Your Chances of Winning Disability on Appeal After an Initial Denial

When you apply for Social Security disability benefits, it's not uncommon for your application to be initially denied. Fortunately, you can appeal. In fact, most people who win their disability case do so on appeal, as opposed to getting the initial application approved.

Your chances of success at the appeals level depend on the reason your disability application was denied in the first place. The two most common reasons for losing your disability case include:

• not meeting the initial requirements for Social Security disability, and
• not providing enough medical information.

Here's what you need to know to understand why Social Security denied your initial claim and what you need to do to increase your chances of winning disability on appeal.

Not Meeting Social Security's Initial Requirements for Disability

Whether you've applied for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability benefits, there are certain initial requirements you must meet to qualify.

Identifying the Issue

If your disability application was denied, the Social Security Administration (SSA) may have found that you failed to meet one or all of the following initial requirements:

• You haven't worked (and paid Social Security taxes) long enough to qualify for SSDI.
• Your current earnings from work exceed Social Security's limit ($1,470 or more a month in 2023).
• Your condition hasn't lasted long enough and isn't expected to last long enough (it must last or be expected to last at least 12 months).
• Your condition isn't "severe" enough—meaning it must have more than a minimal effect on your ability to perform work-related activities.
• For SSI, your income and resources don't fall below the SSI limits.

Fixing a Technical Denial

If your disability claim was denied because you didn't meet one or more of the initial requirements (called a "technical denial"), you'll also be denied at the appeals level—with some exceptions. You have a chance of winning your Social Security appeal in the following circumstances:

• Your disability application was denied because you were earning too much money and you can prove that you're no longer earning too much money.
• You were denied because your income and resources were too high (SSI only) and you can prove that you no longer have too much income and resources.
• Your claim was denied because your condition wasn't considered severe, and your prognosis or the symptoms of your illness have changed for the worse.

Giving Social Security Enough Medical Information to Prove You're Disabled

Social Security could have denied your disability application simply because you didn't provide enough medical information and evidence to support your claim. Social Security needs your complete medical history dating back to when you first became sick or injured.

To increase your chances of winning disability benefits at the appeals level, you'll need to provide additional information and evidence, including:

• a complete list of all doctors you've seen for evaluation or treatment of your condition
• a complete list, including dates of services and addresses, of any hospitals or clinics where you've received treatment
• a detailed listing of the symptoms you experience and how they affect your ability to work and take care of yourself
• reports from clinical exams, treatments, and surgeries
• medical test results, including:
  
  • blood tests
  • imaging tests (MRIs, CT scans, and x-rays), and
  • biopsies performed in the treatment or diagnosis of your illness
• a list of all medications including dosage, side effects, and reason for the prescription, and
• supporting statements from your treating physicians about how your illness affects your ability to work.

Improve Your Chances of Winning a Social Security Disability Appeal

If your initial SSDI or SSI disability application has been denied, you can appeal. And the Social Security appeals process offers several levels of appeal to you. Your chances of winning disability on appeal vary by level.

Your Chances of Winning Disability at Reconsideration

Even if you provide Social Security with your complete medical history and supporting documentation, your claim will still most likely be denied at the reconsideration level (the first level of appeal). Only around 15% of appeals are won at the reconsideration stage—meaning about 85% fail.

If your reconsideration is denied, it's important to request a hearing by the deadline stated in your denial letter (60 days after receipt of the letter); otherwise, you'll be required to restart the application process from the beginning.

Your Chances of Winning at Your Disability Appeal Hearing

Your best chance of winning your claim on appeal is at the hearing stage, the second level of appeal. An average of 50% of claims are approved by the administrative law judge (ALJ) at the hearing stage.

For most medical conditions, the most important item to provide to the hearing judge is a supporting statement from your doctor about the limitations caused by your medical condition. But to be effective, your doctor's statement must be detailed and based on medical evidence.

If you can get your doctor to fill out a form called a residual functional capacity (RFC) form, you have a much better chance of getting approved at your hearing, assuming your doctor agrees that your condition is very limiting, which isn't always the case.

On the RFC form, your doctor should explain:

• how long you can do various activities, such as:
  
  • sitting
  • standing, and
  • walking
• how much weight you can lift
• whether your mental capacities are limited, and
• details about any other limitations your impairment causes.

For more information, see our articles on residual functional capacity and winning a medical-vocational allowance.

Your Chances of Winning Additional Disability Appeals

If you lose at your appeal hearing, you can request an Appeals Council review. The first step to win at this level is to convince the Appeals Council to review your claim, since they reject many requests for review. Working with an experienced disability attorney can help you prevail here, since a lawyer will know which issues to raise and how to argue that your case deserves another look.

And you'll need a disability lawyer to have the best chance of winning should you need to take your case to the final appeal level—federal court.

For more advice on going through the appeals process successfully, see our tips to win Social Security disability on appeal.