The Social Security rules and regulations provide a disability claimant with a number of opportunities to appeal should one be denied. Following an initial denial, a Maine or Massachusetts Social Security disability claimant would appeal the decision by way of filing a Request for Reconsideration and then, upon further denial, by way of a Request for Hearing before an Administrative Law Judge (ALJ). A New Hampshire disability claimant, however, gets to bypass the reconsideration process and proceed straight to an ALJ hearing.
Once denied at hearing, claimants may then bring further administrative appeal before the agency (that is, the Social Security Administration (SSA)) by way of a Request for Review of Hearing Decision/Order before the Appeals Council. A denial by the Appeals Council, however, exhausts one’s administrative options.
At the point in time of an Appeals Council denial, a Social Security disability applicant has exhausted their administrative options. It is important note that the failure to pursue further appeal of the ALJ denial at hearing will result in that decision becoming final under the doctrine of Res Judicata (which means the “matter having been decided”). Should this take place, it becomes very difficult, if not impossible, to bring a new claim that would succeed in providing you with benefits prior to date of the ALJ denial. There are few exceptions to this rule of finality.
And so, the only only avenue left, whether in Massachusetts, New Hampshire or Maine, is for a Social Security lawyer and their claimant is the filing of an appeal to Federal District Court. It is important to understand that the odds of a favorable decision at the Federal District Court level is quite small, with success rates at less than 30% (and with the vast majority of successful appeals involving simply a return of the claim (or what is called a remand) for additional hearing before what may be the very same ALJ that initially denied the claim.
In order to bring a Federal District Court action, one must pay both filing and service costs unless the court determines that there is a basis for a waiving of such costs based on an individual claimant’s inability to afford such costs. In order to proceed in such a fashion, it’s necessary that the court approve a motion to proceed “in forma pauperis.”
It is important to understand that at the Federal District Court level of appeal the standard for review is whether the agency decision was in error as a matter of law or whether the decision by the ALJ was not supported by substantial evidence. The Federal District Court is not tasked with reviewing additional medical records or evidence, as they are not a fact finder. Instead, the Court looks to see whether the ALJ failed to follow the law in coming to its decision or the ALJ failed to base its decision on substantial evidence in the record. For these reasons, the likely remedy is a remand of the case back to an ALJ for additional proceedings (and only rarely is there a direction by the Court that a favorable decision is to be instituted).
Because of the extensive work involved in handling a Federal District Court action, which can run well in excess of $10,000.00 of an attorney’s time with what is a very low success rate, federal law (under what is called the Equal Access to Justice Act) does provide a mechanism whereby an attorney can be compensated on an hourly rate for the work performed at the Court level and for costs to be reimbursed. In order for such time and costs to reimbursed, however, it is necessary that the attorney and their disability claimant prevail against the Agency (that is, SSA) and must show that the Agency’s position was not substantially justified.
Unfortunately, not all Social Security disability claims can be said to justify the time and expense involved with proceeding to Federal District Court. If you or someone you care about, has been facing multiple denials and simply doesn’t know how to proceed, suggest they contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622 for a free evaluation of their case.