Thursday, October 23, 2008

Administrative Law Judge (ALJ) Decision - is it the end?

This question was recently asked online so I thought I'd address it. For all claimants who file for disability, there is typically a 30 percent chance of being approved at the disability application level. For the remaining seventy percent who are not approved for disability and who decide to file a request for reconsideration (the first appeal in the social security disability and SSI disability evaluation process), approximately 15 percent will be approved and 85 percent will bene denied. Of those individuals who decide to file the next appeal, roughly half will be approved at a disability hearing, an occurrence made more likely, of course, when representation is involved at the hearing level.

For most claimants who are denied at the first step in the process (the intial claim, or application), the hearing before an ALJ, or administrative law judge will represent their best possible chance of being approved. However, the fact remains that a large percentage of claims do get denied at hearings (making the need for thorough preparation for a hearing absolutely vital). So, the question becomes "Is the hearing the end?". Not at all. Here are possible courses of action for disability claimants who get denied at a disability hearing.

1. A claimant can file the next appeal, or have their attorney do this for them. Currently, the next appeal in the system is a request for review of the administrative law judge's decision. I say "currently" because, like the request for reconsideration, this appeal level frequently comes up for consideration of eliminiation. BTW, this particular appeal is commonly referred to as an appeals council review, since it is the appeals council in falls church, Virginia that actually reviews ALJ hearing decisions.

2. Appealing a judge's denial is always an option. However, if you are represented at a disability hearing and are denied by a judge, your attorney or non-attorney advocate may choose to advise you to send in an appeals council review request...or not. It will really depend on the merits of the case and the decision that was reached by the ALJ. What happens if you or your attorney decide not to send in an appeal to the appeals council? You can file a new claim and start all over again. Believe it or not, sometimes this is the recommended course of action. However, it is not an appetizing one since going through the entire system a second time may consume many months or perhaps three more years depending on where you live in the country (backlogs vary by state).

Can you file a new claim and also send in a request for review of the judge's decision? Yes, you can. And both will be worked on independently, which is why many representatives may recommend that their clients do exactly this. However, I should point out that you should typically only begin a new disability claim if your case has been denied by a judge---meaning that if you file a new claim while you are still waiting for a hearing to be scheduled, the new claim will not be processed but will simply be merged with the existing file at the hearing office. After all, why would social security bother to process a brand new disability claim when the outcome of the first claim is still undecided.

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