How To Read And Understand The Initial Determination
After the Disability Determination Services completesits initial review of your application, a letter, which SSA callsa notice, is mailed to you or your representative,if you appointed one, to explain the determination in your case andyour right to appeal.
Initial determinations will include information about whetheror not you have been found disabled. The following are three possibleoutcomes for medical determinations:
Fully favorable–means thatSSA has found that you are disabled as of the date you allege yourdisability began. If you are filing for Supplemental Security Income, a finding that your disability began as of the month of yourapplication is a fully favorable determination because SSI paymentscannot begin earlier than the month after the month of your application.
Partially favorable–means oneof two things. Either SSA has found that you are currently disabled,but SSA has determined that your disability started sometime afterthe date you said you became disabled, or SSA has determined thatyou were disabled for a specific period in the past but are no longerdisabled.
Unfavorable–means that SSA hasfound that you do not meet the requirements for disability benefits.
Last Revised: Jan. 22, 2008
What Does A Fully Favorable Partially Favorable Or Unfavorable Notice Of Decision Mean
Following your hearing, you will receive a Notice of Decision in the mail from the judge stating that a decision has been made on your claim.;
You’ve been eagerly awaiting the Social Security decision letter for a while, so you;open it up and right under your name and address you hopefully see: NOTICE OF DECISIONFULLY FAVORABLE.
You may also see: NOTICE OF DECISIONPARTIALLY FAVORABLE, or NOTICE OF DECISIONUNFAVORABLE,NOTICE OF DECISIONDISMISSED.
What does this actually mean? Are you going to get your social security disability benefits or not?
The letter is long and confusing. You want a short answer. Your decision will be one of the following:
Is There Anything I Can Do To Make Dealing With The Social Security Administration Easier
You shouldnt expect as many problems dealing with the Social Security Administration while receiving benefits as you had trying to get benefits in the first place. Sometimes, though, some people have problems. Here are some things you can do to try to minimize the hassle:
- Keep all decisions, letters, and notices you receive from SSA in a safe place.
- Read everything you get from the Social Security Administration. The booklets that come with award letters and notices are well written and informative.
- When reading the booklets you receive from the Social Security Administration, pay special attention to the kind of information you are required to report to the Social Security Administration. Report promptly and in writing and keep a copy with your Social Security papers.
- Dont necessarily believe everything they tell you at the Social Security Administration 800 number. If you have an important issue to take up with the Social Security Administration, sometimes it is better to go to your local Social Security Office.
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Fully Favorable Vs Partially Favorable Social Security Disability Decisions
A favorable decision, in the context of Social Security disability claims, is an approval of disability benefits. More specifically, the term “favorable decision” refers to an approval granted by an administrative law judge at a disability appeal hearing.
If you are approved for benefits, you will receive a hearing decision letter in which the ALJ who granted you the favorable ruling explains both the reasons for the ruling and the established date of onset , which determines the date from which you are owed disability benefits.
Not Listing All Of Your Disabilities
Often, a disabled individual will want to claim disability benefits for a disability. They will even become angry when Social Security asks about other conditions that they feel are unrelated to their claim. They might ask, Why is Social Security asking me about my depression when Im claiming disability due to my heart condition?.
When evaluating a disability claim, the SSA evaluates all conditions to determine if a person is disabled. Usually, the more medical conditions a person has, the more limitations they have. This helps their case since the majority of claims are won based on a combination of impairments.
Remember, the SSAs process is different from the VAs. They determine whether youre disabled or not, rather than awarding benefits for varying degrees of disability. So, you want to list all possible disabilities to support your claim.;
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Is There Any Risk To Appealing
If we appeal a Partially Favorable decision, we appeal the entire decision. With that comes the risk that the Appeals Council may find that you are not disabled at all. If so, they could deny the claim altogether. We would lose whatever benefits we had been awarded via the Partially Favorable decision.
Another thing to consider is that you will not receive benefits while your appeal is pending before the Appeals Council. Sometimes the sacrifice of some backpay is worth the ultimate outcome of getting the monthly benefit and assistance they so desperately need.
You may have questions about the process or what your decision means. Contact your representative, who can better explain the specifics of your situation and help you make the best decision for your case.
The Partially Favorable Ssdi Decision
In a partially favorable decision, you may receive benefits, but the judge sets the Established Onset Date later than the AOD you claimed on your application. This new EOD can actually be much later in some cases.
