The Social Security Administration, which administers the social security disability (SSD) program, denies roughly 36% of all disability applications. That means not even 4 out of every 10 people who apply for social security disability are awarded benefits after the initial application review. Approval following reconsideration, the first level of the disability appeals process, is even worse, with only a 15% approval rating.
The disability approval rate increases substantially, however, during the second phase of the appeal process. In this phase, an administrative law judge (ALJ) presides over a hearing to determine whether your disability negatively affects your ability to work. The ALJ is solely responsible for deciding whether to approve or deny a disability application; unlike traditional court hearings, there is no jury. Although the wait time for an administrative hearing is lengthy – an average of 14.7 months in Illinois – an estimated 50% of applicants are awarded disability benefits following an administrative review.
Because the ALJ controls the outcome of your case, the judge assigned to hear your case is can have a huge impact. Some ALJs have a high approval rating, while others approve very few of the cases they hear. ALJs are bound by the SSA rules, but they have wide discretion in how they run the hearing. For example, the ALJ decides whether you may testify (and how much testimony you can give) and whether to admit testimony or reports from medical and vocational experts or other witnesses. Some judges are fair and honest, some are not, and all come with their own preconceived notions and biases. All of this can influence the outcome of your case.
Our website includes a searchable database that lets you check the approval and denial rating of every ALJ in the country. Although there is no guarantee that your application will be approved, knowing the ALJ’s approval rating before the hearing can help you (or your disability attorney, if you hire one) better strategize how to present your case.
The ALJ will issue a written opinion after the hearing outlining her decision and the rationale for it.
There are three possible decisions the ALJ can make:
- Fully favorable: In a fully favorable decision, the ALJ finds that you are unable to work due to the disability AND agrees with your disability onset date (the date you became disabled). The disability onset date determines the amount of disability back pay you are entitled to receive.
- Partially favorable: In a partially favorable decision, the ALJ finds that your disability affects your ability to work but disagrees with the disability onset date. This means that you are entitled to disability benefits, but the amount of disability backpay you receive, if any, will be decreased.
- Denial: If the ALJ finds that your disability does not interfere with your ability to work, she will deny your claim entirely. Your only recourse in this situation is to file an appeal with the Appeals Council. You have 60 days from the date the ALJ issues her ruling to appeal. An appeal can be based on either a claim that the ALJ’s decision was not based on substantial evidence or if new medical evidence has become available since the hearing that the ALJ was unable to review.
SSD Eligibility – the five-step sequential process
The ALJ goes through a five-step sequential process when deciding whether you are eligible for benefits based on your disability. You must pass each step to obtain a favorable decision. These five steps are:
1. Are you engaged in substantial gainful activity?
This step is fairly straightforward. The SSA considers a person engaged in substantial gainful activity if he earns more than $1,260 per month ($2,110 if the applicant is blind). With limited exceptions, if you earn more than SGA, the ALJ will deny your application.
2. Are your impairments severe?
To be considered “severe”, your medical records must support a finding that your disability interferes with your ability to do basic work-related activities, such as standing, sitting, lifting, bending interacting appropriately with others, and the ability to understand and follow directions.
3. Does your medical condition meet or equal a disability listing?
The SSA Blue Book contains more than 100 medical conditions that qualify an applicant for disability benefits. Each condition has specific criteria that must be met, and must be supported by specific laboratory and other diagnostic tests – a letter from your treating physician indicating that he diagnosed you with a specific condition is not enough to meet the listing.
If your medical condition is not specifically included in the Blue Book, you may still be eligible for disability benefits if the symptoms and limitations you experience “equal’, or are similar to, the symptoms of a listed condition. For example, migraines are not listed as a disability. However, their frequency and severity can sometimes equal the criteria for epilepsy, which is listed.
Because the criteria are so stringent, most applicants don’t meet or equal a listing. In this case, the ALJ will consider your residual functional capacity (RFC), which is what work-related tasks you can do despite your disability (or disabilities).
4. Can you perform prior work?
If the ALJ finds that your disability prohibits you from working in your current job, she will then determine whether you can perform any work you did in the past. For example, if your current job requires you to travel but the disability prevents you from driving, the ALJ could find that you could return to previous jobs that did not have the driving requirement.
5. Can you do other work?
If the ALJ finds that your disability prevents you from performing either your current or prior work, the final step is to determine whether you can perform any other work. This determination takes into consideration your age, education, skills, and prior work history, as well as any reports from the vocational expert (if the ALJ requested a report). The ALJ will deny your disability claim if he finds that you can perform any other work given your background and experience.
If you or a loved one has questions about navigating the Social Security Disability process we can help. Consider the Good Law Group for your representation – call (847) 577-4476.