Receiving Disability Benefits from Social Security is harder at the first two levels than at a Hearing

There should be no reason why trying to win disability benefits from either the Social Security Disability or SSI disability program should be harder at the first two levels of the system. However, there is no denying the fact that it is.

Nationwide, approximately seventy percent of applicants will be denied benefits when they file a disability application. The rate of denial tends to be higher in certain states (for example, many southern and southeastern states such as Mississippi and Alabama have high rates of denial on claims), and lower in others. But, averaged out across the country, an applicant will have only a thirty percent chance of winning a claim and receiving disability benefits when they initially file their claim.

The statistical outcomes at the second level of the system (which is the first disability appeal, the request for reconsideration) are no better and are actually significantly worse. In past years, a person filing their first disability appeal could expect to have an 85 percent chance of being denied for disability benefits. Now, that percentage has gotten a little worse as 87 percent of reconsideration appeals are currently denied.

When a case makes it to the second appeal, which is, overall, the third level of the system, it has a much higher chance of being approved. This, of course, is the social security hearing level, at which a claimant will have their case decided by a social security judge who is, in fact, an administrative law judge, or ALJ. It is also a level at which the case may have the benefit of being "presented" with a rationale for approval.

Generally, at a hearing, the odds tend to be approximately forty percent in favor of the claimant who does not have disability representation. The claimant who does have disability representaion, however, has, typically, more than a sixty percent chance of being awarded disability benefits and then receiving back pay from social security as well as receiving disability benefits on a monthly basis.

Why are cases overwhelmingly denied at the first two levels of the system while the majority of cases are approved at social security hearings? As was stated in the preceding paragraph, at a hearing a case can be presented to the judge with a rationale for approval. This means that additional supporting evidence can be gathered and submitted to the judge, including completed statements from the claimant's physician or physicians.

This is something that does not happen at the level of an application for disability or on a reconsideration appeal. Social Security does not make any attempt to get an opinion from one's doctor, or treating physician. The only thing that social security will do is request an individual's records and have those records evaluated by a disability examiner as well as by the medical and/or psychological consultants who work in the disability examiner's unit.

If the claimant has no recent medical records or is alleging to be disabled but has not been treated for the condition they claim, then they may be sent to what is known as a consultative examination, or CE. Most people refer to these as social security examinations, but they are not performed by doctors who work for the social security administration. They are actually conducted by private doctors.

Unfortunately, they usually last just a few minutes and seldom ever contribute anything positive to a case. In addition to this, cases are seldom ever approved on the basis of the results of a CE.

Social Security Disability Cases and SSI cases would be more likely to be approved if SSA would ask a claimant's treating physician to fill out a residual functional capacity form (this is a type of medical source statement that SSA uses to rate a claimant's mental or physical functional limitations). This would allow the doctor to address all the various ways that the claimant is having difficulty with their disabling condition as well as how it specifically limits their ability to engage in normal daily actvities.

Having said this, it is not likely that SSA will ever adopt the policy of sending RFC forms, or some other type of medical source statement, to a claimant's treating physician. This may be due to cost issues since most doctors would probably begin to demand large payments for filling out lengthy forms.

However, it can be argued that it would be less costly to pay doctors for their time in doing this because disability attorneys and disability representatives routinely ask doctors to complete medical source statements. And doctors' opinions, recorded on medical source statements routinely help to win disability claims at social security hearings.

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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