Another form of partially favorable decision comes when the judge rules that you were disabled at one point in time, but no longer are. You may be able to collect limited benefits, in this case, but only for the period during which you are legally ruled to have been disabled.
What Is The Established Date Of Onset
When a Social Security disability applicant receives a partially favorable decision instead of a fully favorable decision, the reason usually involves the established date of onset . EOD is a fancy term the SSA uses to refer to the date you became disabled. If you were diagnosed with seizure disorder on March 1, 2017, and the SSA accepts this diagnosis as valid when reviewing your disability claim, your EOD would be March 1, 2017.
Can I Appeal A Partially Favorable Decision
Yes, you can. Depending on how much retroactive pay you lose when an ALJ renders a partially favorable decision, you might want to consider appealing this decision to the Social Security Appeals Council. Always consult with an experienced disability attorney before filing an appeal to the Appeals Council.
The Social Security;Appeals Council;doesnt automatically accept all requests for appealing an ALJ decision. However, they will review your case and decide to take the case or send it back to an administrative law judge for additional review.
An example of the possible difference between a fully favorable decision and a partially favorable decision might go something like this:
- You submit your first application for SSDI to the Social Security Administration. You claim the onset date of your disability is May 1, 2018
- The SSA denies your application. You file an appeal to an ALJ.
- On May 1, 2020, the ALJ approves your SSDI application and gives you a;fully favorable decision
- You begin receiving monthly benefits plus receive retroactive pay dated from May 1, 2018
If your SSDI monthly benefits are $2000, then you should receive 24 months of retroactive pay. This amounts to $48,000.
Now, what happens if the ALJ hands down a partially favorable decision and determines your disability onset date is May 1, 2019 instead of May 1, 2018? What it means is that instead of receiving $48,000 in retroactive pay, you will only be entitled to half of that amount, or $24,000.
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What Is A Fully Favorable Social Security Disability Decision
For anyone who has become disabled and is therefore unable to work, the wait on approval for social security disability benefits can be difficult. Individuals in this situation are often living on very limited or no income due to their situation, so being approved for benefits can mean all the difference.
Following the Social Security Administration hearing, the judge will make a decision on the benefits application. If someone is approved, there are still several ways that the disability may be approved. The approval will either be a fully favorable social security disability decision or a partially favorable social security disability decision.
Im Approved For Disability Now What
After you have gone through the lengthy process of applying for Social Security Disability benefits, you might think that as soon as you are approved you will see a check in the mailbox. It could be great if it were that easy!
After the Social Security Administration makes their decision, they will issue and mail a letter. Your online account will also tell you the decision so its important to check that frequently. The letter will usually tell you the conditions you were approved for and how often you can expect medical reviews of your disability. The letter should also list your Established Onset Date. This is the date Social Security decided you became disabled. This date may or may not be the same date you think you became disabled. If the onset date they choose is the same onset date you asked for, this is called fully favorable. If it is a different date, this is called partially favorable.
In addition to the decision letter, you will also receive a letter informing you of your monthly award amount and if applicable, your back-pay amount. You can receive your payment via direct deposit if you have a bank account or onto a payment card which works like a debit card. You can usually expect your back pay and first monthly check to start 30-90 days after the award letter.
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What Is The Difference Between A Fully Favorable And A Partially Favorable Decision
The difference between a fully favorable and a partially favorable decision has to do with the start date of your disability, otherwise known as your disability onset date.
When you complete your disability benefits application, the SSA requires that you list the date that your disability began. The date you write down is the alleged onset date. If the hearing judge agrees that the alleged date is the date that your disability actually began, the judge will issue a fully favorable decision.
On the other hand, if the judge believes that you are disabled but disagrees with you about when your disability actually started, the judge will issue a partially favorable decision. So, for example, if you claimed that your illness became disabling on January 1, but the judge believes that your illness did not become severe enough to become disabling until May 1, the judge will issue a partially favorable decision. You will receive benefits after the waiting period has passed from the May 1 onset date, which would mean that the first month you would get back benefits would be October.
A judge may also issue you a partially favorable decision if s/he believes that you were disabled but that you have recovered and are no longer disabled. This is known as an approval for a closed period of benefits. When this happens, the SSA will pay you a one-time payment instead of ongoing monthly payments.
