Winning An Ssd Appeal In Federal Court
Appealing an SSD claim denial all the way up to federal court is relatively unusual. By the time an SSD application has been reviewed, reconsidered, supplemented with additional evidence, argued at a full hearing before an Administrative Law Judge, and reviewed for errors by the SSD Appeals Council, most benefit claims have been thoroughly litigated. By that time, an SSD applicant seeking benefits usually learns the facts of their case either do not qualify or they are somehow otherwise ineligible. Every argument has been made and considered.
But some cases remain unresolved and are compelling enough to justify the unusual step of appealing the denial of benefits to the federal courts. At this stage, the complexity and technical nature of the legal proceedings require the expertise of a Social Security Disability Lawyer. A non-attorney advocate cannot represent you in federal court. Although you may act alone, it is never a good idea for an SSD claimant to attempt to represent themselves in federal court.
Your federal court SSD attorneys formal pleading documents will trigger responses to be filed by the SSA. The SSA will submit your entire SSD file, including the ALJs full written decision. Your lawyer will argue the specific legal, factual, and analytical failures committed by the ALJ that the Appeals Council failed to correct. The federal court judge will not conduct a whole new trial of your case, only a review of the previous record.
The Three Avenues Of Appeal Are:
A Board appeal can take a year or more to yield a decision.
After a Board hearing, a Veteran may file a Supplemental Claim or take their claim to the U.S. Court of Appeals for Veterans Claims.
The U.S. Court of Appeals for Veterans Claims provides judicial review of final decisions by the Board of Veterans Appeals. The Court reviews the BVA decision, the written record and each partys briefs.
Cases may be decided by a single judge or, if the case presents a particularly significant legal question with broad application, or presents a question of first impression, meaning that the case presents a new legal question not considered by the Court previously, the case may be decided by a panel of three Judges or the entire Court.
The Court may affirm the Board of Veterans Appeals decision in whole or in part, meaning the Court agrees with the BVA and will uphold all or part of the decision. In the alternative, the Court may reverse, vacate, or remand the decision of the BVA in whole or in part, sending it back to the BVA or VA regional office for further action. The Court also may dismiss the appeal, leaving the BVA decision in effect, if the Court does not have the legal authority to consider the appeal, if the appellant has not followed the Courts rules of practice and procedure, or if the appellant withdraws the appeal.
Further appeals are possible, but rare, to the United States Court of Appeals for the Federal Circuit and then the Supreme Court of the United States.
Federal District Court Appeal
Your last option is attempting to get your case in front of a federal district court judge, but the process can be expensive and time-consuming.
Youll be looking for errors in the ALJs conduct of your hearing, or errors in judgment. Few ALJs decisions get reversed outright, but district court judges remand, or send back for reconsideration, roughly half the disability cases they hear.
Youre a lot less likely to succeed in federal court, Grossman says. Most of the time youre barking up the wrong tree.
Its useful then, too, to have an expert an experienced warrior such as Grossman willing to tell you the hard truth.
About The Author
Don’t Miss: Fired While On Short Term Disability
Obtain Supportive Documents From Your Physician
The more evidence you can provide about your disability, the better your chances for approval during the appeal process.
When a claim is denied, it is usually due to the SSA representative determining that you do not meet the requirements to receive SSD benefits. To ensure your appeal results in a successful approval, you need to double-check that you provided the SSA with proper documentation and supporting evidence that validates the severity of your condition.
You can also ask your doctor for a supportive statement detailing how your condition limits your ability to work. These types of statements typically do not affect your standing at the initial stage of the appeal process, but there is evidence that this kind of supporting document from your physician can greatly impact your case at the disability hearing level in front of the Administrative Law Judge .
If your doctor believes that you would benefit from receiving SSD benefits, ask them to fill out this important SSA assessment form, the Physical Residual Functional Capacity Assessment .
Social Security Disability Appeal Basics
Believe it or not, most applications for Social Security disability benefits are denied upon the initial application. Typically, only the most obvious and slam dunk claims are approved after the first step of the application process. If your application for benefits is denied, that does not always mean that you do not qualify for benefits. It often requires an appeal of this initial decision to get your benefits approved. Many people wonder how to appeal a disability decision. The appeals process is the same for SSI vs SSDI.
First, you can simply submit a request for reconsideration. You might have some additional evidence or medical records to provide and you are requesting that the SSA reconsider their decision. Most initial determinations are made by local Disability Determination Services . These are often state agencies that make the initial decision for the SSA. Your reconsideration request is asking the SSA to review and reconsider the decision made by this agency. This is sometimes successful, but not often.
If you are unsuccessful at the hearing, you can continue to appeal your case. Your next step would be to the Appeals Council and finally to Federal court if the Appeals Council review is unsuccessful. Very few cases actually make it to Federal District Court in reality. If your benefits are not approved at the hearing level, then many cases simply get dropped at that point.
