What are the odds of winning my Social Security Disability Insurance claim?

Thursday, 24 March 2016 13: 04
Written by Joni B. Bailey

waiting in line for social security disability insurance

With March Madness in the air, I thought it might be a good time to talk about the odds of winning a Social Security Disability Insurance claim.

Here is the 2015 version of a chart published each year by the government that shows how many cases were approved, denied or dismissed at each level of the administrative process in 2015. 

This is commonly referred to as the “Waterfall” chart.


Let’s unpack the information contained in this chart:

The first thing to realize is that the numbers on the chart represent decisions made at the various levels in that year, not the outcome in  each individual claim.  As a Southern Illinois Social Security attorney, my experience is that a claim typically takes 2-3 years to move through the process from filing to hearing decision. The “back of the envelope” math used in this blog simply compares the outcomes to the original number of claims filed.  This approach is based on the assumption that between the filing date and the final result there will not be a major change in the percentages of wins and losses.

In 2015, 2,756,319 Social Security Disability Insurance and Supplemental Security Income claims were filed.

At the initial level (the first look at the file by an adjudicator):

  • 33% were approved
  • 25% appealed
  • 42% gave up or did not complete paperwork on time

At the reconsideration level (the second look at the file by an adjudicator) in those states that use it:

  • 12% were approved
  • 88% were denied

Between the initial level and the request for hearing level some states have a reconsideration step (second look at the file by an adjudicator) and some do not. 

The field thins out considerably by the time claims reach the hearing level:

  • 27% of the original number of claims file a Request for Hearing
  • 68% of the Requests for Hearing lead to a decision
  • 45% of the decisions at the hearing level are approvals, and this includes decisions that involve an agreement by the claimant to ask for less months of past due benefits
  • the rest give up or do not pursue a hearing

The number of winners compared to the number of claims filed can be broken down this way:

  • 32% are approved at the initial level
  • 3% are approved at the reconsideration level (not all states have this level)
  • 3% go all the way to win some past due benefits at the hearing level
  • .6% go to the Appeals Council after a hearing denial and get a remand or allowance
  • .3% go to the Federal Court after an Appeals Council denial and get a remand or allowance

Remand means there will be another hearing, which might or might not result in a  favorable decision.

The bottom line is that more than half of the claims that are filed are either dropped, dismissed or denied.

What explains this?

  • Many people file a claim as soon as they get hurt or are diagnosed with a major illness. They cannot see into the future and think they may never be able to work again.  They are pleasantly surprised to find that they are able to return to work within 12 months of their alleged onset date (the date they claim they could not work because of illness or injury).
  • Many people learn during the process that Social Security benefits are not available for people who can no longer do their preferred job but can still do other jobs that pay less.

Before filing a claim, it is important to take an honest look at the situation:

  • Will you get better in 12 months?
  • Even though you can’t perform the job that pays well, are there other, easier jobs you can do?

Take it from me as a Southern Illinois Disability attorney:  Claimants cannot afford to waste 2-3 years of their lives without an income “waiting in line” for disability benefits they will not receive. 

Consulting with an experienced Southern Illinois Social Security disability attorney early in the process is a great way to get a candid assessment of the chances of winning a claim. 

Joni Beth Bailey is a Southern Illinois Social Security Disability representative.


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