Frequently, I have clients who have filed for disability benefits over and over again only to be denied, but have never appealed an initial denial. In order to improve their chances at success, they probably should have appealed the initial denial. Unless the disabling medical condition has worsened between applications, there is little to be gained by successive initial applications. Statistics show that the likelihood of obtaining benefits increases by appealing the initial denial. In Wisconsin in 2007, for instance, the state agency assigned to make disability determinations, the Disability Determination Bureau (DDB), denied 66% of all initial applications. The first stage of appeal is called reconsideration. At this stage, the DDB denied 85.2% request for reconsideration. However, at the second appeals level – a request for a hearing before an administrative law judge (ALJ) – many more claimants are awarded benefits. It is frequently said that 50% of claimants are awarded benefits by an ALJ. Some numbers reflect that ALJ’s approve up to 63% of claims. These numbers suggest that it pays to an appeal the initial denial and appeal if denied again at reconsideration.
This is not to say that simply appealing means a claimant will win his or case. There are good reasons that an ALJ may grant benefits when the DDB did not. For instance, claimants are more likely to have an attorney at the ALJ hearing level than at earlier stages. An attorney can assist them in making an effective argument to the ALJ as to why the claimant is disabled. Also, the long wait for a hearing means that the disabling condition may have worsened over time. There will likely be more medical records and therefore more evidence of disability by the time a hearing is scheduled. Also, the claimant will be older, which may put them in an age category in which it is easier to get benefits. There is also some self-selection occurring as appeals proceed further. That is, people who aren’t truly disabled are probably less likely to keep pursuing appeals.
The bottom line is that if a person truly believes their medical condition prevents them from working and the person has medical evidence to support the claim, the chances of success increase if he or she makes the effort to appeal the denials at the early stages and brings the case before a judge.
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