Does Social Security Disability Deny Everyone the First Time They Apply?

If you've filed for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, it's likely Social Security will deny your initial application, and you'll have to appeal. Initial denials happen often enough that you might have the impression that you can only get disability benefits on appeal, but that’s not really true. While Social Security does initially deny most disability claims, about 35% are approved at the first level of review.

That approval rating goes down at the second level of review (reconsideration) to about 15%, and increases to about 50% at the hearing level. Given the statistics, it’s easy to see why many people think that Social Security automatically denies every claim twice. But if you’re familiar with the statistics and the appeals process, you’ll be prepared if you receive a denial letter (and pleasantly surprised if you’re approved on the first try).

How Often Does Social Security Deny Disability Applications on the First Try?

In recent years, the Social Security Administration (SSA) has generally denied about 60-65% of all disability claims at the initial level. If you’re denied on your first try, keep in mind that your odds won’t improve if you continue to make new applications instead of filing an appeal. That’s because your goal is to eventually get your case heard by an administrative law judge (ALJ) at an appeal hearing, where you'll have the best chance of winning your case.

ALJs deny about 33% of the claims they see and dismiss another 16%, meaning about 50% of claims are approved after a hearing. (For more information, see our survey results on denials at the initial application stage and on denials at the hearing stage.) ALJ approval statistics vary greatly by state and even by judge. Some ALJs have an average approval rate north of 60%, while others rarely award benefits and have sub-40% approval ratings. You can find the recent disposition data for each ALJ at the SSA website.

Why Is Social Security's Approval Rate Higher After a Disability Hearing?

The higher rate of approval after a hearing isn't by design or a matter of policy. There are a number of reasons you're more likely to get approved for SSDI or SSI after a hearing.

Time Can Make Your Claim Stronger

It's not uncommon for claimants’ health to get worse while waiting for a hearing (which can take a year or more). So by the time your hearing is held, your medical conditions may have gotten worse enough to qualify you for disability even if you weren’t considered disabled when you first applied.

Likewise, it's possible to move into a higher age category while waiting for your hearing. Thanks to Social Security's medical-vocational grid rules, you're more likely to be awarded benefits when you're over the age of 50. Your chances improve even more when you reach 55.

You're More Likely to Have Legal Help On Appeal

You don’t need to hire an attorney to apply for disability benefits, and few claimants do at this stage with little risk to their claim. But when your initial application is being evaluated by a claims examiner at the state disability determination agency (DDS), there's no one to advocate for you or argue your case.

Once you’ve been denied, it helps to get an attorney who knows how to get the right evidence from your doctors, come up with a compelling theory of disability (reason why the SSA should find you disabled, such as meeting a listing or being unable to do sedentary work), and address errors the agency made in the initial denial.

Because of this, many denials are overturned at the hearing stage because the claimant got legal representation. Over two-thirds of those appealing a disability claim hire an attorney for the hearing. If you have a lawyer, you're more than twice as likely to be approved for benefits than if you don't. (See our survey results on having a disability lawyer at the hearing.)

Different Doctors Evaluate Your Condition at the Hearing

The doctors who work at the state DDS offices are called medical consultants, and medical consultants can be more conservative than the doctors—called medical experts, or MEs—who sometimes testify (usually by phone) at appeal hearings.

Medical consultants are often full-time staff employees at the DDS office, while the medical experts called for a hearing are often retired doctors who are paid on a consulting basis for each hearing. An ME is hired to provide independent testimony at your hearing about the physical or mental conditions you claim are disabling.

Having a busy DDS medical consultant weigh in on your case—which may be the twentieth case they’ve seen that week—can make it more likely your disability claim will get denied the first time you apply. On the other hand, having an independent ME at your hearing can greatly improve your chances for approval.

Judges Get to Speak With You Directly

Before you get to the hearing level, everybody who is making a decision on your disability claim is doing so based on the paperwork in your file without speaking to you. At the hearing, the judge gets to hear in your own words why you can't work, ask you any questions they have about your file, and listen to your answers. Because of this in person connection, an ALJ might be more likely to be convinced of your disability.

How to Get Approved for Disability the First Time

The stronger your medical evidence is, the more likely it is that your disability application will be approved on the initial review. To significantly improve your chances of winning your disability case the first time around, you should take the following steps:

• Make sure you inform Social Security about all the doctors you've seen so that the agency obtains and considers all your medical records.
• Have your doctor write a medical source statement or fill out a residual functional capacity (RFC) form to explain in detail all the limitations your medical condition causes.
• Learn what type of RFC Social Security should give you for your disabling medical condition.
• Research the functional limitations you’ll need to be found disabled and how Social Security decides whether you can work or not.
• Check on the status of your disability claim so that you don’t miss any important notifications or appeal deadlines.
• Promptly complete and return any forms requested, such as the activities of daily living (ADL) questionnaire or the Work History Report.

If you haven’t seen a doctor recently or don’t have health insurance, try to get recent treatment before you start your disability application. The SSA understands that medications and diagnostic tests can be expensive and won’t penalize you for not getting treatment that you can’t afford, but it makes it much more difficult to get benefits if you haven’t at least tried to see a doctor.

Does Social Security Purposefully Delay Claims?

No, Social Security doesn’t purposefully delay claims. Much of the lengthy wait in for a decision comes from backlogs at DDS and at the Office of Hearing Operations (OHO) where cases are assigned to judges. Claims can also be delayed when the agency is having trouble contacting a claimant or obtaining medical records. But if you think your claim is being unreasonably delayed or you haven’t heard back from Social Security in a while, you might try contacting your congressperson to get the ball rolling.

What to Do If Your Social Security Disability Claim Is Denied

An initial denial doesn’t have to be the last word on your claim. If you’ve received a denial letter, it’s important to understand why you were denied. Technical denials—which happen when you don’t meet the non-medical requirements for SSDI or SSI—are harder to appeal than denials based on medical eligibility. For example, if your claim was denied because you don’t meet the income and asset criteria for SSI or you have a remote date last insured for your SSDI claim, you might not be able to get disability benefits no matter how strong your medical records are.

Once you know why your Social Security disability claim was denied, you can decide if you need to hire a lawyer for your appeal or if you can move forward on your own. You aren’t obligated to get an attorney, but it’s usually a smart move, especially if you need to schedule a disability hearing. Disability lawyers work on contingency (meaning they don’t get paid unless and until you win your claim) and many offer free consultations, so it doesn’t hurt to ask around until you find a lawyer who’s a good fit for your case.