Social Security Numbers Shed Light On Disability Appeals

Posted on Apr 05, 2016

Every year, the Social Security Administration releases statistics showing the number of applications it received, approved, and denied. These numbers outline not only the initial applications, but the initial appeal, called a Request for Reconsideration, the request for hearing with an Administrative Law Judge, requests for review in front of the Appeals Council, and even Federal Court case appeals.

In 2015, Social Security received over 2.7 million applications for disability benefits. Only 33% of the applications received were approved. Not everyone appealed the initial denial with a request for reconsideration, but those who did had a 12% success rate. The abysmal rate of approval on reconsideration continues, which begs the question as to why reconsideration requests continue to exist in the first place.

The next level of appeal is a request for hearing to an Administrative Law Judge. This appeal is much different. At this appeal level, the Social Security Claimant is appearing live at a hearing in front of an Administrative Law Judge (also referred to as "ALJ's").  The ALJ is not bound by any prior decision. In many cases, the ALJ is probably reviewing medical evidence that was not available to the prior decision makers.

This is also the first time that an actual employee of the Social Security Administration decides an appeal. State agency officials decide the initial application and the request for reconsideration. Some state agencies have come under fire because the claims evaluators are overworked, and not able to properly evaluate initial applications and initial appeals. As a result, many critics feel denials are issued simply to move the file along and manage the work load. The percentage of reconsideration denials supports this theory.

At hearing, approximately 45% of all appeals are approved. Again, keep in mind that not everybody who is denied it reconsideration will request a hearing. Nonetheless, ALJ's will generally give these appeals significant consideration. The fact that some Claimants wait over a year to two years for a hearing date may also factor into the higher approval rate. Many of the medical conditions at issue in these appeals are progressive medical problems that worsen with time.

If an Administrative Law Judge issues an Unfavorable Decision, the overall chances with the Appeals Council are about the same as the reconsideration request. Only one percent of all appeals to the Appeals Council were actually approved in 2015. However, the Appeals Council remanded about 13% of the cases it reviewed. A "remand" means that the appeal is sent back to the original Administrative Law Judge with instructions to reevaluate the case. The Appeals Council denied 83% of all cases appealed in 2015.

Most people who lose at the Appeals Council do not appeal their case to Federal Court. However, of those cases that take the case to this level, 45% are sent back to the Administrative Law Judge for another hearing. Federal courts will grant benefits in 2%  of the cases they review.

When we represent a Social Security Disability claimant at hearing, we usually appeal an Unfavorable Decision to the Appeals Council. If the Appeals Council denies review, we then confer with attorneys who handle Social Security Disability appeals at the Federal Court level.  If the Federal Court attorney is successful in obtaining a remand of our client' this case back to the ALJ, we take over the case once again, and move forward.

To learn about how the Appeals Council works, check out this article.

Check out this article to learn when you can file a new application while an existing application is on appeal.