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How the Decision on a Disability Application is Made

how do claims get decided

If you are applying for SSDI or SSI benefits, the odds of your being approved are not overwhelming. In fact, the Social Security Administration (SSA) itself reports that just 36 percent of initial claims are approved. This means that close to two-thirds of people who apply receive a notice of denial.

The good news is that you have options if you are disabled and believe that you are entitled to either SSDI or SSI benefits. Before you file any paperwork, it’s essential that you understand how the SSA makes its initial decisions as well as those on appeal.

Who Decides Whether or Not to Approve Your SSDI or SSI Application?

All Social Security claims are first reviewed at a local office by a claims representative (CR). The CR has the responsibility to set up the claim, conduct the application interview for disability, and ensure that the claimant has submitted all of the necessary information that relates to the applicant’s disabling medical condition, any medical history, and the applicant’s work history.

Disability claims are then transferred to a state SSA office for another review and decision. A disability examiner will review all of the records submitted and make the decision on the case.

How Decisions Are Made on SSDI and SSI Applications

The disability examiner is supposed to make sure that everything in your application is complete before handing down a decision. One of their assignments is to gather medical records. If these weren’t submitted with the application, there could be a delay in processing your claim while the records are requested and sent.

The disability examiner will also review your past jobs and your work skills. They may also request additional information about your activities of daily living (ADL). In some cases, the examiner will also independently consult with a medical doctor or psychologist before deciding.

When all of the information is in, the examiner will attempt to answer several questions:

  • Does the claimant have a covered medical condition that meets the requirements of SSDI or SSI?
  • Can the claimant return to any of their past work positions?
  • If no, can the claimant do another job that suits their available skills?

If the answer to the first question is “Yes,” and the second two are “No,” you will receive an approval for SSDI or SSI benefits.

What You Can Do If Your Application is Denied

If you are like so many others and find that your application has been denied, you can file a request for reconsideration. You have just 60 days from the date you received your letter from the SSA to file this request. Unfortunately, many (86 percent) of these “recon” requests are denied as well.

Your request will be reviewed in the same disability agency that denied your initial claim; only it will be assigned to a different examiner. Provided the first disability examiner didn’t make any errors, the outcome is likely to be the same. The good news is that this is often just a stepping stone to a process that can produce different results.

The Next Step If Your Request for Reconsideration is Denied

If your request for reconsideration was also denied, you have the right to appeal that decision to an administrative law judge (ALJ). The ALJ will review your case, and you will have the opportunity to attend a formal hearing. The national average for approval at this level is about 62 percent.

If you are denied once again and believe that you are entitled to benefits. There are several more levels of appeal available. The first is the Appeals Council and the next is federal court. Both have much lower approval rates.

Speak with a Qualified Social Security Benefits Attorney

If you are worried about your SSDI or SSI application at any part in the process, or have already had your claim denied, you should speak with an experienced Social Security Disability lawyer about your situation. At Walton Law, LLC, our experience with these claims can significantly increase your chances of receiving a favorable decision.

Many people bypass getting legal help because they believe that it is beyond their financial means. The good news is that our services will cost you nothing upfront, and you will only pay if we are successful in obtaining benefits on your behalf.

Contact our office now at 251-455-5819 or reach out to us online to schedule a free consultation.

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