I thought this post from my blog might be of help to some of you.
A common question is what to do if a claim is denied by an Administrative Law Judge (ALJ). This is a major decision point in the process for obtaining Social Security Disability benefits. The decision carries significant ramifications so it is important to consider the advantages and disadvantages before moving forward. In this post, I will discuss the options for someone whose claim for Social Security Disability benefits has been denied by an ALJ.
If the ALJ denied your claim for Social Security Disability benefits, you have one of two options:
1) You can decide to disregard your first claim and start fresh.
2) You can also decide to appeal.
Because this decision really does have significant consequences going forward, I do strongly recommend consulting with an experienced Social Security Disability attorney. Choosing one path versus another may mean giving up some rights. While each Social Security Disability claim has its unique issues, here are some basic things to consider in deciding which path to pursue:
Appealing the ALJ’s Decision. If you have received an unfavorable decision from the ALJ, you can appeal this decision to the Appeals Council. In submitting an appeal to the Appeals Council, your attorney should submit legal briefing discussing why the ALJ made mistakes in his decision regarding your eligibility for disability benefits. The advantage to this route is that you keep your alleged onset date (the date you told the Social Security Administration you could no longer work) and protective filing date (the date you filed your application for Social Security Disability benefits). This is important because it means that your back pay would be based on those dates rather than a new date in a new claim. This can be a substantial sum of money. In addition, your Medicare and Medicaid eligibility would be based on the alleged onset dates and protective filing dates rather than a new date in a new claim.
The disadvantage of this path is that the appeals process is a long process. The Appeals Council can take from 12-14 months to decide your case. During this time you are not receiving any benefits. In addition, if they agree with the ALJ, you would have waited a long time and still not been able to receive any Social Security Disability benefits. For many people, waiting this long for benefits can be very difficult, if not impossible.
It is important to note that if you have received an unfavorable decision from the Appeals Council, you will be able to file an appeal in Federal Court. With your Federal Court appeal you will be able to also file a new claim with the Social Security Administration for Social Security Disability benefits. However, this will take still more time without receiving any benefits.
Starting a New Claim. If you have received an unfavorable decision from the ALJ, you can also start a new claim with the Social Security Administration. Starting a new claim can be beneficial because it allows many claimants another opportunity to demonstrate that they are eligible for Social Security Disability benefits. In addition, in pursuing a new claim, you have a new opportunity to prove your disability with a new examiner in the initial stages of your Social Security Disability claim and, hopefully, a new ALJ at the hearing stage. These new people evaluating your case may see your case in a different light and grant you benefits. If granted, these benefits may come much sooner than if you choose to wait out the appeals process.
The disadvantage of submitting a new claim, however, is that you will have a new alleged onset date and protective filing date for your case and, as a result, give up a lot of potential back pay.
There are also certain circumstances in which filing a new case is not an option. One example is when a claimant is filing for SSDI benefits and their Date Last Insured (the date by which they must prove they became disabled) has already expired. In this situation, the only option would be to appeal the decision.