Why do so many Social Security Disability claims get denied?

Over 70% of initial disability claims are denied.

The Social Security Disability process is supposed to be non-adversarial. For most of those that have dealt with the process it can seem like anything but non-adversarial. Considering all my cases past and present I cannot easily sum up all the reasons for so many claims denials. I will not deny at times it would seem that the Social Security Administration (SSA) has a policy of denying as many claims as possible. This is not true, though many who qualify for benefits are denied. While there is no way to completely avoid less-than-fair case outcomes there are ways a claimant can minimize problems in the process. Following are some reasons a case gets denied and how these issues can be helped.

The Unrepresented (or Poorly Represented) Claimant.

Claimants that are represented by a qualified person have an increased chance of getting their claims approved. If a claimant chooses to go the process alone, he must be very proactive and willing to do a lot of legwork on his own. It is still very easy to miss subtleties in the process that a good representative can spot and address right away.

A qualified disability advocate is anyone (attorney or non-attorney) that has knowledge of the Social Security Disability process, laws, and regulations. The best advocate is someone who has a legal education and/or specific training and passion for representing claimants of disability. The best advocates are also able to receive direct payment of fees by SSA either because they are attorneys or advocates that have been specifically approved by SSA for direct fee payment. Being an attorney does not make someone a better disability advocate than a qualified non-attorney. The type of law that governs the disability process is a very specialized area and non-attorneys must maintain continued education in this area of law. An attorney may not have specific training in administrative law. It does not require a traditional law degree to be a great disability advocate. There are fantastic attorneys and non-attorneys that are very successful in getting claimants approved for disability benefits.

A lousy advocate, (even if technically qualified) can hurt the claimant's case. A lousy advocate can be an attorney or a non-attorney. When a claimant has no advocate or a lousy advocate lots of things can slip through the cracks. A good advocate assists her clients in completing and submitting documents, promptly. She makes sure that the medical evidence is requested and received by SSA on a timely basis. She responds promptly to SSA's communications and follows up regularly with SSA and her clients to maintain integrity of the process and for her clients' best interests. There are advocates out there that do not manage cases well. This could be because their office takes on too many cases to manage properly. There are unscrupulous advocates that will purposely delay properly development of a case to increase possible fees. Having no advocate at all can be better than having a lousy advocate.

Like most workers in today's world, SSA claims adjudicators have heavy workloads and limited resources to get work done. This has not prevented most claims adjudicators I have encountered from being compassionate and detail oriented professionals. Unfortunately, this is not the case with everyone in a case decision-making position at SSA. If a claimant is unrepresented or represented by a lousy advocate it can result in the claims adjudicator making less effort in developing a case. A good advocate will have regular contact with SSA to make sure details are not missed. A claimant who braves the process alone may not know the best way to communicate with SSA or identify potential problems with the case development.

A Difficult Jurisdiction

There are too many speculations to address hereon why one geographical area sees a higher percentage of approved cases than another. There is even more speculation as to why one judge would approve the same case a judge 2 rooms down will not. We want the judges to have leeway in how they individually view the merits of a case and it would not good to have them all operating exactly alike. The problem lies where there is a major difference in the percentage of cases approved in one region over another. There should not be these major differences but there are. Another reason to have a good advocate is that he would be aware of issues like these from region to region and be prepared to present a case, accordingly.

Current State of Affairs

According to my colleagues with experience going back to the 80's and 90's; it was much easier to get a claim approved years ago, than today. One reason is the current economic downturn. Before the latest bust, employers could afford a large workforce that included challenged workers. When cuts had to be made these workers were among the first to go. Unfortunately, many of these workers were aged 50 or more and experienced extreme difficulty finding work with their physical limitations and employers willing to work around them. This has resulted in a higher number of people applying for disability benefits than prior to the economic downturn.

There are challenges that SSA faces in maintaining the integrity of available funds for beneficiaries that also cause higher scrutiny of cases than years earlier, also.

Humans being Humans

Nobody is perfect and this includes SSA employees and claimants, alike. Mistakes can be made by SSA employees such as not processing documents properly or not considering medical evidence properly per the rules set forth by SSA. There is always the person who has a bad day. There are adjudicators, claims managers, and judges that unjustly deny a deserving clients benefits.

Claimants often do not understand how to complete forms and documents and do not submit them, on time. Claimants also tend not to understand how to navigate the system and assist SSA with developing the claim. Sometimes there is good reason such as severe illness but some claimants with a good advocate do not respond to communications from the advocate intended to assist with the case development.

In no way is this an exhaustive list of the reasons disability cases are denied. These are the situations I and many of my colleagues in the practice experience generally and can be overcome some of the time.

Feel free to comment or message me with your thoughts or questions!

April L. Roberts, EJD EDPNA - april@aaria.org
www.aaria.org

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