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Explaining the High Rate of Social Security Claim Denials: Unveiling the Process

Updated: Jul 25, 2023

When it comes to Social Security disability claims, the number of denials can be disheartening. Many applicants find themselves facing rejection despite their genuine need for support. In this blog post, we'll delve into the reasons behind the high rate of denials, shedding light on the intricate process involved.

Initial Stage: A Challenging Hurdle At the initial stage of the application process, handled by the Disability Determination Services (DDS) in Carson City, approximately 65% of claims are denied. This decision typically takes around six months to be made. The criteria for approval differ based on age and previous work experience.

  1. Over 50 and Performed a "Sit-Down" Job? If you fall into this category, you face the challenge of proving that your functional capacity is even less than that required for a sedentary job. The standards are stringent, making it difficult to obtain approval.

  2. Under 50 Years Old? For applicants under 50, the burden of proof becomes even greater. You must demonstrate that your functional capacity is significantly impaired, preventing you from even performing sedentary work.

Reconsideration Stage: Uphill Battle Continues During the reconsideration stage, also handled by DDS in Carson City, approximately 87% of claims are denied. This process takes around six months as well. The odds of approval remain slim, making it crucial to present compelling evidence of your limitations.

Hearing: Your Best Shot at Approval The hearing stage, presided over by an Administrative Law Judge (ALJ), offers the highest chance of approval. However, it takes approximately 15 months for a hearing to be scheduled. Here's why the hearing stage provides a better opportunity:

  1. Functional Capacity Evaluation: In 66% of cases, ALJs determine that the claimant's functional capacity is indeed less than sedentary. This favorable finding can significantly increase the likelihood of approval.

  2. Additional Factors Considered: Unlike earlier stages, the ALJ takes into account other aspects beyond the medical records. You have the opportunity to personally address the judge and present information that may not be evident in the documents.

  3. ALJ's Discretion: ALJs have more flexibility in decision-making and can consider individual circumstances "outside the box." This can work in your favor, particularly when your case has unique challenges or complexities.

  4. Increased Success Rates: With skilled representation and a strong case, claimants tend to win the majority of the time at the hearing stage.

Disparity Between Reviewers: An analysis comparing the ALJ and DDS approaches revealed significant discrepancies. Reviewers utilizing the ALJ approach determined that 48% of cases should have received awards, whereas those using the DDS approach concluded that only 13% deserved approval.

In conclusion, understanding the various stages of the Social Security disability process and the disparities within them is crucial for navigating the system effectively. While the initial and reconsideration stages may pose significant challenges, the hearing stage presents a better opportunity to present your case comprehensively.

©2023 Noel Anschutz / Professional Advocates, Inc.

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