All About Social Security Disability Appeals

Social Security
The Judge denied my claim for Social Security Disability benefits, should I appeal?
If you are denied benefits following a Social Security Disability hearing, you have the right to appeal to the Appeals Council. The Appeals Council will either deny review, grant review and reverse the Judge’s decision, remand the decision for a new hearing or issue a partially favorable decision. The choice to file an appeal might not be as clear cut as you think.
Unfortunately, the Appeals Council is more concerned with making sure that the Social Security Administration follows the law and its own regulations and policies; as opposed to determining whether or not you are disabled. Also, appealing to the Appeals Council is a lengthy process, taking around 12 to 18 months.
Also, if you do choose to file an appeal, you will not be able to simultaneously file a new claim, which may be the better option. So, you and your attorney should carefully discuss your options and choose which route best serves you. Unfortunately, the Appeals Council only grants review in a very small number of cases. Generally, it is somewhere between 15% and 20% of cases.
Determining Whether Filing For an Appeal is the Right Move
Again, the Appeals Council is not so concerned with whether or not you are disabled. It is primarily concerned with whether the Judge made a legal error or whether the Judge’s decision is supported by substantial evidence. If there was no legal error and the Judge’s decision was supported by substantial evidence, then you likely will be denied review from the Appeals Council. I explain to clients that they may not agree with the Judge’s decision, but if there is support for it in the record; then the judge’s decision will likely withstand the substantial evidence test; and you will be denied review. Therefore, if there is no legal error or oversight on the part of the Judge, and the substantial evidence standard is met; I generally recommend against filing an appeal.
However, another factor to consider is that even if the Appeals Council grants review, that does not guarantee a reversal of the Judge’s decision. Instead, the Appeals Council can simply remand the case back for another hearing or back for clarification with the same Judge that already ruled against you. A remand to the same Judge is likely to lead to the same result.
Sometimes you will not have a choice as to whether to appeal or file a new claim. If your date of last insured status has already passed; then you will not be able to file a new claim and your only option would be to appeal. If you do get denied review by the Appeals Council then you have exhausted all of your administrative remedies and you will be able to file in Federal Court.
Best Arguments for a Successful Appeal Council Review
What are the best arguments for successful Appeals Council review? The best arguments are those where you can show that the Judge failed to follow the law or a social security regulation or ruling, and his or her decision is not supported by substantial evidence, and you are disabled. Simply arguing that you are disabled alone is usually not going to be enough. Generally, the Appeals Council does not even look at the issue of whether or not you are disabled until after it finds that the Judge’s decision is either not supported by substantial evidence, is legally erroneous, or that there was an abuse of discretion.
Decision Not Supported by Substantial Evidence
What does it mean to show that the decision is not supported by substantial evidence? Essentially, your attorney should look to see if the medical evidence outlined in the decision is accurate.
This list is not an exhaustive list of all the issues.
What does it mean to show that the Judge made a legal error? Generally, the decision must be evaluated to see if the Judge misapplied the law or failed to follow the steps in the sequential disability analysis.
The 5-Step Analysis
The sequential disability analysis is a five step analysis that must be applied in every case. A Claimant must meet the criteria in each of the five steps before moving on to the next step. Essentially, if a Claimant meets the criteria of all five steps then there will be a finding of disability.
What if I want to appeal a partially favorable decision? An example of a partially favorable decision is one where you are granted benefits but perhaps your alleged on-set date, (the date when you allege your disability started), was moved forward and you do not receive retroactive benefits. If you appeal this partially favorable decision to the Appeals Council and they grant review, the entire decision comes under review, not just the onset date portion of the decision. Therefore, you risk the Appeals Council reversing the entire decision, and not just the one part you found objectionable.
As demonstrated in this article, there are a lot of facets to consider when deciding whether to pursue an appeal to the Appeals Council. You should consult with an Attorney to go over your options. Of course, initiating your social security disability claim with the assistance of an Attorney will greatly increase your chances of success in the first place, avoiding the need to appeal.
At the LaBovick Law Group we provide free consultations where we will review the facts of your case to determine if this is the right program for you. Call us today at (561) 623-3681 for your free evaluation.