Getting Awarded for Disability — the Different Levels of Appeal

by Jennifer Scherf

There are always exceptions, but in general it is very hard to prove you are entitled to Social Security Disability prior to a hearing.

Initial Application: Time frame of three to four months

The most recent statistics from November 2010 show that of all claims filed in 2009, only 37 percent were awarded at the initial level. This does not track claims in which the applicant was represented by an attorney versus claims in which the applicant was not. If you wonder if you need to retain an attorney, call around and ask their award rates. You can also ask referral sources like the state bar or the National Organization of Social Security Claimants’ Representatives (NOSSCR).

Request for Reconsideration: Time frame of two to three months
There is no statistic available as to how many of the 63 percent of claimants denied at the initial level filed an appeal versus those who just gave up. Of the people who did file the next appeal (request for reconsideration), only 14 percent of those claims were awarded. (This is nationally; in general the award rate at reconsideration in Texas has been lower than this.)

Request for Hearing before Administrative Law Judge: Time frame of six to 12 months
Of the applicants who filed the next appeal and requested a hearing, 63 percent were awarded. This is the last appeal level where you get to argue the facts and attempt to prove you are disabled. Also, the award rate depends significantly on the judge you get. You cannot choose your judge, but some are much more likely to deny you than others.

Usually, the hearing level is when an attorney gets involved in a case. I believe that is why there is such an increase in awards at this level. Also, at the hearing you get to speak to the judge face to face. At the initial and reconsideration levels, you only get to fill out questionnaires, but do not get to speak to a decision maker about your condition.

Request for Review (Appeals Council) and Federal Appeal (District Court): Time frame of 1 to five years
The next two levels of appeal, the appeals council and district court, are actually there to ensure that the judge followed the rules that have been set out by the Social Security Administration (SSA); they do not consider whether or not you are disabled. You will absolutely need an attorney who specializes in this area at these levels.

Getting an attorney involved after your initial denial is the best plan. That way the attorney has time to develop the medical evidence in your case prior to the hearing. This means recommending tests and treatment as well as getting all the relevant records. An attorney can also help ensure that SSA keeps on task and can give you the best opportunity to prove your case.

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