In this article, you will learn:
- How the decision to grant benefits is made and by whom
- How benefits are calculated
- How often claims may be denied
Social Security makes that determination. Initially when a person applies, social security has delegated the authority to make disability decisions to each state individually. States have their own Disability Determination Services or DDS, and so at the initial level, the state agency will make that decision. They will have a case worker and physicians review all of the claimant’s evidence and make a decision. If you’re denied, you can file a request for reconsideration. That too is decided by the state agency, and both the initial and reconsideration appeals are done without the claimant meeting anyone from Social Security face-to-face. If you’re denied initially and upon reconsideration, then you have the right to request a hearing before an administrative law judge, and that will allow you to have a face-to-face legal proceeding with Social Security on your own, and have a judge make a new determination on your eligibility.
How Social Security Disability Benefits Are Calculated
Everyone has a primary insured amount – your PIA. It is a calculation is based on all of your earnings recorded. The formula to actually arrive at the PIA is incredibly complicated. I wouldn’t even begin to know how to tell someone how to calculate their PIA. It Is calculated by Social Security, and they set the amount.
When To Apply For Disability Benefits
It would be too early if you’re still working. So, the threshold question for anyone seeking disability benefits is, are you engaging in substantial gainful activity? If the answer is, yes, you can never be disabled. So, until your earnings drop below substantial gainful activity, which is an amount Social Security sets every year, you cannot apply for disability benefits. You would be denied on what’s called a technical denial. I think the proper time to apply is when you have reached the point that your condition prevents you from performing substantial gainful activity, as well as you know that the condition is going to last for 12 continuous months, because if you have a condition that prevents you from working, but it only prevents you from working six months or eight months, you’re also not ever going to qualify for disability because the condition has to be expected to last for at least 12 continuous months or result in death.
When someone has become unable to work because of a medical condition, and then knows that the medical condition is going to cause permanent, significant long-term limitations, that’s the right time to apply. In theory, if you didn’t prove your disability began within that time period of your insured status, then you would not be able to draw benefits even if you’re disabled, because you have to prove that your disability began prior to the expiration of your insurance status.
How Often Social Security Disability Claims Are Denied
If you look across-the-board, generally at the initial level, about 25% to 30% of people are approved. So, that means 70% to 75% of people are denied. The majority of people are denied initially. At the reconsideration level, the denial rates are even higher. Particularly in Kentucky, we are talking about a 90% denial rate at the reconsideration level. People who then go on to file the request for hearing, the national average is probably a little under 50% are approved at the request for hearing level. Now, you’ll find that if you’re represented, that percentage can go up quite a bit because people who are represented generally have quite a higher percentage or chance at success. I’ve done this for 25 years, and within those 25 years, some years you win 90% of your cases, and some years you win 60%. It varies tremendously.
Some of the reasons that people are denied is first and foremost, Social Security doesn’t believe that the condition will last for 12 continuous months. Another reason is that Social Security says you can’t do your past work, but we think you can do something easier. That’s probably the most common answer people are given when they’re denied. Social Security thinks they can do something else other than their past work.
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