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 is 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. But when you look at the statistics, it's easy to see how so many people would believe Social Security has such a policy.
Though the approval statistics vary by state, 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 a judge in an appeal, which gives you the best chance of winning.
The rate of denials is much lower after a hearing: only 35% of claims are denied at this stage (and about 20% are dismissed, meaning that 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.
The higher rate of approval after a hearing isn't by design or policy; for instance, 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.
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 were three times 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 file, there’s no one to advocate for your case.
Additionally, the doctors (called medical consultants) who work at the state disability determination agencies (DDSs) are sometimes more conservative than the doctors (called medical experts, or MEs) who are sometimes called to appear (by phone) at hearings. DDS medical consultants are often full-time staff employees at DDS, while the medical experts called for hearing are often retired doctors who are paid on a consulting basis for each hearing. Having a medical expert at your hearing can greatly improve your chances of an approval.
Finally, 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 at the first level, 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." 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 that an applicant will be denied on a disability claim and will file a new application at a later date, only to find that his or her insured status for Social Security disability benefits has expired. When this happens, an applicant's only option is to hire a lawyer to get the prior disability claim reopened or file an SSI disability application (SSI is the low-income program, which 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 is based on a person's work history in the last five out of ten years. The DLI can basically be thought of as an expiration date for Social Security Disability benefits. For more information, see our article on the date last insured (DLI).
Updated August 3, 2020