What are the chances my disability appeal will be approved?

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Question:

What are the chances my disability appeal will be approved?

Answer:

Your chances of success at the appeals level depends on the reason you were first denied.

Not Meeting Initial Requirements

If you were denied because you didn’t meet the initial requirements for disability, you will also be denied at the appeals level, with some exceptions. The Social Security Administration (SSA) sometimes finds that the claimant has failed to meet one or all of the following initial requirements:

  1. • The applicant cannot earn $1,040 or more a month from working.
  2. • The condition must last or be expected to last at least 12 months.
  3. • The condition must be “severe,” meaning it must have more than a minimal effect on the applicant’s ability to perform work related activities.
  4. • For SSI, the applicant must have income and resources below the SSI limits.
If you were denied because you were earning too much money, or your income and resources were too high (SSI only), and you can prove that you are no longer earning too much money, or that you no longer have too much incomes and resources (for SSI only), you have a chance of winning on appeal.

If you were denied because your condition wasn't considered severe, and your prognosis or the symptoms of your illness have changed for the worse, you have a chance at winning on appeal.

Not Enough Medical Information

Applicants are often denied simply because they failed to provide the SSA with enough information to support a favorable decision. To increase your chances of an approval at the appeals level, you must make sure that the SSA has a complete medical history dating back to when you first became sick. Examples of the information you need to provide the SSA are:

  1. • A complete list of all doctors you have seen for evaluation or treatment of your illness.
  2. • A complete list, including dates of services and addresses, of any hospitals or clinics where you received treatment for your illness.
  3. • A detailed listing of the symptoms you experience and how they affect your ability to work and take care of yourself.
  4. • Reports from surgeries, blood tests, MRI’s, CT scans, x-rays, or biopsies performed in the treatment or diagnosis of your illness
  5. • A list of all medications including dosage, side effects, and reason for the prescription. 
  6. • Supporting statements from your treating physicians about how your illness affects your ability to work.

Increasing Your Chances of Winning on Appeal

Even if you provide the SSA with your complete medical history and supporting documentation, there is still a high chance that your claim will be denied at the reconsideration level. If your reconsideration is denied, it is important to request a hearing by the deadline stated in your denial letter (60 days after receipt of the letter); otherwise you will be required to start the application process from the beginning.

For most medical conditions, the most important item to provide to the SSA is the last one on the list, a supporting statement from your doctor about the limitations caused by your medical condition. 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 winning your appeal, assuming your doctor agrees that your condition is very limiting. On the RFC form, you doctor would state 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 so on. For more information, see our article on residual functional capacity.

by: , Contributing Author

This article is provided for informational purposes only. If you need legal advice or representation,
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