You may have heard that getting Social Security Disability Insurance (SSDI) is a hard road to travel, if not practically impossible. The SSDI process can take anywhere from30 days to two years for benefits from an initial claim to be approved, and along the way there will be denials and appeals. It seems unfair – you’re hurt, or you’ve developed a mental or emotional condition that renders you unable to work, and yet you’re being denied benefits from a system that you’ve paid into all your working life. But more than two-thirds of people applying for benefits have their initial application denied. It takes perseverance to see this process all the way through, and many people give up on the process too easily. After all, when you’re hurt, you just don’t have the energy needed for this lengthy procedure. And yet, being denied benefits can negatively impact your family – if you’re unable to work, you could lose your home, become mired in deep debt, and be unable to fully enjoy life.
While the path to SSDI benefits isn’t a walk in the park, it’s also not impossible – if you don’t give up before the process is finished. This is where an attorney with experience in SSDI cases can be particularly helpful.
The entire process from application to awarding of benefits can take up to five distinct steps before a final judgment is rendered. These steps, along with the most recent percentages of success (2013), are outlined below:
- Application: Allowed – 33%; Denied – 67%
- Reconsideration: Allowed – 11%; Denied – 89%
- Hearing with Administrative Law Judge (AL J): Allowed – 48%; Dismissed – 17%; Denied – 35%
- Appeals Council: Allowed – 1%; Dismissed – 4%; Remanded – 17%; Denied – 78%
- Federal District Court: Allowed – 2%; Dismissed – 9%; Remanded – 42%; Denied – 46%
Appealing a Denial
Most people applying for SSDI expect to be denied the first time, and understand the high likelihood of being denied after reconsideration. Nationally, approvals are granted only 11% of the time during the reconsideration stage; in the Indiana, however, it’s notably lower – only 4.8%.
A hearing with the Administrative Law Judge (ALJ) generally follows the denial at reconsideration, but the process is not over even after an ALJ denies the case – an attorney can continue on to the Appeals Council, Federal District Court, and the 7th Circuit Court of Appeals. A claimant still has the opportunity for approval of benefits past that point – the chances of their case being remanded (returned) to a lower court for reexamination at the Appeals Council and Federal District Court levels are almost 60%.
Why Cases Are Remanded
There are numerous reasons SSDI claims are remanded to a lower court. Often, initial claims cases are reviewed by doctors with specialties completely unrelated to the case they are reviewing – for example, an OB/GYN may be making a decision on a bipolar disorder case or a case of Degenerative Disc Disease. Though all physicians enter the medical field with the same basic training, specialists train extensively in one area of expertise, rendering their judgment most effective in that area. As you might imagine, this can give judges in higher courts a reason to remand a case – in fact, Judge Richard Poser of the 7th Circuit Court of Appeals (which serves, in part, the state of Indiana) recently took issue with this problem. In a case presented to the Court of Appeals, Judge Posner took issue with the conclusions handed down by the ALJ and two doctors that examined the case of an individual with chronic pain seeking SSDI. The two doctors offering opinions on the case were a pediatrician and an anesthesiologist, causing Posner to write, “We note the oddity of inviting a pediatrician to opine on the medical condition of a 28-year-old woman, and likewise the oddity of asking anesthesiologists to evaluate spinal-cord problems.”
More than a third of claims are denied at the ALJ level, and the errors made in these denials result in nearly half of their decisions being remanded. The most common mistake ALJs make is the denial of benefits without a thorough analysis of the case, particularly with assigning weight to treating sources. In the 7th Circuit, there have been a lot of rulings chastising the ALJs for incorrectly denying benefits. In one decision, Judge Posner threatened to start sanctioning ALJs for denying benefits without a thorough analysis of the claim.
Why Representation is Important
Applying for SSDI takes a great deal of patience and persistence, and having an attorney with the experience to see the process through all the way to its natural conclusion can make all the difference in your receiving benefits. An attorney with experience in the SSDI process will take a worthy case all the way to federal court and beyond if necessary. If you’re considering applying for SSDI or have just begun the process, contact Gerling Law.