Most people need to see a judge to get disability benefits from Social Security. Social Security has a very strict evaluation process that includes impairment listings that address illnesses and disorders for all body systems. These impairment listings set forth the criteria needed to meet or equal the severity requirements for the social security disability program.
Individuals who meet or equal an impairment listing will not need to see a judge to get disability benefits. Additionally, individuals who have residual functional capacity ratings that are severely restricted may be able to get disability benefits on the basis of a medical-vocational disability approval.
Medical vocational disability approvals are based upon an individual’s age, education, work history, and residual functional capacity. These types of approvals use a five-step process in which a disability examiner, or judge if the case is at the hearing level, will determine if the claimant can go back to their past work and, if not, whether the claimant do some type of other work. If the answer to both questions is no, they may be awarded disability benefits.
If an individual cannot get disability benefits approved by meeting or equaling the criteria of an impairment listing (for instance, the impairment list for rheumatoid arthritis, or the impairment listing for lupus, or the impairment listing for depression or bipolar) or through a medical vocational allowance for their initial disability claim, they will have to use the Social Security disability appeal process if they still hope to be approved for disability benefits.
Rates of approval
Approval rates for initial disability claims (initial claims are disability applications) are at about 35%, meaning that about 65% of initial claims are denied. Only about 10-15%t of cases are approved at the first appeal level, the reconsideration appeal level.
This means that if one hundred people filed an initial disability claim, only about thirty-five would get disability benefits. And if the sixty-five individuals who were denied at the initial disability claim level filed a reconsideration appeal, only ten to fifteen of those who appealed would get disability benefits.
Meaning: out of the original one hundred individuals who filed a claim, there would still be fifty-five individuals who would need to see a judge to get disability benefits from Social Security.
While these approval rates are discouraging, individuals who have to see a judge have the best chance of being approved for disability out of all of the levels of the Social Security disability process. National approval rates for administrative law judges average about 66%.
The wait for a hearing date
The worst thing about having to see a judge to get disability benefits is the wait for a disability hearing. Social Security hearing offices across the country have large backlogs of hearing requests and are receiving record numbers of new hearing requests. This has resulted in a long wait for a disability hearing.
Many people are waiting twelve months or more for a hearing and, while their chances are good for an approval of disability benefits, there is no guarantee that they will get disability from Social Security even if they see a judge.
Having said that, though, hearings represent the best chance of approval since, with representation, the approval rate can exceed 60%. Why is this? There are several reasons, one of which is that, at a hearing, an ALJ, or administrative law judge, will give full consideration to a statement supplied by a claimant’s treating physician, as long as statement is not contradicted by the medical records.
Also, disability representatives will usually research a case and determine how it is supported by the various rules and regulations that guide the decision process.
Finally, hearings are not like the earlier levels of the system where a decision is made by a disability examiner with practically no input from the claimant. At the hearing, the claimant or their disability representative will present a case for approval, which may involve interacting with whatever expert witnesses the judge has chosen to have appear (typically, a vocational expert or a medical expert).
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Source: https://www.ssdrc.com/section-4.html
