Disability Lawyers in Denver: Inconsistencies in Disability Decisions Between State Agencies and Judges

Social Security disability claimants can experience vastly different results depending on whether their claim is decided by a state agency (at the initial or reconsideration stages) or by an administrative law judge (on appeal). Each tends to rely upon different types of evidence to determine eligibility. Neither can make disability benefit decisions that are incongruent with medical evidence; however finders of fact often arrive at opposite conclusions with regard to the same claimant.

For instance, decision-makers within state agencies tend to take an objective approach to the determination of benefits and rarely investigate a claim beyond the medical findings. Many agencies depend on the Listing of Impairments provided by the federal Social Security Administration to issue a denial or favorable decision. Claimants under age 50 struggle the most with state agency decisions as their young age often weighs against the likelihood of a favorable decision.

State agencies also might use formulas or algorithms that require the input of certain criteria and factors to determine disability eligibility. The results of these formulas serve as the basis for determination of the claimant’s Residual Functional Capacity (RFC). While this may seem like an evenhanded approach to disability determination, injuries and afflictions tend to affect people in different ways. Thus, two individuals with the same factors and identical medical conditions could face widely different limitations with respect to their ability to work. For this reason, objective formulaic determinations of disability benefits fail to take into account specific issues faced by each unique claimant.

As any of thedisability lawyers in Denver can attest, administrative law judges (ALJs) tend to take a more subjective approach in evaluating disability claims. ALJ’s are keen on investigating the entire case and often take the claimant’s credibility into account when making a decision. Younger disability claimants regularly fare better with ALJs because age is not necessarily a precluding factor in the determination of one’s ability to work despite injury or illness.

The Social Security Administration has released data comparing state agency decisions to ALJ decisions. For instance, ALJs awarded disability benefits to those with back injuries 75% of the time while state agencies found eligibility in only 11% of such claims. Of those claimants under age 50, only 2% received benefits from state agencies while ALJs awarded benefits to 68% of applicants.