Clients for over
thirty years with
Grand Junction 970-245-0499
Toll Free 800-870-4951
The Statistics of the Process.
As you may already know, SSA has a four step administrative process to determine
disability. These steps are the Initial application, Request for Reconsideration (which is
not used in Colorado for most claims), Request for Hearing and Request for Review of
Hearing Decision. Denials at the fourth step can be appealed to the federal district
court that has jurisdiction. For the purposes of our discussion, I am only going to
discuss the four administrative steps. There are statistics for each of these steps,
noting as with “success” rates, “statistics” need to be viewed with some skepticism.
During a recent year, 2,526,298 claims for disability benefits were filed at the Initial
level. Of these, approximately 40% or 910,000 were allowed (approved). Two brief
digressions at this point. First, contrary to common belief, everybody is not turned down
at the Initial level. In fact, 71% of all claims approved are approved at the Initial and
Reconsideration levels. Please note that this is not 71% of all claims filed. It is 71% of
all claims approved whether at the Initial, Reconsideration or Hearing level. Second,
again in accordance with what appears to be another common belief, many people file
Initial applications over and over again. I hear people say (frequently enough to
mention) that “I have applied for these benefits three times and been turned down each
time”. There is a belief in some quarters that the third time is a charm. It is not.
Appealing the denial of your initial application can protect your retroactive benefits, keep
your claim within the date for which you are insured (DLI), and offer the opportunity to
develop longitudinal medical evidence in support of it.
In a recent year 546,599 of the claims denied at the Initial level requested
Reconsideration. For the time being, ten states including Colorado do not have the
Reconsideration level; although, Nebraska, New Mexico and Wyoming do. Initial
denials in Colorado (for claims both filed and denied in Colorado) are appealed directly
to the Hearing level. The time frames for Reconsideration are about the same as those
for the Initial level. With some exceptions a determination is usually made at either
level in 60 to 90 days. Within this time frame a limited amount of new evidence is
usually available for Reconsideration with the result being a denial rate of about 86%.
Nearly every claim denied at Reconsideration during the recent year is appealed for a
hearing by an Administrative Law Judge. Of the 469,315 appealed in a recent year,
16% (75,000) were dismissed for various reasons (the claimant failed to appear at the
hearing or went back to work are a couple of typical reasons). Of the remaining
369,315 claims at Hearing 295,668 were approved or about 80% of the claims that are
adjudicated at Hearing. Current data is not available; however, new applications have
increased significantly perhaps nearly doubling over the last year or so. Approval rates
also appear to have dropped proportionately. For example, the 80% approval rate at
hearing indicated above is now shown as, nationally, to be about 46% which indicates
that some kind of representation, attorney or non-attorney representative, is something
a claimant should seriously consider obtaining.
Nearly every claim denied at Hearing, and probably some of those dismissed, are
appealed to the Appeals Council at which point 75% of the appealed claims are denied
(in the language of the agency, the decision of the ALJ is affirmed). Winning at the
Appeals Council usually means that the claim is sent back to an ALJ for another
hearing (the legal term for this is “remanded”). That is also the typical “success” at the
federal district court level. As I said earlier, if I kept detailed statistics of winning and
losing, I would count any case I had to appeal to either the Appeals Council or the
federal district court as a loss because, even if it is ultimately “won”, it will in most
cases require a new hearing which will take as long to schedule as the first one that
was lost and appealed. Waiting up to two years for benefits in the usual process is
painful enough for claimants who are usually barely getting by economically and
medically. Success is bittersweet, if sweet at all, if it comes after taking up to four years
or longer in the appeals process with a new hearing.
Social Security Disability Attorney