Don’t Miss: Disability Compensation Va
Top Tips To Win Your Appeal
Your disability appeal gives you one more chance to get the benefits youre entitled to receive. What follows is a brief discussion of our top tips to help you win your appeal.
1. File A Timely Appeal
Your group ERISA policy requires a timely written comprehensive appeal.
2. Include The Correct Paperwork
For a proper appeal, you will need to submit medical, vocational financial, and occupational proof of your disability. You also need to submit complete paperwork showing all relevant testing, information, medications, objective evidence, including any new information, about your disability.
3. Attach A Detailed Letter Of Support
Please let family, friends, co-employees, doctors, caregivers who can outline how hard you tried to get better and how your disability prevents you from returning to work write a detailed letter.
4. Be Honest
Under no circumstances should you exaggerate or lie in your appeal letter or any documentation you file with your insurance company. Not only could your appeal still be denied, but stretching the truth could cause you additional legal trouble and headaches.
Make sure youre also being honest and transparent with your doctor. The information your doctor provides could push your appeal over the top, so do not hold back when discussing your disability with your physician.
5. Submit Medical Evidence
6. Submit A Written Medical Opinion From Your Doctor
7. Speak With A Disability Attorney
Work With A Social Security Attorney
Because a reconsideration appeal goes through the same review channel as the original SSDI claim, the chances of getting your disability appeal approved by the SSA are not good. In fact, a report released by the SSA stated the agency denied 87 percent of all cases heard during the first stage of the appeals process in 2018. One of the most effective ways to improve your chances during reconsideration is by hiring a state-licensed Social Security lawyer.
Your attorney will know how to strengthen your case by submitting additional convincing documentation from both your physician and employer. Hiring a lawyer also ensures you file for reconsideration long before the 60-day deadline.
Schedule a free case evaluation with a Social Security attorney today to boost your chances of winning a disability appeal.
Read Also: What Is A Gaf Score
Understanding The Compassionate Allowance Exception
As part of the appeals process, your application could be approved if it meets the guidelines for compassionate allowance. SSA guidelines for compassionate allowance include the following dire medical conditions:
- Acute leukemia
- Specific forms of cancer
- Specific brain injuries
Many other diseases are on the compassionate allowance list. You can also submit your medical diagnosis for consideration as a compassionate allowance. This step also has its own process of hearings and reviews. Our team will represent you at these events and make sure your application contains all required medical evidence and support.
Provide Your Personal Information
As we had mentioned in the CPP Disability Appeal Process article, it is utmost important that you provide your correct and updated personal information, as we have seen many applicants neglected this and missed important messages from Service Canada.
- Your Full Name
Re: Denial of Canada Pension Plan Disability Benefits
I am writing to appeal my denial of Canadian Pension Plan Disability benefits. I have included additional information about my arthritis and have attached updated and detailed medical records from my family doctors and specialized treating physicians.
Don’t Miss: Non Medical Requirements For Ssdi
Getting An Ssd Claim To Federal Court The Social Security Disability Appeals Process
Social Security Disability claimants have a right to appeal every decision denying them benefits. To explain how an experience SSD lawyer wins a federal court SSD appeal, well review all the appeal levels that come before that stage in the process.
Initial Claim Denial: When you file your SSD claim, your application is reviewed and denied at this initial stage, requiring a claimant to request the claim be submitted for reconsideration. Because the reconsideration is conducted on basically the same information available to the initial claim evaluator, few initial denials are reversed by this reconsideration review. If denied again after reconsideration, filing an appeal leads to an ALJ hearing.
ALJ Hearing Denial: The claim review conducted by an Administrative Law Judge is much more in-depth and includes your personal participation with your own SSD lawyer or advocate. These hearing often find grounds to award benefits that were denied earlier. The ALJ must review specific facts and make detailed findings on the record, and issue a reasonable judgment based on the evidence.
The ALJ Hearing is extremely important to any eventual federal court appeal. The federal court judge is limited in what they can consider in your SSD appeal.
If the claim is denied by the Administrative Law Judge after hearing, then an appeal is filed bringing the case before the Social Security Disability Appeals Council, the highest level of appeal within the SSA for claims denied SSD benefits.
Social Security Disability Appeal Time Frame
Among the key mistakes go-it-alone claimants make is resubmitting their applications after theyve been denied at the initial review stage. OK, appeals take substantially longer than originating an application, but youre still running up against odds that are at least two-to-one, where more than half those who appeal wind up getting SSDI benefits.
Better to get the appeals process rolling, even if it winds up taking a full two years. If when you finally prevail, youre most likely going to receive a lump sum dating to when you began the process.
We mentioned two years. Some cases do drag on that long, and longer. But in Grossmans experience, the average time to get to a hearing and with the right counsel win your appeal is about 18 months.
