Almost every Social Security Disability claimant ask the question, “what are my chances of winning”. No one know the answer. Despite this fact, we can look at overall win rates. It is important to keep in mind, that these are just general percentages. These percentages are not the odds that you will win. They are the overall odds for a random disability application that responds timely and accurately to requests for forms and information. This pool of claimants timely appealed and stayed in regular contact with their examiner.
Initial Level Decisions from 2010- 2018
The number one reason claimants do not get favorable decisions throughout the process is for ‘non-medical reasons’. These non-medical reasons consist of claimants that fail to respond timely to requests for information, they no-show consultative examination or just decide to quit the process altogether by not appealing. Looking at the numbers below, we can see that over 1/3 of the people who receive a decision at the initial level quit the process. This does NOT even take into account the people who quit between the initial application and the actual initial decision!
The first step in the process is the initial level. An initial level decision is made by an examiner at the Disability Determination Services (DDS). DDS will compile a lot of written information, which includes most importantly, your medical records.
After your file is complete a medical decision will be rendered. Between 2010 and 2018, over 15 million medical initial determinations were made. Of those 5.5 million resulted in a favorable decision. You can see that approval rates for SSDI claims were 47%, while SSI claims were approved at a rate of 23%.
Reconsideration Level Decisions from 2010-2018
In the event a claim is denied at the initial level, it can be appealed by asking for a reconsideration. A reconsideration review is also made at DDS by an examiner. As you can see, approval rates are significantly lower at recon. This is likely because not much changes between initial level and reconsideration. There may be a few additional office visits in your medical record, but as long as your file was properly prepared at the initial level, there usually is not anything of significant difference to warrant a different outcome. Off all the reconsiderations that were made between 2010 and 2018, only 9% were favorable. 11% of SSDI claimants received favorable decisions while only 7% of SSI claimants received favorable decisions.
I think the most significant statistic to be gleaned from this table is that of the 9.9million claimants who were denied at the initial level (Total decisions (-) Allowances from the above table) only 5.4 million asked for reconsideration.
All Hearing Level Decisions for 2010-2018
After a reconsideration denial, a claimant has the right to request that his or her case be heard by an Administrative Law Judge. If an appeal is made after recon, your file will be transferred to the Office of Hearings Operations (OHO). OHO has 163 hearing offices and over 1,500 ALJs. Approval ratings at this level are higher than any other level. 53% of medical decision result in favorable decisions. 62% for SSDI and 45% for SSI claims. It should be noted that between 2010 and 2018, almost 1.3 million claims dropped off between reconsideration and the hearing level. Some of these are non-medical denials and some are likely a result of not appealing the reconsideration denial.
What to do to Improve your Approval Odds
What can you do to improve your odds?
- Don’t quit. The disability process is long and arduous. You will likely become frustrated and want to quit. Don’t!
- Submit your complete medical record. Medical records win claims. You need to make sure your decision maker has your complete medical record. It is your job to notify your lawyer or the SSA of any and all relevant medical providers. If a provider will not respond to a request, you could and should try to help.
- Get opinion evidence from your providers. Doctors are not required to fill out RFCs, but you should do what you can to get one.
- Fill out informational requests, timely and accurately. If SSA sends a form, fill it out the best you can and send it back as soon as you can..
- Hire a Lawyer. Claimants who hire a lawyer are more likely to win. Hire that lawyer early on in the process.