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What’s causing the Social Security Disability denial epidemic?

The allowance rate for Social Security Disability (SSD) benefits is dismally low during the initial claims process — but, why?

In 2016, the last year for which statistics are publicly available, medical allowances on initial applications are only granted on 44.4% of claims. At reconsideration, only another 11.2% of claims are medically approved. Yet, close to half — 52.3% — of all the claims that go before an administrative law judge (ALJ) are granted a medical allowance.

How is that possible? In order to get the answer, you have to understand what happens during the claims process at the initial phase. When you first file a claim for disability, the medical decision isn’t made in your local Social Security office. Instead, your claim is routed to a central agency in each state known as the Disability Determination Services (DDS).

Once you file is compiled, a DDS claims examiner will hand your case to a doctor for a review. Supposedly, the doctor is looking at all the evidence in your file and coming to a careful decision that takes all of the evidence into consideration.

In reality, investigations have uncovered the sobering truth: Some doctors spend only minutes with each file to make a decision. In fact, investigative reporters found that there’s no standard system of review for the doctors — which means your odds of approval in one state could be drastically different than your odds of approval in another state. The Social Security Administration (SSA) doesn’t even have a central database to track each doctor’s performance to see which ones are actually doing their jobs carefully and which ones are just collecting their paychecks.

For example, even though federal standards say that medical consultants should review no more than 1.5 cases per hour, some doctors are reviewing up to five claims in that same time period — which means they cannot possibly be giving each claim a good look.

When you file a reconsideration after an initial denial, you’re essentially going through the same process you did with the initial claim. A different doctor will make the decision on your case, but there’s no guarantee he or she will do a better job. That’s ultimately why half of the claims that go before the ALJ should have been approved in the first place.

If you’ve struggled to get your Social Security Disability approved, it might be time to get some legal assistance.