented. And this is because an experienced claimant's representative (as we said, an attorney or non-attorney can fill the role) will have familiarity with:

A) How cases are determined, both procedurally and as required by law and regulation;

B) The definition of disability used by the social security administration;

C) How vocational (work related) and medical information is viewed by SSA;

D) The importance of obtaining a medical source statement from a claimant's treating physician.

E) The information that was used to decide the case at the levels prior to the hearing level (the application and the reconsideration).

Having said this, though, it is not impossible to win a disability claim at the reconsideration level. Because the rate of denial on reconsideration appeals (remember that the reconsideration is the first appeal and it is also handled by a disability examiner, albeit a different disability examiner than the one who handled the initial claim) is so high (85-87 percent), many people simply assume that it is nearly impossible to win at that level.

Obviously, simply using an observation of case outcomes, this may seem very true. But cases at this level can be won when an effort is made to provide sufficient medical record documentation to the disability examiner who is working on the case, particularly when a strong effort is made to obtain a statement from the claimant's treating physician that is backed up by that doctor's own history of treatment with the claimant.

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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