Its discouraging to get turned down, Grossman says, but thats only the beginning.
But you have to get busy. Social Security gives you 60 days from the date you receive the agencys decision to present your request for an appeal in writing.
Also Check: Ga State Disability
Provide Documentation That Supports The Extent Of Your Disability
The requirements for SSD approval are quite clear. You must have earned enough work credits in your employment history and be disabled by your condition to the point that you are unable to support yourself financially without the assistance of social security disability benefits.
When a claim is denied, its typically because the SSA representative has determined that the claimant does not meet the requirements for SSD benefit approval.
To ensure that your appeal is a success at the reconsideration stage of appealsor any appeals that might come afteryou must be sure that you are providing the SSA with enough evidence and documentation to support the severity of your condition.
In some cases, you may need to fill out additional waivers so the SSA representative can review other medical records, or even have your physicians provide documentation that confirms you are unable to earn a living due to the extent of your condition. If you want to win your appeal, your reconsideration request has to be ironclad.
Requesting A Va Decision Review Or Appeal
The VA changed its appeal process as of February 19, 2019. Below, we discuss the new decision review process, which applies to VA decisions made on or after Feb. 19, 2019. If you are already in the middle of appealing a decision dated before Feb. 19, 2019, the legacy appeals process applies. We can assist you with it, as well.
The decision review process provides three options for appealing a denied VA benefits claim. If the results of your first appeal are not satisfactory, you have additional appeal options.
Don’t Miss: How To Get Disability In Ga
Our Birmingham And Montgomery Ssd/ssi Lawyers Will Handle Your Social Security Disability Appeal
Before private practice, served as lawyers in the Social Security Administrations division of administrative appeals. They are knowledgeable about how claims are processed and why claims are flagged for closer scrutiny and ultimately rejection.
We can address the common reasons that result in denied claims:
- Incomplete medical records or work histories frequently lead to a denial.
- Errors in filling out the forms are the root of many denials.
- Younger workers are presumed to be able to perform some type of work.
- Subjective complaints such as pain or fatigue are given less weight than objective medical records.
- Mental impairment claims require substantial documentation by other professionals.
- People who stop seeing their doctors are often assumed to be on the mend.
- People who were not represented by an attorney on the initial application may not even know why their claim was turned down.
Is There An Alternative To The Full Application Process
Yes. The Social Security Disability Insurance has an initiative called Compassionate Allowances . This is a process whereby the Social Security office can provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards. There are 88 qualifying rare diseases and cancers on the list. Compassionate allowances allow the office to quickly identify diseases and other medical conditions that qualify under the Listing of Impairments, based on minimal objective medical information. Compassionate allowances allow Social Security to quickly target the most obviously disabled individuals and get their benefits to them.
It is possible that certain members of your family qualify for benefits based on your condition and your previous work.
Those family members include:
Don’t Miss: California State Disability Amount
Consider Hiring An Attorney
Many people have trouble navigating the legal system when it comes to their disability case. Knowing that they must file the proper forms, meet all the deadlines, and write up presentations of their evidence tends to overwhelm many people. That is why a lot of people turn to an attorney, especially when it comes to a disability hearing. Completing the initial SSD application on your own is fairly easy, but an attorney is often needed to help get your case approved at the appeals level. If you need help or have received a denial letter, then you should probably consider hiring a disability lawyer to help you.
Correct Any Errors On Your Initial Application
Many appeals are resolved at the reconsideration phase. However, if there were errors in your initial application, a second pair of eyes may catch the same errors, which will result in a rejected application.
Your disability application and all other forms and documents filed with the SSA must be complete and error-free. If you completed the initial application yourself, you might want to consult with a lawyer. A disability attorney can review the application and make any corrections necessary to avoid repeating the same problem during the appeal.
Don’t Miss: Failure To Find Sexual Partner Is A Disability
A Lawyer Can Help With Your Chances Of Winning Your Appeal
With the Social Security Administration denying a majority of disability claims, you must submit convincing medical evidence to meet the standards established by the federal agency. If you do not meet the medical standards established by the Blue Book, then the SSA will deny your initial claim. Not all is lost, as you have the right to file an appeal for reconsideration. An appeal for reconsideration is conducted just like the initial claim. A team of medical examiners from the SSA reviews your appeal and then makes a decision on it.
Unfortunately, the SSA denies most appeals for reconsideration as well.
This brings us to the second stage of the appeal process, which is called a hearing in front of an Administrative Law Judge . If you have not hired a Social Security attorney by this stage of the process, then you should be proactive and work with a lawyer who may acts as your legal advocate.
The chances of winning a disability hearing with a may lawyer increase dramatically. Your attorney can coach you on the questions you can expect to get during the hearing. In addition to preparing you for the questions asked by the ALJ, your lawyer can help you gather and organize more medical evidence than you submitted for the initial claim and appeal for reconsideration.