Success Rates for Social Security Disability Insurance Claims
Copyright © 2012 AARP. All rights reserved.
Social Security Disability Insurance (SSDI) covers disabled workers and, in some cases, the family members who depend on them financially. SSDI benefits may also go to disabled widows and disabled adult children. Not everyone who applies for SSDI is approved, and many who eventually are approved go through a long appeals process first.
According to the Social Security Administration (SSA), being disabled means either you’re incapable of working for at least a year or you have a condition that will end in death. This status can be hard to prove, and experts may not even agree. Claims involving pain, chronic fatigue, mood disorders, and other problems are hard to measure. Some people have good days and bad days. Some people have periods of apparent good health that are then disrupted by rough episodes.
The SSA weighs a lot in reaching a decision about whether someone’s limitations are this serious. This includes an applicant’s work experience, skills, education, and age, in addition to his or her health condition.
If you believe you have a legitimate case for SSDI, you should pursue it. But know what you’re getting into. About two-thirds of disability claims are turned down at first. Of those that are appealed, more than 60 percent win at the hearing level, and some prevail at later stages of the process.
The following table shows the different rates of denial and approval at various stages of the appeals process for disability cases, which are the most common source of dispute. As you can see, denials are highest for reconsideration requests and lowest at hearings before an administrative law judge (Note: When an appeal is remanded, that means the Appeals Council has sent the case back to the administrative law judge with recommendations that may or may not be favorable. A denial means you lose. A dismissal also means you lose, because your case is thrown out.)
|Appeals to reconsideration||13%||87%|
|Appeals to administrative law judge||62%||13%||25%|
|Appeals to the Appeals Council||2%||2%||74%||22%|
|Appeals to federal court||4%||9%||40%||47%|
Source: Social Security Administration (www.ssa.gov/budget/2012LAE.pdf, Table 3.20)
The majority of applicants for SSDI benefits get an individual version of a denial notice the first time they apply for benefits. The notice generally includes a brief explanation of why the claim for benefits was turned down, along with a brief summary of the SSA’s criteria for disability. The notice also includes guidance on how to appeal the decision and notes that the claimant has the right to representation in mounting an appeal.