INITIAL DISABILITY DENIAL RATES ARE HIGH.

The denial rate on initial Social Security disability claims is approaching 75 percent.  Only the most obvious impairments get approved and often they involve claimants over the age of 55.

When you file a disability benefits application, the initial decision is made by a state agency called the Disability Determination Service (DDS) or "state agency."  DDS is a state run agency funded by federal dollars.  They gather and review the medical records to make the first decision about whether the claimant is disabled under the Social Security Act.  In most cases, DDS finds that the person is "not disabled under our rules."

The most common reason stated for denial is this:  "While the evidence shows that you have some restrictions and may not be able to perform the types of work you did in the past, there are other kinds of work that you are still able to perform."  This is known in the industry as a Step 5 denial.  Can't do past work but can do some other work.

What is the denial rate at the state agency level so high?  Several possible reasons are offered:
  1. DDS is set up to reject claims, not approve them.  The philosophy seems to be, make sure that nobody ever gets disability benefits who doesn't deserve them.  It is not, be sure that nobody who deserves benefits ever gets denied. If error is made, it is on the side of denials, not approvals.
  2.  Approved claims get reviewed for quality assurance about 90 percent of the time.  Denied claims get reviewed for qualify assurance less than 20 percent of the time.
  3. The process is fairly mechanical, not personal.  The decison maker does not meet the claimant and in most cases the claimant is never examined by a Social Security doctor.  If the check boxes don't line up, the claim is denied.
  4. The system is simply over-worked.  Sometimes all of the medical evidence is not obtained.  They try but if a doctor doesn't respond, evidence may not be included.
If your claim is denied, you have one recourse in Alabama:  Appeal to an administrative law judge and ask to appear at a hearing.  Your appeal must be filed within 60 days of the denial.  You may add 5 days for mailing time.  (In Tennessee you must file for Reconsideration at DDS before you may ask for a hearing; Reconsideration is just a waste of time because their denial rate is even higher than the initial denial rate, nearly 95%).

 

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