Receiving a denial of your Social Security Disability claim from an administrative law judge (ALJ) after a hearing can be disheartening. After the long process of gathering evidence, attending a hearing (or multiple hearings), and waiting for a decision, a denial can feel like a major setback.
You may be wondering, “Should I resubmit my claim or consider other options?”
The answer to this important question depends on several factors, and it’s crucial to understand your options before making your next move.
Understanding the ALJ’s Decision
Before deciding whether to (a) appeal the Judge’s decision or (b) refile a new initial application, it’s important to carefully review the ALJ’s decision. The denial letter usually contains a detailed explanation of why your claim was denied. Understanding the reasons for the denial is key to determining your next steps. Common reasons for denials include:
- Insufficient Medical Evidence: The judge may have determined that your medical records purportedly did not adequately support the severity of your condition.
- Non-Compliance with Treatment: If you didn’t follow prescribed treatments without a valid reason, the judge may have considered this in the denial.
- Ability to Perform Other Work: The judge may believe that you can still perform some type of work despite your impairments.
Understanding the reasons for the denial will help you make a more informed decision about how to proceed.
Did the ALJ Make a Legal Error in Issuing the Decision?
Perhaps most importantly, in order for an appeal of a denial to be successful, you must be able to demonstrate that the judge committed some sort of legal error in issuing the unfavorable decision.
A Social Security judge’s decision denying a disability claim can be overturned if there’s a “legal error,” meaning the judge failed to apply the law correctly in some way.
Here are some examples of legal errors that could arise in these cases:
1. Failure to Consider All Medical Evidence
- If the judge does not evaluate all the medical records or fails to consider important evidence that supports the disability claim, this can be a legal error. Ignoring or overlooking key evidence may violate the requirement to fully develop the record.
2. Improper Rejection of Treating Physician’s Opinion
- Social Security regulations require giving significant weight to the opinions of a claimant’s treating physicians if their opinions are well-supported and consistent with other evidence. If a judge rejects a treating physician’s opinion without a legitimate reason, this can be a legal error.
3. Ignoring Subjective Complaints Without Proper Analysis
- When assessing a claimant’s credibility regarding pain or other subjective complaints, the judge must provide a clear and reasonable explanation for disregarding these complaints. Failing to properly analyze or explain why the claimant’s subjective complaints are discounted could be considered a legal error.
4. Incorrect Application of Medical-Vocational Guidelines
5. Improper Step-By-Step Analysis in the Sequential Evaluation Process
- Social Security uses a five-step evaluation process to determine disability. If the judge skips steps or fails to analyze each step correctly, this is a procedural error that can be grounds for reversal.
6. Failure to Follow SSA Regulations or Rulings
- Social Security has specific regulations and rulings, such as SSRs (Social Security Rulings), that judges must follow. If a judge disregards or misinterprets these rules, it constitutes a legal error.
7. Failure to Provide Substantial Evidence for the Decision
- A judge’s decision must be based on “substantial evidence,” meaning there must be relevant and sufficient evidence that a reasonable person would accept to support the conclusion. If there’s a lack of substantial evidence to justify the decision, it can be overturned as a legal error.
8. Failure to Consider Combined Effect of Multiple Impairments
- If a claimant has multiple health conditions, the judge must consider the combined impact of all impairments on the claimant’s ability to work. Ignoring the cumulative effect of impairments can be a legal error.
9. Improper Use of Vocational Expert Testimony
- If the judge uses vocational expert (VE) testimony to determine whether the claimant can perform certain jobs, any error in phrasing hypothetical questions or disregarding significant limitations can be grounds for legal error.
10. Bias or Prejudgment by the Judge
- If there is evidence that the judge showed bias, hostility, or a prejudgment of the case, this is a violation of the claimant’s right to an impartial hearing and can constitute a legal error.
If a legal error is identified, the case may be appealed to the Social Security Appeals Council or federal court for review, with the possibility of the decision being reversed or remanded for a new hearing.
Understanding whether the Judge committed any legal errors in issuing the decision will help you make a more informed decision about how to proceed.
Should You Refile or Appeal?
Refiling a claim may seem like an easy option, but it’s not always the best way to go. Here’s why:
- Refiling Means Starting Over: When you refile, you start a new claim from scratch. That means you have to go through the entire application process again, which can take months. And unless your circumstances have changed significantly, the new application is likely to be denied for the same reasons as before.
- You May Lose Benefits for Past Months: If you reapply, you may lose the ability to collect benefits from the date of your original application. The Social Security Administration (SSA) only awards benefits starting from the date of the new application, which could result in the loss of months or even years of potential benefits.
- You Need to Be Aware of Your “Date Last Insured”: In a Social Security disability case, it is essential to confirm that your “date last insured” (DLI) has not expired. Your DLI is the last date you are covered under Social Security Disability Insurance (SSDI) based on your work history and the Social Security taxes you’ve paid. If your DLI has expired, you must demonstrate that your disability began before that date to be eligible for SSDI benefits. Failing to prove disability onset before the DLI can result in denial of benefits, regardless of your current condition. Therefore, make sure you know your DLI and have medical evidence documenting your disability from before that date. This information is critical when preparing your case, as it affects eligibility and the type of evidence needed to support your claim.
Instead of reapplying, many claimants choose to appeal the ALJ’s decision. The appeals process typically involves taking your case to the Appeals Council, which reviews the ALJ’s decision for errors. If the Appeals Council finds an error, it can reverse the decision or send the case back to the ALJ for further review.
When Should You Refile?
There are situations in which refiling may be appropriate. For example:
- New Medical Evidence: If you have obtained new, compelling medical evidence that wasn’t available at your original hearing, refiling may be an option. This new evidence could significantly strengthen your case.
- Worsening of Your Condition: If your condition has worsened since your hearing, and you now meet a listing in the SSA’s Blue Book or have new impairments, refiling may be worth considering.
- Age Change: Ages 50 and 55 are critical milestones where approval rates often increase. If you were denied disability benefits just before reaching one of these key ages, refiling may be a wise strategy.
- Time Passed Since Denial: If it has been a long time since your denial and you are outside the appeal window, refiling may be your only option.
The Importance of Legal Advice
Navigating the Social Security Disability process can be incredibly challenging, especially after a denial. Whether you choose to refile or appeal, having experienced legal representation can make a significant difference. An attorney can help you understand the nuances of your denial, gather the necessary evidence, and present a stronger case in your appeal or new application.
If you’ve been denied Social Security Disability benefits and are unsure of your next steps, consider contacting a qualified disability attorney like Nick Ortiz of the Ortiz Law Firm. We can provide guidance tailored to your specific situation and help you make the best decision moving forward.
Remember, a denial doesn’t have to be the end of your claim. With the right approach and support, you can still achieve a successful outcome and secure the benefits you deserve. Call us at (888) 321-8131 to schedule your free case evaluation.