Recent data released by the Social Security Administration (SSA) suggests that the SSA is increasing its approval rate of Social Security Disability Insurance (SSDI) claims. During the last ten years, annual approval rates have been as low as 33%. In the fiscal year 2020, its initial application approval rate increased to 39%.
Unfortunately, the time it took to make an initial decision also increased. On average, it took 131 days for SSA to process an initial application.
When the SSA denies a claim for SSDI, the applicant can request reconsideration of that decision. Reconsideration is essentially a first appeal from a denial letter. Claimants have an opportunity to provide additional evidence to correct deficiencies in proof that the denial letter identifies.
On average, it now takes 122 days for the SSA to process a request for reconsideration. The SSA grants SSDI benefits in about 11% of the cases in which it is asked to reconsider an initial denial.
An appeal of a reconsideration denial triggers a hearing before an administrative law judge. In fiscal year 2020, about 49% of claims were approved after a hearing. Ten years ago, the post-hearing approval rate was about 63%. On average in fiscal year 2020, it took 385 days for an appeal to be processed.
The statistics make clear that the opportunity to obtain SSDI benefits improves when applicants take a denied claim through the full appeal process. While it may take a couple of years to prevail, a successful claimant will receive an award of back benefits. Representation by a skilled SSDI attorney throughout the appeal process increases the opportunity for a successful outcome.
Social Security Disability Insurance claims are denied for many reasons. Understanding the most common reasons can help applicants prepare an application that is more likely to be approved.
Inadequate Medical Documentation
The existence of a qualifying disability needs to be supported by medical evidence. When the evidence is weak or ambiguous, claims are more likely to be denied.
Not every disability qualifies an applicant for SSDI benefits. A qualifying disability must prevent an applicant from performing any substantial gainful activity for at least a twelve-month period.
“Substantial gainful activity” is a fancy way of saying “working for wages.” The SSA awards SSDI benefits to individuals who cannot return to their former jobs and who cannot transition to new employment. The new employment does not need to be a job that the claimant has actually performed. For example, if the claimant can no longer lift heavy objects but can sit at a bench and assemble components, the claimant might not qualify as disabled.
Some impairments, such as the amputation of both arms, are automatically regarded as disabling. Most impairments require the SSA to determine whether the medical evidence meets the SSA criteria for being a disabling condition.
To make a successful claim for benefits, it is not enough to provide medical evidence that shows the existence of a severe impairment. The evidence also needs to explain how that impairment affects the applicant’s ability to work. A doctor’s note to an employer saying that an employee is currently unable to work is not sufficient evidence of a disability. The doctor may need to explain how functional capacity testing revealed specific limitations in mobility that make it impossible for the applicant to return to work.
In many cases, disability lawyers must help doctors understand how to document the impairment in sufficient detail to satisfy SSDI requirements. Disability lawyers also help clients communicate information to their doctors that explain why the client is incapable of working.
If the SSA believes the medical records are insufficient to prove or disprove the existence of a qualifying disability, the agency may request an independent medical examination. However, applicants should not count on a favorable examination. Nobody knows an applicant’s medical condition better than a treating physician. Applicants should always work with their doctor to provide sufficient medical evidence rather than hoping that an independent examination will provide the medical evidence they need.
Failure to Follow Doctor’s Advice
The SSA expects claimants to make a sincere effort to recover from their impairments. They may believe that claimants are malingering when they fail to follow a doctor’s instructions.
Claimants may have their own reasons for failing to follow through on treatment recommendations. Claimants who are referred to physical therapy may have transportation problems that make it difficult to keep appointments. More commonly, claimants stop going to physical therapy because the exercises are painful. Yet pain is an expected outcome of exercise. Claimants who don’t at least keep their appoints and give their best effort will find that SSA views their failure to follow treatment recommendations as evidence that their condition has improved.
Prior Claim Denials
Strict time limits apply to appeals from SSA benefit denials. Some claimants decide that it will be easier to apply again at a later time rather than to gather new evidence in time to meet a deadline to request a reconsideration.
Starting the process over again is not usually a wise strategy. The SSA may conclude that it already ruled on the claim. Unless the application clearly presents new evidence, the SSA might not give serious attention to a second application based on a disability claim that it has already denied.
Failure to Respond to SSA
The SSA frequently requests additional information from claimants. When claimants ignore those requests or fail to respond by a deadline, the SSA is likely to deny the claim.
Many disabled individuals are overwhelmed by the application process. They may lack the energy to gather requested information. Claimants with brain injuries may not understand the SSA’s request. Representation by an experienced SSDI lawyer assures that the SSA will receive an appropriate response by the deadline that it establishes.
Failure to Challenge Opinions of a Vocational Expert
At the hearing stage, the administrative law judge will often ask a vocational expert about the availability of jobs that the claimant can perform. The judge will ask the expert to assume that certain functional limitations identified in medical records exist.
Effective cross-examination of the vocational expert may include asking the expert to assume the existence of different facts that are also supported by the medical records or by the claimant’s testimony. Cross-examination may also challenge the expert’s opinion that a person of the claimant’s age and work experience has transferrable skills that qualify the claimant for jobs the claimant has never performed. Representation by a skilled advocate is often the only effective way to challenge the evidence provided by vocational experts.