How many times will you be denied disability?
If you know individuals who have applied for disability, you may have heard the idea that you have to apply a certain number of times before you get approved, or that a disability claim has to be denied a certain amount of times before eventually being approved for SSD or SSI. Both notions are incorrect.
What happens in most disability cases
In the majority of claims, this is what happens. The disability application is filed and then gets denied (usually, a 70 percent denial rate); the request for reconsideration appeal is filed and gets denied (usually an 85 percent denial rate for this appeal); finally, a disability hearing is held and the individual has a much better chance of being awarded benefits.
All of this happens not because of some rule that says a person has to file X number of times or be denied X number of times, but simply because the deck is stacked against a person at the first two levels of the system. It is only at the third level, the disability hearing before an ALJ, that a person can appear before the decision-maker who is a judge, present an argument for approval by their disability attorney, and respond directly to questions. Quite importantly, of course, is the ability to be seen in person and not be simply a case file.
Most individuals get denied disability twice
For a high percentage of individuals with good cases and good representation provided by a disability lawyer or non-attorney representative, there will be two denials and then an approval. However, no rule guides this outcome, and the quality of the case evidence and the preparation of the case can make all the difference.
Some individuals will be denied even at their hearing and the choice at that point will be to 1. stop any further action, 2. file a new claim, or 3. do the next appeal involving the appeals council. What to do next is something that should be considered very carefully and this is where consultation with one’s attorney can be vitally important.
Things to keep in mind about being denied disability
1. If you get denied for disability, remember that most people do get denied.
2. Do not give up. Though some people will make the right decision in stopping, for most this is a clear mistake.
3. File your appeal promptly. Do not take the 60 days allotted for doing an appeal. Get the appeal filed IMMEDIATELY so your case can move as fast as possible in an otherwise slow disability system.
4. If your next step is to request a disability hearing, get a representative or lawyer to help you.
Filing appeals instead of re-applying is IMPORTANT
If an individual is denied, it is to their benefit to appeal the denial rather than file a new disability claim. It would stand to reason if a person’s disability claim is denied, the decision is not going to change if they just file another disability claim (which will be sent to the same state disability agency, DDS, also known as disability determination services). More than likely, it will just be denied for the same reasons that their first disability claim was denied.
Doing the first appeal, the reconsideration, is better than starting all over. While reconsideration appeal approval rates are dismal–about ten to fifteen percent–they are still a step in the right direction.
Reconsideration appeals are also sent to disability determination services for a medical decision; the only difference is that another disability examiner reviews the file and makes a decision. Logically, unless the first disability examiner made a mistake, or new medical evidence has come to light, the reconsideration appeal may be denied for the same reasons that the initial disability claim was denied.
It may seem like the reconsideration appeal is no better than filing a new disability claim at first glance. However, filing a reconsideration is much better than filing another initial disability claim (in other words, filing a brand new claim) because it is a step closer toward a social security disability hearing conducted by an administrative law judge, or ALJ.
If the reconsideration appeal is denied, and this is usually the case, then the disability claimant can file a formal “request for hearing before an administrative law judge”.
The ALJ hearing results in an approval for benefits for about two thirds of all disability claimants who follow the appeal process to the hearing level. While an individual may receive several denials prior to winning their disability benefits, they will win their benefits much faster if they follow the appeal process.
Even if they have to go through the appeal process more than one time, they are still more likely to be approved for disability benefits than a disability claimant who files a multitude of initial disability claims.