ALJ Hearing Decision

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
  • Unfavorable.

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.

The Dismissal

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.

Unfavorable Decision

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.

 

5 Comments
2002/2004 is when I became disable, I signed up on s.s disabilty in 2014, I just went in April to talk with ALJ. It's now July . I seen a couple red flags that my lawyer did.. One was he said s.s would go back to 2003 on payments if I win even got a letter. Next was in his office the one I talked to was the one going to court with me but yet a different person was their. Then he jumps to if I win I would get paid back to 2016. In his office I was not told he didnt have my hospital records, I was not aware until after we talked to the judge. Not only do I have this medical problem but several mental health problems..My case is now in written dission so I'll wait and if needed go back to court again because of a lawyer who wasn't no help at all.
by Scooby July 17, 2018 at 01:06 PM
Hi I wrote that first post under a character off of Dukes of Hazzard but I wanted to give an update, I called Falls Church Odar Tuesday the 10th of July 2018. And was told that my claim was being written by a decision writer, and as the 18th of the month it will be 6 months from the date of the hearing, I know that Falls Church is very backlogged but come on! I can't imagine what could have taken this long, I've considered that it might be interrogatories from ALJ to ME or MC, but my atty or myself have not been notified which it is a rule that ALJ's have to proffer any post hearing interrogatories unless he is going to issue a fully favorable decision, this is what I hope but the 6 months scares me, I've been struggling for 3 years and 10 months now, I will update what the decision was and why, good luck to anyone who is going through this process.
by John Doe Knows July 13, 2018 at 11:11 PM
I am not proud to say this but I have done most of my adult life in prison , the last bid being 80 months , and after I was released I found myself not being able to adjust back into society , I became paranoid and afraid to leave my home , after 4 months I decided to file for ssi disability and unfortunately the mental health center was no longer in operation and I could not find out what happened to my records where I sought help in preteen and teenager years for alcoholism at age 15 and 16 and not sure if I was diagnosed with anything else , but something was bad wrong with me , so with no proof of prior MH problems I was sent to a psych that worked for the ssa and I also added physical problems on my application and had started seeing a primary care provider in first month out of prison , well you guessed it ! I was denied after going to their psych , their MD, their X-ray technician and my primary Dr, I was turned down , so I hired an experienced attorney for reconsideration to only be denied again , so after many more months and getting therapy from coastal horizons and medication for both mental and physical ailments at my primary care Dr, I finally got my turn to see an ALJ judge , and the hearing went well, the VE said i couldn't do any jobs but the ALJ left the case open because my primary care records were delayed 2 weeks but contained a list of all my meds , PA and Dr's notes , my diagnosis uncontrolled high blood pressure avg of 145/95 each visit (every month) hypothyroid disease , degenerative discs in lower back , PTSD , agoraphobia, anti-social personality disorder , stress related anxiety panic disorder , ADHD, sounds like a no brainier huh ? Oh and I'm age 51 , with a GED from 1986 and last worked as a house painter in 1995 , my hearing was 3 months ago for just SSI , check my ssa account online everyday but keep getting same BS message , your hearing was held , the ALJ judge is reviewing your claim and developing for further information , a representative may contact you if further information is needed, then below that my local social security office with address and zip code , well if my claim is with the judge then why is my local office listed ? The judge is located in Falls Church VA and my local office is in Wilmington NC and 90 days and the judge is still reviewing my claim ? What's wrong with this picture ? I feel like biting a nail in two , so stressed and aggravated, been fighting for benefits since 01/06/2015. My brother's girlfriend is 21 yrs old and got approved on her first application for $1,350 per month and only thing wrong with her is she is too damn lazy to even pick up behind herself , but she has a drivers license , drives a car daily , and lives alone and blows her money every month on renting movies , ordering pizza , buying video games and smoking pot , once again what's wrong with this picture ? Oh forgot to mention she gets $ 192 in EBT benefits and Medicaid , I am determined to fight till the bitter end and after I get approved I am going to try and help everyone I can get their claim approved if I feel they were unjustly denied , and I hope more and more people will join together and help people with useful information and links to learn about the appeals process and most of all show them they are not alone !
by Roscoe P. Coletrane April 14, 2018 at 12:25 PM
I have a problem. My son had a hearing with an ALJ back in April 2017. In October 2017 he received a denial letter from the ALJ. We have a disability lawyer who has sent his claim to the appeals council in November 2017. One of the issues during the hearing was my son's vision. We had medical evidence from an eye specialist that my son was considered legally blind due to his visual field & acuity, but the ALJ denied him disability. My son had his yearly eye exam done on March 2, 2018 which has again been confirmed that he is considered legally blind or statutory blindness. Which this evidence was sent by our lawyer to the appeals council to verify that my son meets 4 "listings" 2.02, 2.03, 2.04 & 2.07 (I think it's called) for legal blindness per Social Security rules. I know it's a 1-3% chance that the appeals council will overturn the ALJ's decision, but can that happen especially when they read over all the medical evidence that the ALJ didn't address about my sons vision? Also, can claimants with visual impairments and/or legal blindness receive more in disability benefits? Thanks
by Michele April 6, 2018 at 09:24 PM
I've been denied by an ALJ. The AC wouldn't even consider looking at the file, even though the ALJ made mistakes. It's all a crap shoot. Now I'm waiting for my second ALJ to give me a decision. They have a reputation of taking 5 months or more and approves only 18%..with only half of that getting fully favorable. They should be dethroned. But FIRST, my reconsideration by SSA, wasn't even LOOKED at! I got a denial the same day I appealed!! My first ALJ approved only 13%. My second one only 18%. Other ALJs in my location approve 40% and up. Twice I got the lowest they have. And I have lots of medical files proving severe DDD, RA, AFib, Renal disease, and much more including BP, Personality disorder, major depression, ADD! But I still get denied... and as much as you all hate when we say this....I've seen people claim pain and then go out dancing or Zumba...and they get approved. Crap shoot.
by none February 21, 2018 at 07:47 PM
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