deniedWhy Should I Appeal an SSDI Denial?

It’s no secret that the Social Security Administration denies most disability applications. First time applicants are rejected at just under 65% of the time. The SSA knows that many of the denied applicants will not appeal because some people are not familiar with the appeal process and some just decide not to bother appealing. Others take the bull by the horns and try again.  

 

First Stage Denial- 35%

Only about 35% of applicants are approved with their first application. This is because their disabling conditions must fit the criteria set forth by the Administration. There is very little leeway or subjective opinion used to determine benefits at this stage. If your condition fits the written “book” and you qualify in other areas such as time worked then you will most likely be approved. No fit- no approval.

The problem here is that many people don’t fit into a single mold. Some people have multiple medical conditions that individually do not qualify for the awarding of benefits according to the published list. At the initial application stage the conditions are rarely added together and little consideration is given to how those conditions affect the total sum of the person’s abilities.  

Second Stage Appeal- 15%

The second application review simply makes sure the first reviewer performed their job correctly and did not miss something. Thus the chances of approval here are only about 15%. You may be able to increase your opportunity for approval at this stage by submitting more medical records showing worsening health conditions or tests that confirm previous diagnosis.

Third Stage Hearing- 48%

When Social Security disability applicants appeal their denials for the second time their case is heard by an Administrative Law Judge (ALJ). At 48% approvals, this stage has the greatest opportunity for people to obtain their benefits, yet many people give up before getting here.

It is during the appeal hearing that, for the first time, an SSA employee has the authority to look at your case and approve it without following the strict “letter of the law” of the SSA’s published medical guidelines. The ALJ can look at the sum total of a person’s physical problems and determine that a person is eligible for benefits based on subjective health criteria.

Further Appeals

If your case is denied by the ALJ, there are appeal options still available but your chances of winning decrease significantly. A fourth appeal will go to the Appeals Council which has only a 3% approval rate, There is only an approximate 5% approval rate if your case goes to a federal court. However, there have been cases where a person solidly should receive disability benefits and their case was repeatedly denied. Although difficult, these cases do have an opportunity to win. Some cases have even been heard before the United States Supreme Court.

The Math

A person’s chance of winning on appeal can be laid out in an approximate mathematical table like this:

                If 100 people apply and 35 people win, then 65 people are denied.
                If all 65 of the people who are denied appeal, 10 will win on appeal leaving 55 denied.
                If all 55 of the people who are denied appeal, 26 will win on appeal leaving 29 denied.
                If all 29 of the people who are denied appeal, 1 will win on appeal leaving 28 denied.
                If all 28 of the people who are denied appeal, another one 2 will win on appeal leaving only 27                                   people denied.

So, all told, you have almost 75% chance of receiving benefits if you follow through on the appeals process. 

Why Not?

With the ultimate odds of winning so great, why would someone not file an appeal? For one reason, some people do not qualify according to program guidelines and, therefore, cannot be approved no matter how many appeals there are. For example, if a person has not worked and paid into the Social Security system long enough to qualify for benefits they will be denied. They cannot be awarded disability benefits under the Social Security Disability Insurance (SSDI) program. In this case the alternative is to apply for Social Security Insurance (SSI) instead. The monthly benefits are generally not as high, but it still would provide some income and most people receiving SSI also qualify for Medicaid and other state benefits such as food stamps and electrical assistance.

If You Qualify

Read your SSDI denial letter carefully for an explanation as to why benefits were not awarded. If the reason is anything other than a personal disqualification as listed in the paragraph above then you should contact a Social Security disability lawyer and consult with them concerning an appeal. A lawyer can recommend a path forward. The Cochran Firm disability attorneys will provide you with a FREE consultation. Call us or fill out the form on this page now. 

 The bottom line is that you should appeal your Social Security disability appeal denial because, all told, you have nearly a 75% chance of winning. 

 

 

 

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About the Cochran Firm Disability Lawyers
Recognized as one of the nation’s premier law firms, The Cochran Firm handles cases on behalf of clients seeking a Personal Injury Lawyer, Criminal Defense, Medical Malpractice, Bankruptcy Attorney in Atlanta or Social Security Disability Lawyer.The Firm can be reached at 1-800-THE-FIRM (1-800-843-3476) or fill out the form on this page. “Working for You.” Article by Benjamin A. Irwin, Esq.

 

 

 


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