The ALJ’s Hearing Decision: Fully Favorable, Partially Favorable or Unfavorable
Once your hearing is completed the Administrative Law Judge (“ALJ”) will issue a written decision. The length of time it will take to issue the decision depends on the individual Judge. In the Pensacola, Fl / Mobile, AL area, the time varies from just a couple weeks to over six months.
The Judge’s decision will be one of the following:
- Fully Favorable;
- Partially Favorable;
- Dismissed; or
Below we will discuss each of these outcomes, and your appeal options for each.
The ALJ Hearing Decision is Not The End of The Line
The first thing you should know is that a denial of your claim by the ALJ does not mean that your claim is forever over. The ALJ hearing stage is not the end of the application process. The next stage of appeal after an ALJ hearing is to file an appeal with the appeals council. An unfavorable ALJ decision can be appealed by you or your lawyer, or even by own motion of the appeals council itself.
Each claim is unique. Whether to appeal to the appeals council is a decision that should be weighed depending on what your individual decision says and how the ALJ decided the claim. The mere fact that the Judge was wrong in his or her decision is not enough for an appeal. You must show that the Judge made a legal error in issuing the decision. (i.e., that the decision was without substantial justification.”).
Fully Favorable Decision
First we will address the “Fully Favorable” decision. This is the title of the decision you want to see when you open your decision letter. As the title says, it means the decision is fully in your favor and judge has ruled to give you everything you asked for. In a typical Social Security Disability Insurance (“SSDI”) or SSI claim it means that the judge has found you disabled as of the onset date you put in your application and discussed at the hearing.
Note: Obtaining a Fully Favorable ALJ Hearing Decision does not necessarily mean you will receive back-due benefits for every month going back to the onset date the ALJ found you disabled. That’s because in a Social Security Disability case you can only get paid up to one year prior to the date when you actually filed your application for benefits.
For example, if you applied in January 2012 and were found disabled as of January 2010, the farthest back Social Security will pay you monthly benefits is to January 2011 – even if the ALJ found you disabled as of an earlier date than January 2012. Moreover, in SSDI cases they also do not pay you for the first 6 months of disability (this is sometimes called “the waiting period”).
In an SSI claim, you cannot receive any past due benefits for any month prior to the date you actually applied for SSI. However, there is no 6 month waiting period as in an SSDI claim. So, for example, if you applied for SSI in January 2012 and were found disabled as of January 2010 in your SSI claim, your back due benefits would only begin as of January 2012.
Another Note: There are some other situations where you may be able to qualify for benefits further than one year prior to your SSDI application. For example, if you had a prior claim and you are successful in asking the Judge to re-open the prior claim, that can give you an earlier payment period and more back due benefits. This is rare and beyond the discussion of this page, but it can be done.
You should also know even if you do not appeal the favorable decision (and in most cases you will find that you most likely will not want to), the Appeals Council can review the decision on its own motion. This is very rare, so you shouldn’t be too concerned about it, but you should take immediate action on the Appeals Council decision if it does happen to you.
Partially Favorable Decision
The “next best” type of decision you may receive from an ALJ is a “Partially Favorable” decision. This usually means that the ALJ found you disabled, but not going back to the date you alleged you became disabled in your application for benefits. You should closely read the decision to determine why the Judge did not go all the way back to your “alleged onset date.” In most cases this means that you will lose some past due benefits you may be entitled to. However, in some cases you may not lose any back due benefits and it may not be worth appealing the decision.
If the partially favorable decision finds you disabled after your “Date Last Insured” (DLI) this can directly affect the type of benefits and health insurance you will receive. If you are found disabled after your DLI, you will only be eligible for SSI benefits and not SSDI benefits. This could make a big difference in the amount of money you receive every month, and whether you will receive Medicare health insurance as compared to Medicaid.
Of course, a Partially Favorable decision could simply indicate the evidence was only strong enough to win your claim as of a date later than the one you put in your application. in an SSDI claim, as long as you are found disabled on or before your DLI, you would still be eligible for disability insurance benefits – you just may receive less past due benefits.
You should always consider having a lawyer look at the decision to help you determine whether you should appeal this type of case. And, as described above, there is always a slight possibility the appeals council could review the claim on its own motion and decide you were not entitled to disability at all or send it back for a review of the whole issue all over again.
Another type of decision you may receive is a dismissal of your claim. There can be many reasons for this. The most common is when did not show up for a hearing and you were unable to show good cause for not appearing. You may also have your case dismissed if the ALJ decides that your Request for Hearing was not filed on time, or if the claim has already previously been decided on the same issues with the same facts. You can appeal dismissals to the Appeals Council.
An Unfavorable Decision is the one you don’t want to see when you open your decision letter. However, do not lose all hope. The ALJ Hearing is not the end of the disability review process. You do have the right to appeal the decision to Appeals Council. You should seriously consider hiring a lawyer to help you with your appeal because it takes a careful eye and detailed understanding of the regulations to get unfavorable decisions reversed or remanded (sent back to the Judge for a new hearing with specific instructions from the Appeals Council to the ALJ on what the Judge is to consider).
The Appeals Council will review cases where: there is evidence of an abuse of discretion by the ALJ; there is an error in the law cited; the actions, findings or conclusions of the ALJ are not supported by substantial evidence; or there is a broad-based policy procedural issue that may affect the general public interest. In some cases, the best course of action is to just file a new claim. In others, it is worth pursuing an appeal. Again, you should discuss these options with an attorney to determine the best course of action in your particular case.