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My claim was denied by the Administrative Law Judge at the hearing level. What’s next?
That is a good question. The procedural process involved in appealing a Social Security Disability claim includes several levels. To fully answer this question, we should review what analysis the Social Security Administration (“SSA”) makes when it evaluates a disability claim, and then walk through the determination levels within the SSA.
The SSA evaluates disability claims based on a basic definition of “disabled.” Under social security rules an individual is “disabled” if he or she cannot engage in substantial gainful activity (earning $900 or more from work) for at least twelve (12) months, or the condition is likely to result in death, and, as a result of the disabling condition, the individual can no longer engage in his or her past employment or other potential, appropriate employment. If the claimant is not engaging in “substantial gainful activity,” the analysis proceeds to ask whether the claimant has a severe impairment, defined as one that has more than a minimal impact on the ability to do basic work activities. The next question asks whether the severe impairment “meets or equals” a Listing of Impairments, which lists several physical and psychological impairments. If a claimant’s severe impairment meets the requirements in that respective listing, then the SSA may find the individual “disabled.”
If the SSA finds the claimant’s severe impairments do not meet or equal a Listing of Impairments, the analysis proceeds to an inquiry of whether the individual can engage in past relevant employment or other potential, appropriate, and available employment based on that claimant’s psychological and physical limitations.
Note that the determination levels within the SSA include (1) the Initial Application, (2) Reconsideration, (3) Administrative Law Judge (“ALJ”) Hearing, and finally (4) the Appeals Council. Claimants also have a right to appeal an unfavorable decision from the Appeals Council to Federal District Court.
Keeping all of the SSA’s “disability” analysis in mind, there are several points in the analysis determination that a claimant can appeal if his or her claim is denied or is only partially favorable. For example, assume that Jane filed an initial application alleging that she was disabled as a result of major depression beginning in January 2007. Assume further that Jane was denied on the initial application, on reconsideration, and then filed a Request for Hearing with an ALJ. If, as result of the Hearing, the ALJ determines that Jane meets the Listing of Impairments for depression but that this disability did not begin until August 2007, then Jane may want to appeal this decision by filing a Request for Review in the Appeals Council, since the decision is only partially favorable. Jane believes her disability began eight (8) months prior to the ALJ’s determined onset date. If Jane can support, with medical evidence, that her disability began in January of 2007, then she would be entitled to more retroactive benefits, and appealing this decision might be in her best interest.
In response to your question, since you were denied at the ALJ Hearing level, you should file a Request for Review with the Appeals Council. When appealing an unfavorable, or partially favorable decision, you must set forth the grounds upon which the ALJ erred in rendering his or her decision. Therefore, you must cite specific errors the ALJ made throughout the disability analysis recited above. The Appeals Council has the ability to deny a claim, grant benefits based on the record and written arguments presented, or it may remand the case back to the ALJ Hearing level for an additional hearing. If the Appeals Council denies your claim, you may file an action in Federal District Court. If the Appeals Council remands the decision to the ALJ hearing level, then you should prepare for an additional hearing based on the grounds set forth in the Appeals Council’s order.
In conclusion, there is a multi-part analysis that goes into the SSA’s determination of whether a claimant is disabled. If any part of the decision is unfavorable to the claimant, he or she may file an appeal to the next level within the SSA, or ultimately in Federal Court.
Should you have any questions regarding social security benefits, or if you would like to consult with an attorney, please contact our office.