Are you thinking about filing a Social Security disability appeal after receiving a partially favorable decision in your Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) claim? Read this article first so that you understand the risks of requesting review by the Appeals Council.
Appealing a Partially Favorable Decision in Your Social Security Disability Claim
You will receive a written decision from the administrative law judge (ALJ) anywhere from two weeks to five months after your Social Security disability hearing. The decision will either be: fully favorable, partially favorable, or unfavorable.
If the decision is fully favorable, then great! You’ve won your claim.
If the decision is unfavorable then you should usually request Appeals Council review. Make sure that you file your request for review by the Appeals Council within the applicable deadline.
If your decision is partially favorable then you have a difficult decision to make.
Benefits of Appealing a Partially Favorable SSD Decision
There are two reasons to appeal a partially favorable SSDI or SSI decision: to receive additional back pay and to receive medical coverage soon than you otherwise would. SSDI beneficiaries become eligible for Medicare eventually, whereas SSI beneficiaries will become eligible for Medicaid coverage.
Risks of Appealing a Partially Favorable SSD Decision
The Social Security Administration (SSA) takes the view that if the Appeals Council grants review of your case then your entire case is open to review. This means that the Appeals Council has the power to reverse the ALJ’s decision finding you disabled and to find that you do not meet the SSA’s definition of disability.
Though circuit courts in other parts of the country have weighed in on whether the Appeals Council can expand its review to your entire case and not the onset date of disability, courts in Virginia have not. For example courts in the 3rd and 11th circuits have found that the Appeals Council must give notice to the claimant if it is going to expand review to issues not raised by the claimant in his or her request for review. By contrast, the 6th and 7th circuits have found that the Appeals Council does not need to give notice of its intent to expand review. Virginia is in the 4th circuit.
Deciding Whether to Appeal a Partially Favorable SSD Decision
As a Richmond SSD lawyer and Virginia Beach disability attorney, I’ve advised hundreds of disabled adults who are trying to decide whether to appeal a partially favorable decision from the ALJ. In these cases it is important to analyze both the strengths and weaknesses of the case, and to calculate the potential value of additional past due benefits that will be paid if you win your onset appeal. If your case is a close call, or if the ALJ awarded more than 18 months of past due benefits, then it may not make sense to file an onset appeal.
Make sure you ask your attorney to explain the risk of losing all your benefits by appealing a partially favorable disability decision. Though the risk of this happening is low, it is still there. And unless you may receive a significant amount of additional past due benefits then it is probably not worth taking even a small risk. If the Appeals Council reverses the ALJ’s decision and takes away your benefits, you may have to go a year or more without receiving any disability payments. And you may even lose in federal court, in which case you’ll receive nothing.
If you have any questions about this, or other legal issues that arise in Social Security claims, call, text, or email Corey Pollard for a free consultation. We help disabled adults and children throughout Virginia.