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Which Social Security Disability Benefits Can Veterans Receive
Veterans may be eligible for two types of Social Security benefits: Supplemental Security Income or Social Security Disability Insurance . The SSA expedites applications for veterans who became disabled during active military service on or after October 1, 2001, as well as veterans with 100% permanent and total disability status.;
The Social Security Administration doesnt take your VA approval into account when determining your eligibility for Social Security disability. While there was a time when a high VA rating helped your changes of SSA approval, the SSA changed this in 2017. The SSA will also not consider your discharge status or whether your disability is connected to military service.
Dont Get Complacent: Stay In Medical Treatment And Consider Work Activity Carefully
Many claimants limit or cease medical treatment.; This is a big mistake.; For many with an intractable medical problem, one for which many medical treatments and medications have not been successful, this is understandable.; But if you face a Continuing Disability Review, you are going to need the support of treating medical professionals.
Oftentimes social security will require a medical evaluation in a Continuing Disability Review.; Should that doctor who you see only once and is paid for by social security contend that you have improved and are able to return to work, you need an opposing opinion from your treating doctor.; Ceasing medical treatment after winning a disability case will leave you vulnerable to being taken off disability.
The second area of complacency is working while on social security disability.; At least 90% of the calls I get from claimants removed from disability involve work and a failure to understand the implications of work.
The bottom line: work activity and social security disability do not mix. Supplementing your social security disability with part-time work will come back to bite you every time!; Once on disability, there is only one reason to work: to test improvement in your health to see if you can in fact return to full-time work and get off disability.
How Far Back Will My Benefits Go
Your benefits should begin with the month of the date of entitlement in your case. Many people ask why benefits dont begin on the date they were found disabled. Social Security disability benefits never begin on the date one is found disabled because of the waiting period of five full calendar months. Another rule limits payment of back benefits to 12 months before the date of the application. Therefore, your benefits begin either 12 months before the date of application or;five full months after the date you were found to be disabled, whichever is later.
The Cover Sheet Of The Favorable Decision Says That The Appeals Council May Review The Decision On Its Own Motion What Does This Mean
In a very small number of cases the Appeals Council in Falls Church, Virginia, will decide on its own to take away benefits awarded by the decision of the administrative law judge. If it is going to do this, the Appeals Council will almost always send you a notice within 60 days of the date of the judges decision. This is rare, so it is unlikely that the Appeals Council will do this in your case; but if it happens you will have to work out with your attorney how to deal with it.
The Big Picture: What Is The Future Going To Look Like Fully Favorable Disability Decision Now What
When we get a Fully Favorable ALJ decision, clients often ask me: Does this mean that I am on disability now forever?. ; The answer is no, but you are on disability as long as you remain disabled under the Social Security Act and are unable to work.
For most people with a chronic health problem that is not likely to improve and indeed is likely to worsen this means they will remain on social security disability.
But, it is, unfortunately, true that whether you are in fact still disabled is a question that Social Security can examine and in some cases can conclude you are no longer disabled.
However, there is a very important difference between your fight to win disability and what the government must show to take your disability away.; When a claimant files for social security disability, the burden of proof is on the claimant to establish an inability to work.; The presumption is that you are able to work.; But once on disability, the claimant is no longer required to prove that they are disabled.
Now, for the government to take; the claimant off disability the government must prove 2 things:
- Your medical condition have improved;
- That improvement is sufficient to allow a return to substantial gainful activity .
If you are wondering what does a disability approval letter look like?, there is a screenshot of part of one of these letters at the top of this post.
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What Is The Biggest Difference
When the established onset date is later than the onset date , your benefits will be reduced in relation to the past due back payments or retroactive benefits that you may receive. In many cases, the difference between the EOD and the AOD can amount to thousands of dollars in lost back payments. A partially favorable decision may be appealed. There are some technical issues that you need to be aware of before you make the decision to appeal. Disability Support Services has proven experience in filing and appealing Social Security claims. If you have questions about the difference between a fully favorable and a partially favorable SSI or SSDI decision please call us. We will help our clients through every step of the process. It is our goal to help you get the award that you deserve.
What Will The Amount Of My Monthly Benefits Be
The amount of your first months benefits is shown in your Social Security file. However, the Social Security Administration may recalculate your benefit amount before it pays you. If the Social Security Administration recalculates, it may come up with a higher benefit amount because, for example, all of your earnings might not have been posted when the original calculation was made. Also, there are cost of living increases that are applied every December.