What are the chances of winning a disability appeal in Texas?

Typically, on average, Social Security Disability and SSI disability applicants will stand about a 15-20 percent chance of winning benefits on their first disability appeal in Texas. This first appeal is known as a request for reconsideration appeal. The reconsideration is handled by a disability examiner at DDS (disability determination services) just as is the case with an initial claim.

The process involved on a reconsideration is identical to the disability application. Records are gathered from the medical treatment sources listed by the claimant and once these have been received, the examiner will determine if the claimant may be approved on a listing or approved under a med-voc allowance.

The majority of claims, it should be noted, are approved through the medical vocational decision process in which it is found that the individual lacks both the ability to return to their past work, but also lacks the ability to do some type of other work as well that, ordinarily, they would be suited for based on their age, education, and work skills.

Common questions about filing for disability in Texas
How long does the first appeal usually take?

It should be noted that reconsideration appeal decisions are often made very quickly. This is because most of the case development that was done on the initial application for disability is very recent. The medical records, as well, are also most likely very recent. And, in cases where the claimant has not been back to see one of their doctors it may be that there are no additional medical records to evaluate. So, while a decision on an initial claim will average 90-120 days, a reconsideration appeal decision is often completed in less than half that amount of time.

In cases where no additional medical treatment has been indicated by the claimant, and the evidence that was previously submitted for the application level is beginning to "age out" (become older than 60 days), it may be that the reconsideration examiner will need to schedule a consultative medical exam. In other cases, it may be that the reconsideration appeal will be done very quickly with no real purpose other than to verify that the first examiner who worked on the disability application made a valid decision that does not need to be overturned.

Regarding reconsideration approval-denial statistics, to be more specific, in a recent year (according to data provided by the Social Security Administration), approximately 16 percent of SSDI (Social Security Disability insurance) cases were approved at the reconsideration level, while only 11 percent of SSI disability cases were approved. Nationally, about 15 percent of reconsideration appeals are typically approved. In general, reconsiderations have a fairly low rate of approval. And it is for this reason that their primary utility value is in simply getting through this step so that a disability hearing may be requested.

Disability Hearing chances in Texas

What are the chances of being approved at a disability hearing in Texas? On average, a person who has been denied in Texas at the application level and on a reconsideration appeal, and who then files a request for a hearing, will have a 50-60 percent chance of being awarded benefits by a judge (and ALJ, or administrative law judge). In the majority of cases, the chances of approval will be enhanced when a claimant goes to such a hearing with a representative who may be a disability lawyer or non attorney advocate).

A disability lawyer or a non attorney advocate (many non-attorneys are former social security employees) will focus, prior to a hearing, on assembling as much medical information as possible on a claimant's behalf. This often includes contacting a claimant's doctors to see if they will provide statements which support a claimant's allegations of disability. However, even when an attorney is involved, a claimant will still need to be seen somewhere for medical treatment. This is because in order to be awarded benefits, medical evidence must be obtained that establishes A) how far back a disabling condition exists (to establish back pay amount and, in the case of SSD, to determine when medicare coverage begins) and B) whether or not the individual is currently disabled.

The chances of winning disability benefits via an appeal will always be subject to providing the Social Security Administration with sufficient medical record documentation. In other words, medical record updates and detailed statements from one's treating physicians. Unfortunately, the ability to provide this type of documentation is predicated on the abililty to receive continuing medical treatment and many claimants arrive at a point (while they are filing for disability) where they no longer have medical insurance.

Nevertheless, even claimants who no longer have health insurance should still try to be seen by a doctor every now and then for the purpose of keeping their medical condition documented. For many individuals, this will mean visiting a free clinic, health department, or a hospital's emergency room. Because even if your condition worsens as you fight to win your disability benefits, unless this is documented, your chances of winning an appeal will be less.

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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