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Sometimes It is Not Enough to Prove I...

Social-Security-Disability-Forum » Sometimes It is Not Enough to Prove It, You Must Appeal It.  

If you're unhappy with the Social Security administration's response to a claim for benefits, the administrative review process could help you. All requests for review must be submitted in writing, and time limits may apply; you usually have 60 days to appeal at each step. First you should request that the initial determination be reconsidered. You can then submit new information and evidence for your claim. This will take another 4 to 6 months, and generally results in a second denial.

If you are denied again, you can ask for a hearing before an administrative law judge at the office of hearings and appeals. It takes about 7 months more to get to a hearing in South Carolina right now. This is where most claimants hope to win their case. Because of the difficulties you face if you lose at this point, it is crucial that you present the best case you possibly can.

If you lose before the administrative law judge, you are in a lot of trouble. The next appeal step is to the Appeals Council in Washington. Presently this is taking more than a year in most cases. The overall success statistics are low; and many firms do not handle appeals beyond the hearing level. However, with aggressive case development to specifically refute the findings of the judge, a case can be won at this level. It is about impossible to win at this level without an attorney.

If you lose at the Appeals Council level you can file a civil action in a federal district court. This absolutely requires an attorney.

One thing you should be careful about is a rule called "res judicata." This is a complicated subject, but the bottom line is that once you go a certain distance in the process and lose - generally to the hearing - if you do not appeal, it becomes more difficult, and sometimes impossible, to win a claim later. The moral is that you should be careful about filing a claim unless you are serious about it. This is a somewhat more serious problem in the Fourth Judicial Circuit - the Carolinas, the Virginias, and Maryland - than it is in some other areas. On the other hand, do not wait to file a claim if you are truly disabled. You can lose eligibility if you wait too long. If you need help with an application and live in South or North Carolina, please call us at 1-800-775-3985 or click here to e-mail us.

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cherylanderson (Unregistered Guest)
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Posted on Monday, April 25, 2005 - 2:00 am:   Edit Post Delete Post View Post/Check IP    Move Post (Moderator/Admin Only) Ban Poster IP (Moderator/Admin only)

I'm 35 yr old from Ia.I had ruptured discs in my lower back. 1 surgery on it. Also diagnosed with depression, dissociative disorder, ptsd and add.I been thru many jobs-lost them due to my mental health problems. I worked in security and law enforcement. Filed ssdi in 2001. Judge spent more time trying to figure out how to exclude evidence than actually evaluate it at hearing. Excluded testimony of the vocational expert witness that soc sec provided (not provided by my atty). She testifies that I can not work. Judge ignores all of that testimony and excludes it and also tosses out all of my mental health evidence-says I can go back to work. I have no income but I do not qualify for any public assistance of any kind because I have an IRA. The system would have me blow all of the money in my IRA now. So now I am forced to decide weather to spend my IRA now for real needs like food, rent and health expenses or not spend the IRA plan ahead & be punished in the present.
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cherylanderson (Unregistered Guest)
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Posted on Monday, April 25, 2005 - 2:06 am:   Edit Post Delete Post View Post/Check IP    Move Post (Moderator/Admin Only) Ban Poster IP (Moderator/Admin only)

Oh yeah soc sec also combined my file with a person with the same name into one person. When my atty first saw my file it was a huge mess. At least 6 months to a year wasted on this alone. God forbid social secutity use soc sec numbers to sort files out.
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cherylanderson (Unregistered Guest)
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Posted on Monday, April 25, 2005 - 2:24 am:   Edit Post Delete Post View Post/Check IP    Move Post (Moderator/Admin Only) Ban Poster IP (Moderator/Admin only)

Oh yeah I was also in voc rehab but they kicked me out. We could not identify a job that I would be able to do considering my education, work experience and physical and mental conditions. I told them the expert witness said I could not work. Frankly they were stunned when my claim was denied. I was too. How can a judge just ignore expert testimony, refuse to state any of the testimony and throw it all out?
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Paul McChesney (Admin)
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Posted on Monday, April 25, 2005 - 5:41 am:   Edit Post Delete Post View Post/Check IP    Move Post (Moderator/Admin Only) Ban Poster IP (Moderator/Admin only)

I am sure you have serious problems. You do not give me the limitations from your conditions, nor set out what each of the doctors said, so I would be guessing to say what your chances would be on appeal from such a decision. But if you cannot work you must appeal, or file a new claim, or both, depending on the detailed facts of your case.

But your story does help me make this comment, about the ALJ's who make the decision on the third round, the one at which most people without overwhelming disability hope to win their case:

The good things about the hearing system is that the ALJ is somewhat independent, and can make a decision based on what he or she thinks is right, provided it is supported by some evidence; and the ALJ's are selected based on testing of their knowledge of the law.

The testing selection process means that, as far as their attitudes toward other people, and their philosophy of life, they are selected more or less at random.

So, if you wonder about what 100 different ALJ's might think about your condition, you could imagine what 100 random people you know think about your condition. Most would be sympathetic, and a few would not.

If you draw an ALJ with the latter attitude, you are in trouble, even if you are disabled.

The cure for that problem is almost as bad as the disease: You can appeal the ALJ decision, first to the Appeals Council, who sends back about 25% of the cases appealed to it, and then to the Federal District Courts, where your chances vary widely depending on the exact facts of your case and the content of the ALJ's decision.

District Court judges are chosen by the President and confirmed by the Senate. Clinton appointed few judges, and so the general drift of the District Courts over the last few years has been more conservative in all ways. And there are a fair number of people floating around who are drawing benefits and shouldn't be, and the judges know that, and it makes them slower to act. So it has become more difficult to win cases before the District Courts.

The great virtue of the District Courts, though, is that the judges are appointed for life and cannot be removed except for committing crimes, and are therefore free to do what they think is right. This often, but not always, gives you a fair chance before the District Court; and the possibility of an appeal means that hostile ALJ's are somewhat constrained.

One problem is that this appeal takes a long time: in 2005, about 9 months to the Appeals Council, and a trip to the District Court can add more than a year, on top of the already catastrophically long delay to the hearing. Anyone who does not have long term disability insurance or a spouse with a substantial income will undergo profound life changes while they wait for their new hearing, often in front of the same, but chastened, ALJ.

Another is that many lawyers handle cases only at the hearing level, and are not familiar with appeals beyond that level.

Several suggestions:

Try to remember not to despair or give up. It is possible to win after a hearing denial.

Be sure your lawyer handles a lot of appeals, or associates another lawyer who does.

If you are reading this and are thinking of hiring a lawyer, be sure to consider hiring one who is prepared to handle an appeal to the District Court if necessary. One of the first things I remember George Thomason telling me many years ago is to prepare every case as if the ALJ will be hostile and you are going to have to win it at the District Court. That is good advice. In order to do it, you need to know how to win at the District Court.

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This site is maintained by Paul McChesney, an attorney who has been practicing disability law for around 25 years in North and South Carolina.

If the subject of disability is important to you, or if you want to find out more about us, you should explore the rest of this site. To do so, go to our homepage, Carolina-disability.com.

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