My claim has been denied by an Administrative Law Judge: What are My Options?

January 6, 2015

If your claim has been denied by an Administrative Law Judge (ALJ), you now face a very tough decision: appealing the ALJ’s decision, or filing a new claim. If you have not yet hired a lawyer to represent you, it is unquestionably in your best interest to do so now.

In this post, we will explain the important factors to consider when you’re in this difficult situation, and why you need the experience of a local Chicago Social Security Disability law firm to represent you.

The reality is that while many previously denied claims are approved by an Administrative Law Judge, and that an experienced Illinois Disability Law Firm can make a difference between winning and losing, some well-deserved claims are yet again unfairly denied. Thankfully, the process doesn’t end at this point.

An appeal of an ALJ denial is called a “Request for Review,” and a separate entity of Social Security called the “Appeals Council” receives the request and makes a decision. This is the third stage of the Social Security Disability system’s appeals process, and the process is very different from the other levels of the appeal.

It’s first important to understand the purpose of the appeal—it is not just to determine the merits of your disability claim. This means that the Appeals Council’s job is not to conduct another hearing, review the evidence, and make a decision based on the same; rather, the Appeals Council’s role is to determine if the ALJ who denied the claim made an error of law. While there is no way to predict exactly how long it will take for the Appeals Council to make a decision, it currently takes about an average of one year.

In the past, Social Security allowed a person to file a new claim while waiting for the Appeals Council to make a decision. In late 2011, Social Security changed its rules, and now requires a claimant to choose between filing a new claim and filing an appeal.

The Appeals Council does not grant all requests for review. Social Security law provides that the Appeals Council will review a case if:

  1. There appears to be an abuse of discretion by the ALJ; (2) There is an error of law; (3) The action, findings or conclusions of the ALJ are not supported by substantial evidence; or (4) There is a broad policy or procedural issue that may affect the general public interest; (b) If new and material evidence is submitted, the Appeals Council shall consider the additional evidence only where it relates to the period on or before the date of the administrative law judge hearing decision. The Appeals Council shall evaluate the entire record including the new and material evidence submitted if it relates to the period on or before the date of the administrative law judge hearing decision. It will then review the case if it finds that the administrative law judge’s action, findings, or conclusion is contrary to the weight of the evidence currently of record.

(20 CFR § 404.970, (a) (b)).

As you might expect, there are a myriad of examples and applications of this law.

So, how do you make the difficult choice between continuing to fight your current claim, and filing a new claim? Is it ever advisable to give up the back pay at stake on your current claim, and to start over with a new claim? This depends on many factors, including your medical evidence, the written decision of the ALJ who decided your claim, your testimony at the hearing, your work record, and other non-medical facts.

In short, it’s a complicated choice—another reason why you need the advice of an experienced and dedicated Social Security Disability law firm to help you.

Call our experienced and passionate team of attorneys today for a free consultation. In many cases, you can meet with a lawyer within the next few days in one of our conveniently located offices in Chicago or Palos Hills.