Will I be approved for disability on my appeal?

A disability applicant's chance of being approved for disability on appeal is not guaranteed and will depend on the merits of the case as well as the level of the appeal. One fact, though, is very clear: the first appeal that a claimant who has been denied for disability can file has a low probability of success while the second appeal (the disability hearing) has dramatically higher chances of resulting in a Social Security Disability or SSI award. To get to the second appeal, however, a claimant must go through the process of filing the first appeal.

The First Appeal

If you are filing a reconsideration appeal, it is unlikely you will win your appeal. It has been estimated that only 10 or 15 percent of initial claim denials are overturned at the reconsideration appeal level (recent reports indicate a 12-14 percent chance of approval at this level, depending on one's state of residence).

Why is it that reconsideration appeals are so heavily denied? Reconsiderations are sent back to the same state disability agency (in most states, the agency is called DDS, Disability Determination Services) for a decision; therefore the same procedures and methods of evaluation are applied to reconsideration appeals that were applied to the initial disability claim.

The only real difference between how an initial disability application and a reconsideration appeal are handled has to do with the fact that a different disability examiner decides the outcome of the reconsideration. As you might guess, if the reconsideration level examiner does not believe there were errors in the initial disability, or no new substantial medical records are presented, then it is likely that the reconsideration appeal decision will be the same.

The Second Appeal

An administrative law judge at a disability hearing, on the other hand, has more flexibility when making the decision for your disability claim. What do we mean by 'more flexibility'? It can be summed up this way:
  1. The disability judge will not have his or her decision reviewed by a supervisor who is concerned with how many approvals have been made by his or her case processing unit.

  2. The judge will typically respect the opinion of the claimant's treating physician; whereas the disability examiner's agency (DDS) historically has a low rate of compliance with regard to giving the opinion of a claimant's doctor the appropriate weight of consideration.

  3. The judge will, if they deem fit, bring in a vocational witness to further develop the claimant's likelihood (or not) of being able to re-enter the workforce, based on their condition, education, and skills.

  4. The judge will hear arguments and a rationale for approval from either the claimant or their disability lawyer if they are represented (at a hearing, disability representation is strongly recommended).
For these reasons and more, statistically there are far more disability approvals at the hearing appeal level. For most disability applicants, their best chance for a disability approval will be at the administrative law judge hearing.

How many cases are approved at a disability hearing?

With regard to this question, statistics change year by year. They also vary by state. It is often quoted that the average disability hearing approval rate is about sixty-five percent; when you consider another ten percent of dismissed are dismissed for reasons other than a denial, this is an extremely high approval rate.

A federal statistic in recent years indicated that approximately forty-percent of claims were approved at the hearing level if a claimant went to the hearing without the benefit of social security representation, while sixty-two percent of represented claimants were awarded benefits.

If you fall into the percentage of cases who are not approved, denied, at their disability hearing, you are at a decision point. You can appeal your disability hearing decision by filing an Appeals Council Review appea,l or you can file a new claim for disability benefits. New Social Security rules prohibit filing a new disability claim while you wait on your on Appeal Council Review decision. If you have an attorney or non-attorney representative, they can advise you as to which path you should take.

If you do not have a disability representative, you have to make the choice. Very few Appeal Council Review appeals end in an outright approval for disability. Most appeals are denied with a few being remanded back--to the administrative law judge who made the original decision--for review.

But even those disability cases that are remanded to the ALJ for review are often denied. You or your representative must decide whether this appeal is an unnecessary waste of time or it is worthwhile for you to wait the that time it takes to get their decision before filing a new disability claim.

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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