What are the Odds or Chances of Being Approved for Disability?

Regarding the chances of being approved, at the first level of the Social Security Disability and SSI system, the national average statistics are that approximately thirty percent of all claims will be granted.

When a claim is granted and an award for Social Security Disability or SSI is made, the claimant will typically receive a notice of award which contains information as to the payment amounts (disability back pay and ongoing monthly benefits) and when payment can be expected to be received. If a case is approved following a hearing before an administrative law judge, the claimant will receive a favorable notice of decision, which explains why the case was approved, and will then subsequently receive the notice of award.

The corollary to the thirty percent approval rate for an initial claim, i.e. application for disability, is that seventy percent of initial claims are turned down. There are many reasons as to why disability claims are overwhelmingly denied at the application level. Part of it may be due to the fact that most claimants are not represented by a disability lawyer until later, particularly after they have been denied at least once, and especially if their case is at the hearing level.

It can be argued that disability representation is not crucial at the earliest level of the system, but there are instances in which cases are won prior to the hearing level because they were represented by an individual who was intent on getting the case resolved without the need for a hearing.

However, the primary reasons behind the high denial rate for disability applications most likely has to do with the fact that the social security administration has a culture of denial that allows disability examiners (the individuals who decide claims at the first two levels of the system) to often ignore the opinion of a claimant's treating physician, even when that physician has sent in a detailed and objective statement which supports their patient's claim for disability.

In addition to this, disability examiners are subject to having their decisions reviewed by quality control units which tend to focus their reviews on cases that have been approved by examiners, not cases that have been denied by examiners. Thus, the effect on disability examiners is that they do not approve nearly as many claims as they deny, even including cases with excellent medical evidence to support them. Were this not the case, we would not see nearly so many cases denied by disability examiners and then later approved by judges at disability hearings.

At the second level of the system, the request for reconsideration appeal, only about 15 percent of cases are granted, meaning that approximately 85 percent of claims at this first appeal level are denied. The fact that an even higher percentage of cases are denied on the first appeal is not suprising when one considers the fact that the reconsideration process is identical to the disability application process and the only difference between the two levels is that they involve different disability examiners.

At the disability hearing level, a claimant will stand a forty percent chance of being approved if they are represented by a disability lawyer. The odds of approval even without representation are considerably greater than at the previous levels. However, individuals who are represented can increase the odds of approval by fifty percent greater than this. Claimants whose cases are prepared and presented by a disability lawyer have a win rate of better than sixty percent, according to federal statistics.

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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