In Brown v. Colvin, a case from the United States Court of Appeals for the Seventh Circuit, the claimant had applied for Social Security Disability Insurance (SSDI) benefits due to severe back problems and obesity. When she first applied for disability benefits, her application was denied. She then filed for reconsideration.
Filing for reconsideration is typically done in writing or via the Internet, and a co-worker of the Social Security Administration (SSA) employee who first denied your application will review your application. For this reason, SSA considers this a peer review process. Almost all applications that were initially denied will be denied once again at the peer review stage.This is a lot of denials, because, as our Boston disability benefits attorneys can explain, the vast majority of initial applications are denied once they are filed without very little regard to whether a particular claimant is actually disabled and otherwise eligible to receive benefits.
At this stage in the process, claimant requested a hearing before an administrative law judge, or “ALJ,” as SSA and Social Security disability lawyers often call them. The ALJ hearing is a fairly formal hearing before the ALJ. He or she will likely ask a person hired as a vocational expert (VE) who is going to use an archaic book from the 1970s known as the Dictionary of Occupational Titles (DOT). This is supposed to be an independent evaluation, but the VE is hired by SSA and is nearly always there to find a reason why the claimant is not disabled within the meaning of the statute. It should come as no surprise that the ALJ once again denied the claimant’s request for disability benefits.
Once a claimant has been denied by an ALJ, the claimant can request an appeal before the SSA’s review commission, but this is a discretionary review, meaning the agency does not have to grant it, and, for that reason, they often deny such requests without a hearing. At this point, the claimant can appeal to the United States District Court and, if that doesn’t work, the U.S. Court of Appeals. That is what happened in this case.
The basis for appeal was that ALJ rejected the treating physician’s opinion that the claimant (his patient) could not perform certain types of work. There is a general presumption that a treating physician’s opinion is correct. This does not mean it can’t be overcome by contradictory evidence, but that evidence must be sufficient enough that a reasonable finder of facts would form such a conclusion. In this case, ALJ did not have any competing medical opinion, but rather chose to substitute his own opinion for that of the doctor.
For this reason, the court of appeals determined that ALJ had erred as a matter of law by abusing his discretion in disregarding the expert medical opinion proffered by the claimant. The case was reversed and remanded for further proceedings consistent with their opinion.
If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at 1-888-367-2900.
Brown v. Colvin, December 22, 2016, United States Court of Appeals for the Seventh Circuit
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