Clients, friends, and even colleagues often cite me this "fact" regarding applications for SSI and SSDI: "You always get denied initially and then win on appeal." I usually explain that I don't believe this is generally true. What do you say?

Clients, friends, and even colleagues often cite me this "fact" regarding applications for SSI and SSDI: "You always get denied initially and then win on appeal." I usually explain that I don't believe this is generally true. What do you say? in topic Appeals

Answer

Yes, this is definitely something we hear quite a bit and a very pervasive rumor that an applicant has to be denied X number or times, or can only win on appeal. The truth is that if the evidence is in the initial filing showing that an applicant meets the criteria for SSI or SSDI, he/she will be approved at the initial stage. Our national SOAR statistics show that we have a 65% approval rate at the initial stage, with our top states having an average approval rate of 84% (in 2015). This is because we focus on getting all of the information in the file from the beginning, whereas many people who are eligible for benefits are denied because they don’t have assistance in gathering this documentation.

Some lawyers who take fees for assisting with disability claims specialize in appeals and don’t provide the evidence in the initial stage – they wait for the application to be denied and then work on the appeal. For an application at the appeal stage to be successful, the vast majority of the time it requires new evidence that wasn’t originally presented (there are some cases that are overturned due to oversights at DDS). So, it’s not that DDS wants to deny the case from the beginning, they just didn’t have the right information. It doesn’t save them any money to automatically deny people and then send them to appeal (in fact, it actually costs them more money in adjudicator time, medical records requests, and consultative exams).

All of that said, I can see why people may think this is “generally true.” The overall national approval rate for SSI/SSDI (without SOAR) is only 29%. So yes, that means 71% of people are denied. However, it’s not possible to dig into these numbers to know how many applicants needed more evidence and how many just don’t meet the disability criteria, but it certainly leads to many myths about the process.