May 20, 2016

Anatomy of a Social Security Hearing Decision Part I: How do I know if I won?

If you have a Social Security disability hearing in front of an Administrative Law Judge (ALJ), you probably will leave the hearing without knowing whether you won or not.  Most claimants have to wait between thirty and ninety days to receive the ALJ’s decision in the mail.  (Sometimes it can take even longer if the judge needs to get additional information.)

When you receive your decision and look it over, you still might have trouble telling whether you won or not!  The decisions have a lot of information in them, and it can be hard at first glance to figure out what’s important.  The first page of your decision will look something like this:

Decision page 1

 

 

The first clue you have about the outcome of your case is the title at the top.  There are four possibilities:

Notice of Decision – Fully Favorable:  Congratulations!  You won!  A “fully favorable” decision means that the ALJ found that you became disabled as of your alleged onset date and continue to be disabled.  An ALJ also issues a favorable decision when the claimant agrees at the hearing to change his or her alleged onset date or to accept a closed period of disability.

Notice of Decision – Partially Favorable:  This decision is typically mostly good news, but not always.  In short, a partially favorable decision is one in which the judge found that you are (or were) disabled for some of the time since your alleged onset date, but not for all of that time.  If you received a “partially favorable” decision, it could mean one of two things:

  • The judge gave you a closed period of disability.  In other words, the ALJ found that you became disabled as of your alleged onset date (or at a point later in time) but also found that your condition later improved to the point that you became able to work.  Most likely, you will be eligible for the benefits you were supposed to receive during that closed period, but you will not be eligible for continuing disability payments.
  • The judge amended your onset date.  In other words, the judge found that you are presently disabled, but he or she found that your disability was not severe enough to meet Social Security’s requirements until a date later than your alleged onset date.  Most likely, you will be eligible for continuing disability payments, but you will not receive as much back pay as if the judge had found you disabled as of your alleged onset date.

Notice of Decision: Unfavorable: This decision is bad news.  It means that the ALJ found that you do not meet Social Security’s medical requirements to receive disability benefits.

Notice of Dismissal: This decision means that the ALJ dismissed your request for a hearing without deciding whether you are disabled or not.  Typically, a request for a hearing is dismissed for one of the following reasons:

  • You failed to show up for your hearing and didn’t give a good reason for missing it.
  • You asked the judge to dismiss your claim because you no longer wished to pursue it.
  • You did not file your request for a hearing on time and didn’t give a good reason for filing it late.

 

There are two things to keep in mind as you read the first pages of the decision.

  • Your notice of decision is, to some extent, a form letter.  Therefore, every decision has the section that says, “If You Disagree With My Decision.”  I often receive phone calls from clients who have received fully favorable decisions, but they are confused because the notice tells them what to do if they want to appeal.
  • The ALJ only has the authority to find that you meet the medical guidelines for disability.  As the first paragraph of the decision tells you, another part of Social Security will review the “non-disability” requirements; that is, whether you still have enough work credits to receive Social Security Disability Insurance (SSDI) or whether you continue to meet the financial cutoffs for Supplemental Security Income (SSI).  In the vast majority of cases, your eligibility for SSDI will have already been determined when you applied; there should not be any reason that it would change.  However, if you have applied for SSI and your household income has increased dramatically since your application, it may affect your continued eligibility for SSI benefits.  Your local office will be responsible to determine how your income and resources affect the amount of your monthly benefit.

Even after your hearing is over, your attorney or representative is an excellent source of information.  I always encourage my clients to call me if they have any questions regarding their decision.

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