For most applicants, the second level of appeal (the disability hearing) for Social Security Disability (SSDI) or SSI represents their best chance of winning disability benefits. Nationwide, almost half of all disability denials are overturned at the second level of appeal, resulting in the applicants' being awarded benefits (and the chances of approval jump to over 60% when the applicants are represented by a disability attorney).
Why are applicants more likely to be approved for Social Security benefits at the second level of appeal?
Judges have more independence. First, because second appeals are decided by administrative law judges (ALJs) rather than Social Security disability claims examiners. Social Security disability examiners are under a great deal of "unspoken" pressure to keep their number of disability approvals down. ALJs, however, are able to act independently in accordance with the medical evidence presented.
Hearings allow in-person testimony. In addition, the second level of appeal is a hearing, which presents the disability applicant an opportunity to interact on a personal level with the disability judge deciding his or her case. In contrast, initial applications and reconsideration appeals are decided by disability examiners employed by the state disability determination services (DDS) agency, and they do not involve any personal interaction with the applicants. These claims examiners make their decisions based solely on medical records, without ever speaking to the applicants directly about their symptoms and how they prevent them from working. At the hearing, disability applicants have the opportunity to tell the judge directly about their symptoms and to describe how these symptoms limit their ability to perform daily activities. Read more about what happens at a Social Security Disability Hearing.
Judges give more weight to doctor's opinions. ALJs tend to pay more attention to statements from applicants' treating physician(s) regarding their physical or mental conditions and resultant limitations than do claims examiners. A detailed medical source statement, or residual functional capacity (RFC) statement, from your physician, detailing exactly what you can and cannot do in light of your impairments, can carry great weight with disability judges. (Unfortunately, treating doctors' RFC statements are largely ignored by disability examiners, who tend to go with the opinion of the consulting physician assigned to their DDS unit, despite the fact that the unit physician has never personally examined the claimant. Like the disability examiners, physicians employed by DDS rely on medical records rather than in-person examinations to form their opinions.)
Lawyers can help win hearings. For those who persevere, the second disability appeal presents a real chance of winning SSDI/SSI benefits, and applicants who have legal representation of some kind are in an even better position at a hearing: A good disability attorney will craft an argument as to why you should get disability benefits that is both persuasive and in compliance with current disability law. Read more about why having a disability lawyer at your hearing increases your chances of winning disability.