Question: I read that most disability claims are initially denied by Social Security, only to be approved by a judge on appeal. Doesn’t that imply that the initial application and review process is designed to favor denying otherwise legitimate claims?
Answer: It depends on who you ask. I think some claims are approved at the hearing stage for practical reasons. For instance, sometimes an applicant’s medical condition deteriorates while waiting up to a year for a hearing.
Other denials are overturned at the hearing stage because the applicant hired a lawyer after getting a denial letter. 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, 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.
I also asked the author of Nolo’s Guide to Social Security Disability what he thought. David Morton III, M.D. is a former chief medical consultant for Social Security and has made medical decisions on many disability claims. Here is what he had to say.
“There have always been rumors that Social Security intentionally denies applicants at the state agency level and makes them appeal—that the SSA wants to deny disabled applicants. This idea is false, and arises out of the fact that administrative law judges (ALJs) reverse so many medical and non-medical assessments by professionals at the state agency level.
While some deserving applicants are initially denied by incompetent doctors, or examiners who shouldn’t be making medical determinations, most applicants are denied simply because they are not disabled according to Social Security’s definition.
Here is why they win on appeal. ALJs overrule medical doctors in the evaluation of medical data, although they are not doctors. Can you imagine how loud attorneys would scream if M.D.s starting demanding the right to make the non-medical part of disability determinations, with the power to overrule the attorney? Doctors reading the determination reasonings of ALJs are often mystified at the ALJs’ reasoning.
What needs to happen is for Social Security doctors who are really knowledgeable about the system to be present at every disability hearing to provide a medical assessment that the ALJ is compelled to use. Currently, ALJs sometimes hire retired doctors as “medical experts” to testify at hearings, but most of these experts have never worked inside Social Security and do not fully understand its policies for awarding disability.”