When pursuing a Social Security disability claim, it is important to understand that the disability determination process is not a perfect one. The majority of individuals are denied on their initial application, and, at the end of the appeals process, only 1 in 3 are ultimately approved for receipt of disability benefits. When a claimant receives a partially favorable decision of their claim, which is not entirely uncommon, there are some very important considerations to take into account before deciding whether you should appeal that decision. A wrong decision can prove to be devastating.
Receiving a partially favorable decision typically involves receiving a decision that means the Social Security Administration (SSA) has found you are “disabled” as that term is defined under Social Security’s rules, but that you are being found disabled with an onset date different than the one you alleged on your application for benefits. For a Social Security disability lawyer, properly advising a claimant as to whether to appeal that decision is not always an easy one.
Initially, it may be clear that because of the need to show that one has remained disabled from a “severe medically determinable impairment” that either has met a medical listing of impairment or had remained severe and disabling such that the individual will remain disabled from all forms of gainful employment for what will be or what has been a year or longer (or is likely to result in death) that either the condition was not diagnosed or treated until a later point in time (and so the proof of the condition simply does not exist at an earlier time). This may make the decision whether to appeal much easier.
Before one decides to appeal, it is important to understand how the appeals process works. If one is a New Hampshire Social Security lawyer and your client (who is a resident of New Hampshire) is faced with the prospect of appealing the decision, it is important to note that the case will proceed on appeal to a hearing before an Administrative Law Judge (ALJ). However, if you are Maine or Massachusetts Social Security lawyer and your client residing out of Maine or Massachusetts is faced with a partially favorable decision upon an initial application, the claimant would need to undertake a request for reconsideration. The two procedures carry with it much different risks, assuming the attorney is handling the claim in a manner that best protects their client.
With a request for reconsideration, Disability Determination Services will undertake a review of the claim once again and there remains the risk that upon reconsideration the favorable decision will be turned around: one runs the risk that the benefits awarded (both past due and ongoing) can be found to be awarded in error. SSA will in turn ask for the return of funds that have been paid in the interim and will discontinue the receipt of one’s ongoing checks. This can happen without any forewarning. Thus, the decision by a Social Security lawyer or a claimant to appeal a partially favorable decision on reconsideration needs to be undertaken with significant caution, and with an understanding on the part of the claimant that they may lose the benefits that have been awarded previously.
If, however, one is proceeding with a Request for Hearing before an ALJ, there are many more protections afforded to disability claimants and their attorneys. There is little risk to proceeding to the hearing level with an appeal of a partially favorable decision unless one actually proceeds to hearing. Before that time, there is the possibility that an ALJ will review a brief undertaken by one’s attorney explaining why they believe a fully favorable decision has been warranted. In order to succeed with such an argument, however, it will be necessary to show that the claimant still remains disabled under Social Security’s rules on an ongoing basis so as to justify the receipt of an ongoing check. In some circumstances, the ALJ will agree ahead of the hearing that the only issue to be decided at hearing is the prior period of time which was not granted. Having an experienced Social Security disability attorney who can address these issues for you is essential to receiving the best outcome in your case (and avoiding what can be a disaster). We recently were contacted about assisting with a claim where the prior representative did not provide the appropriate advice and assistance and the claimant now finds themselves appealing to the hearing level (with it never being explained to them that an appeal at reconsideration could result in an outright reversal of their partially favorable decision: they have in turn been informed that they are now faced with repaying a substantial overpayment).
If you or a loved one is faced with fighting their Social Security Administration, understand that there is no reason to go it alone or without the benefit of aggressive legal advice and assistance. Contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622 to see how we can make a difference for you.