Many times before we have mentioned in this blog how difficult it can be to prove a disabled worker is unable to work and qualify for benefits, but by looking all the decisions Social Security issued in 2016 this really illuminates how difficult it can be.
There are basically five different situations where Social Security decisions are issued. These include the initial application phase; the Request for Reconsideration phase; the hearing before an Administrative Law Judge (ALJ) phase; the Appeals Council phase; and the federal court phase.
Applicants can follow these phases after receiving a denial at the phase before and appealing the decision.
The first phase is the initial application phase. According to Social Security’s fiscal year 2016 numbers, 67 percent of all initial applications for disability benefits were denied for medical reasons compared to an approval rate of just 33 percent.
During the second phase of the process, the Request for Reconsideration, these are people who appealed denials on their initial applications, 88 percent of these claims were denied compared to just 12 percent that were approved.
If applicants are denied at both the initial application and Request for Reconsideration levels, the next step appealing the decision is the request a hearing before an ALJ. During this phase the ALJ will look at all the compiled medical evidence (usually several years’ worth) to determine if the claimant meets Social Security’s rules of being disabled. This is a claimant’s best chance at being approved, but in fiscal year 2016, just 46 percent of people who had hearings were approved compared to 35 percent that were denied. Another 20 percent of cases before an ALJ were dismissed for various reasons. If a case is denied or dismissed by an ALJ, claimants can appeal to the Appeals Council. The Appeals Council will examine the AJL’s decision to look for any significant errors made in the decision. In fiscal year 2016, the Appeals Council denied 82 percent of these cases and approved just 1 percent. In other instances, the Appeals Council found errors in ALJ decisions 14 percent of the time and sent these cases back to the ALJ for a new hearing.
The final phase of the process, if an applicant has been denied at the previous four levels, is to file an appeal in federal court, this is basically like suing the Social Security Administration. All federal claims brought against Social Security in fiscal year 2016 resulted in just 2 percent approvals and 42 percent denials with 49 percent of cases being remanded to a lower level.
This process, if a claimant continues to appeal unfavorable decisions all the way through to the federal level can take up to five years, sometimes even longer. At the end of the process, if the claimant never receives a favorable ruling they can start the process over with a new claim and follow the same path. Those who say it is easy to get Social Security disability benefits have obviously never applied and gone through this process.
