Are the Chances of Winning Disability Benefits Higher at a Social Security Hearing with a Judge?

At the first two levels of the disability system, there is often little a claimant can do to avoid being denied disability benefits under SSD (Social Security Disability) or SSI (supplemental security income disability). This is because those levels of the system--the disability application and reconsideration appeal--are decided by disability examiners. Disability examiners in every single state have higher denial rates than administrative law judges (who issue decisions at disability hearings).

Why is this the case? There are several possible reasons. First of all, the process that is used by disability examiners does not allow claimants to meet the decision-maker (the disability examiner in this case) and present an argument in favor of their case. Because disability examiners operate in a closed system, claimants do not have the opportunity to know anything of any real importance about the processing of their case until they have received a notice of decision.

In contrast to this, claimants who go to disability hearings have the opportunity (directly, or through their appointed disability lawyer) to:

A) Review their file;

B) Add medical evidence to their file;

C) Check to ensure that no medical records are missing from the file (a common complaint of applicants who have received a notice of denial from a disability examiner is that crucial medical records are either missing from the file or were never gathered by the examiner, despite the fact that the claimant listed a specific treatment source at the time of filing the disability application).

D) Take questions from the decision-maker which may be used to clarify key points regarding the claimant's medical history or work history.

The disability hearing stage is also distinctly different in that administrative law judges prefer to have available to them the opinion of the claimant's own physician. It is for this reason that competent disability attorneys will usually try to obtain a detailed medical source statement from a claimant's treating physician as this can carry substantial weight at a hearing.

Disability examiners, on the other hand, tend not to give proper consideration to the opinion of a claimant's own doctor or doctors. This may be due, in part, because disability examiners use a process that requires them to have their own decisions reviewed by a medical doctor who works in their processing unit (a unit medical consultant). This insular system may produce a tendency to disregard the opinion of the doctor who has actually treated the patient in favor of a doctor (who works with the disability examiner) who has never treated the patient and has never even met the patient.

However, to answer the question with which we started, yes, the chances of winning disability benefits at a hearing held by a judge are substantially higher. To get to a disability hearing, however, a claimant must first be denied on an application for disability and then on a reconsideration appeal.

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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