Is it true that Social Security denies everyone after they file an application, to force them to have to appeal to get disability benefits?
No, it's a myth that all disability claims are denied the first time around. The Social Security Administration (SSA) has no regulation, policy, or formula that influences the disability system in such a way that most initial applications for Social Security disability benefits are automatically denied the first time. But when you look at the statistics, it's easy to see how so many people would believe Social Security tries to deny most applications.
Nationwide, about 65% of all disability claims are denied on the first application filed with the Social Security Administration. And Social Security will keep denying you for disability at that rate if you continue to make new applications instead of filing an appeal. Generally, your goal is to eventually get your case heard by an administrative law judge (ALJ) at an appeal hearing, which gives you the best chance of winning.
The rate of denials is much lower after a hearing: about 35% of claims are denied at this stage (and around 20% are dismissed, meaning that about 45% are approved). For more information, see our survey results on denials at the initial application stage and survey results on denials at the hearing stage.
These approval statistics vary greatly by state as well, with some hearing offices awarding cases at a rate of around 60% or more, and other offices awarding cases at a rate of less than 40%. You can find your state in our approval statistics by state area to find out what the chances of approval are in your area.
The higher rate of approval after a hearing isn't by design or policy. There are a number of reasons for this.
Time. Applicants' medical conditions often deteriorate while waiting a year or more for a hearing; by the time the hearing is held, they qualify as disabled. Similarly, applicants sometimes reach a higher age category while they wait for a hearing. Because of Social Security's grid rules, you're more likely to be awarded benefits when you are over the age of 50. Your chances improve even more when you reach the age of 55.
Legal help. Other denials are overturned at the hearing stage because the applicant hired a lawyer after getting a denial letter. Over two-thirds of claimants hire legal representation for the hearing, and those who had a lawyer are more than twice as likely to be approved for benefits as those without. (See our survey results on having a disability lawyer at the hearing.) Disability lawyers are trained to get the right evidence from the applicant's doctors, come up with convincing theories of disability, and find errors made by Social Security. In contrast, when the initial claims examiner is looking at your application at the state disability determination agency (DDS), there's no one to advocate for your case.
Politics. The doctors (called medical consultants, or MCs) who work at the state DDSs are sometimes more conservative than the doctors (called medical experts, or MEs) who are sometimes called to appear (usually by phone) at hearings. DDS medical consultants are often full-time staff employees at DDS, while the medical experts called for a hearing are often retired doctors who are paid on a consulting basis for each hearing. So having a DDS medical consultant weigh in on your case (maybe the twentieth case that week) makes it more likely that your claim will get denied the first time you apply. On the other hand, having a medical expert at your hearing can greatly improve your chances for an approval.
Humanity. Judges are human. When they meet an applicant in person and can connect a medical file to a face, and hear in the applicant's own words why the applicant can't work, they may be more likely to be convinced of the applicant's disability.
While many applicants for Social Security do get denied on their first try, those that have very severe impairments that make it impossible to work are often able to get benefits on the first try, especially if their medical condition meets a medical "listing."
Even if your condition doesn't meet a listing, to significantly improve your chances of winning your disability case the first time around, you should:
Some people also believe that the SSA denies claims for SSDI (Social Security Disability Insurance) to delay a case, hoping that the applicant's eligibility for SSDI will run out before the applicant can file another claim. This isn't true, either, although it does sometimes happen. An applicant might be denied on a disability claim and will file a new application at a later date, only to find that their insured status for Social Security disability benefits has expired. When this happens, an applicant's only options are to hire a lawyer to get the prior disability claim reopened or to file a disability application for Supplemental Security Income, or SSI. (SSI is the low-income program, which generally pays lower benefits than SSDI).
What does it mean when we say that an applicant's insured status for Social Security disability has run out? SSDI is like an insurance policy, and every SSDI applicant has something called a DLI, or "date last insured." The DLI can basically be thought of as an expiration date for Social Security disability benefits. A person's DLI is based on their work history and is the last point in time when they have worked for five of the last ten years paying taxes into the system. For more information, see our article on the date last insured (DLI).
Updated January 20, 2022