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Case Study on a Social Security Disability Claim. How Final is the Judge's Decision
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Case Study on Social Security Disability Benefits: How Final is a Favorable Decision by an Administrative Law Judge?
It’s not often that a Social Security claim gets as confusing as the case of client X. Of course long delays and lengthy appeals are to be expected. For what it’s worth, SSA has been apologetic and very proactive with various initiatives to reduce the backlog of disability claims.
Mr. X has had a claim in the system since 2005. He has seen many years of destitution while fighting for benefits. He suffered onset of a severe back injury in 2001. He tried to continue his usual occupation until he could no longer endure a full day’s work. He filed appeals after each denial of benefits he received. He filed a Request for Hearing before an Administrative Law Judge in 2006. He waited and waited to receive a notice of a hearing. He became concerned and wrote to his local congressman. The congressman’s office sent a letter to the hearing office on Mr. X’s behalf. Perhaps the letter had an effect since he received a notice of hearing a mere 2 years since he filed his request.
We have all heard stories of these delays and we understand that it is a situation born out of the significant number of claims filed yearly. It is expected that 3.3 million disability claim will be filed this year. Mr. X made it to his hearing. He weathered the storm of poverty and was granted his opportunity to present his case before a Federal Administrative Law Judge.
The hearing went well, according to Mr. X, who explained that at the end of the hearing the judge told him not to worry, he would be approved. Shortly after the hearing, about a month or so, Mr. X received a Notice of Fully Favorable Decision finding him disabled as of 2001. The decision indicated that the judge was going to reopen Mr. X’s prior application for benefits to insure he would receive his full retroactive benefits.
It seemed that the worst was behind him and there was finally a light at the end of the tunnel.
He waited a couple of months for his benefits to commence but to no avail. He thought his patience paid off when he received another letter from the hearing office. Could this be word of his anticipated benefits?
When Mr. X read the letter he felt as if he was coming out of a dream. A pleasant dream where his claim for disability benefits was approved by a nice judge he appeared before. The letter was another notice signed by the Administrative Law Judge entitled, Notice of Denial – Unfavorable Decision. Was it all a dream?
He frantically looked through all his paperwork, accumulated from 4 years of pursuing his benefits to find the first notice. Perhaps he was crazy he thought. When he finally saw the envelope worn from months of being shuffled around, he trembled as he opened it. The words “Fully Favorable Decision” stood out boldly. He had mixed feelings. He wasn’t crazy, but he was still destitute. He had no idea what could have transpired. The decisions espoused completely opposing conclusions boasting the truth of the each decision based on the same medical documentation.
He made every effort to find out what to do next. He sought legal assistance. The attorney was stifled by the hearing office at every effort to right the wrong. Clearly, the judge cannot issue a fully favorable decision and follow it with an unfavorable decision without giving Mr. X the right to address the evidence that was now being used against him. That’s unconstitutional at best and unconscionable after verbally expressing the favorable decision at the hearing. After all, Mr. X remarked, wouldn’t any reasonable person give pause before signing a decision denying benefits after already signing a decision that granted benefits?
The answer provided the attorney was that a subsequent hearing was held which the claimant refused to attend. Where was the notice of hearing? Where was the recording of the hearing? There was no evidence of a second hearing. Mr. X wanted action. He was disgusted by their attempt to excuse this miscarriage of justice.
When a claimant is dissatisfied with the decision of an Administrative Law Judge, the proper step to take is filing a Request for Review of the Hearing Decision by the Appeals Council. Being left no other recourse, Mr. X filed a request for review by the Appeals Council. After another year, Mr. X received a decision. It wasn’t as clear as the decisions from the judge, stating yea or nay. It was entitled, Notice of Remand Order.
It contained pages and pages of the procedural history of his case. It raised questions about the procedure that would result in two opposing decision based on the same information. It contained a lot of remarks about the credibility of Mr. X. It mentioned Mr. X’s work attempts and rose questioned about Mr. X’s work history and skill level. It contained everything but a conclusion that he deserved benefits. It did instruct the judge to make a new decision. The problem that faced Mr. X was his total frustration at the process that had now dragged on for 5 years.
He has been given the opportunity for another hearing. He remembers how long he waited for his first hearing. He is consumed with the lack of funds to survive. He was told that his case would be schedule in 3 or 4 months. This is unacceptable. He called upon an advocate he read about online. The legal sources involved with the case in the past were tired of Mr. X’s attitude. He needed to get a handle on the legalese contained in the notice from the Appeals Council. His life depends on the success of his claim.
The advocate obtained copies of both decisions. He obtained the Remand Order. Mr. X demanded a proactive strategy for his new representative. There is no time to wait for a hearing. The advocate decided that the best strategy was to prepare a brief for submission to the Administrative Law Judge. With a Remand Order on file, the ALJ has a responsibility to comply with the Appeals Council’s orders. The brief had to contain everything the Appeals Council tasked the judge to obtain.
With the use of modern technology such as email and faxes, records were obtained from MR. X’s previous employer, his current and past physicians. The judge was sent the brief and attachments including supportive reports from his doctor. The cover letter expressed the critical nature of the situation.
Mr. X required follow-up calls to the hearing office. The brief was mailed to the judge by priority mail with confirmation. A call was placed to the judge’s clerk to provide alert about the crucial documentation that was in the mail. The follow-up calls lead to a brief scare. The priority mail was signed in to the hearing office but even with a “heads up” somehow it was misplaced.
The clerks did not seem worried. There was months before the hearing would be held. This is unacceptable to Mr. X. The letter that was with the brief explained the critical nature of the situation. Mr. X was requesting that the judge review the brief and attachments and make a fully favorable decision an on-the-record . Mr. X needs relief and waiting a week is too much.
The hearing office called the advocate the next day and told him that the file was on the judge’s desk. Assurances were made that the priority mail with the brief and the reports were located and before the judge as of this morning.
Can he rest assured? The decision is up to the judge. The advocate does not doubt the ultimate outcome and he tells Mr. X to attempt to keep his spirits up. So now he waits. Once again, he waits to get word from the judge. The worst he can hear is that the judge will not render a favorable decision without a hearing. That will mean more waiting. It will mean he will have to endure another hearing discussing his failing health and his inability to perform daily activities. It will mean living destitute for awhile longer. It means he will again have to wait for the mail and open another envelope breathlessly hoping for good news. It means that when he is granted benefits, he will have to wait to receive his benefits.
What he needs to hear is that it’s over. Wake up, Mr. X. It must have been a dream. You had a hearing and the judge sent you a favorable decision. It must have been a nightmare. What kind of world would it be if terrible things that that happened?
We know he won’t be told that it was a nightmare. He did attend a hearing where he was told he was approved for benefits. He did receive a favorable decision, heralding the receipt of back benefits that would change his life. That decision was rescinded and now he must wait some more.
Will the judge decide that Mr.X should receive benefits without a hearing? Time will tell. It will certainly be interesting to hear what the judge will have to say to the Mr. X at the hearing, if he insists on holding one.
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