The majority of Social Security Disability Insurance (SSDI) claimants will be required to go to a hearing before an administrative law judge (ALJ) at the Social Security Administration (SSA) if they are eventually to be awarded benefits. These hearings can be very difficult, if not seemingly impossible for an unrepresented claimant, as there are rules of procedure and evidence that will come into play, and the claimant will need to have a good grasp on trial practice skills, which is not likely the case. Ultimately, proving a Social Security Disability Insurance claim is not easy.
There is no reason though that an SSDI claimant should not be represented by an experienced attorney. The system is also set up in such a way that there are no legal fees unless and until the claimant is successful and recovers disability benefits. If the claimant is successful, and obtains retroactive benefits, the legal fees will be paid by SSA as a percentage of the benefits award, but there will be no out of pocket costs to the claimant. If the claimant is not successful, there will be no fees owed to the SSDI attorney.
Retroactive Benefits in Social Security Disability Cases
As our Boston SSDI attorneys can explain, retroactive benefits are benefits from the date of disability to the date on which benefits are ultimately paid. Unfortunately, this is typically more than year after first filing for benefits. The process works by the claimant first filing an application for Social Security Disability Insurance benefits. This includes gathering medical records and a letter of opinion from a treating physician that the claimant is suffering from a disability and can no longer work. It is essential that the claimant has a work history because in order to qualify for SSDI benefits, a claimant must not only be disabled, but also have worked long enough to have earned the requisite number of quarterly credits. The number of credits that are required will depend upon the age of the claimant.
SSDI Applications Process
Once the application has been filed, it will most likely be denied upon a finding the claimant is not disabled , and this has little to do with whether the claimant is actually disabled. Once the initial application has been denied, the Boston SSDI claimant will have 60 days to file a written request for reconsideration. This is done by filing Form SSA-561. This is generally applicable where claimants have been denied for a medical reason. If a claimant was denied for reasons other than medical, there will be more involved including getting an accurate work history prepared. Regardless of the reason, the request for reconsideration will likely be denied since almost all of the applications are at this stage in the process. After a denial of a request for reconsideration, the claimant can apply for a hearing before an ALJ. This is the hearing at which a claimant should definitely have an experienced Boston SSDI lawyer representing them.
Leon v. Berryhill
In Leon v. Berryhill, a case from the U.S. Court of Appeals for the Ninth Circuit, claimant applied for Social Security Disability Benefits in 2010. This was after previous applications had been denied in the past. In the application at issue in this case, claimant was denied, again denied on the request for reconsideration and was eventually granted a hearing before an ALJ. At this hearing, ALJ denied claimant’s request for benefits on grounds claimant was not disabled.
At this point, claimant filed an appeal in the United States District Court in which jurisdiction was proper, and the court remanded the case for further proceedings before SSA. The claimant appealed this decision by the district court. The grounds for the appeal was that ALJ improperly rejected claimant’s testimony without providing reasons for doing so. An ALJ is permitted to reject claimant’s pain testimony, but only after he or she gives credible legal reasons for finding a lack of credibility.
There was no issue that the opinion was insufficient at to the reasons why ALJ found claimant’s testimony to be not credible, but claimant argued on appeal that the district court was required to credit her testimony as true under the aptly named credit-as-true. The court however, found that a district court judge can direct an award of benefits by crediting the claimant’s testimony as true when the order lacks sound judicial reasoning, but is not required to do so. The court can instead remand the case for further proceedings so the ALJ must decide again whether to credit claimant’s testimony. If at this point, ALJ still wishes to deny benefits by discrediting claimant’s testimony, this is appropriate if the reasoning is sufficiently established in the order denying benefits. This is what the district court judge decided to in this case.
This is complex issue, and a lot of cases involve difficult issues of proof. The best way to prevent such a situation from occurring is to support claimant’s testimony by testimony or records from the claimant’s treating physician that claimant is disabled within the meaning of the Social Security Act. Once there is testimony from the claimant’s treating physicians, it will be much more difficult to discredit this testimony even if the ALJ has a medical expert consultant testify for SSA. These so-called independent medical experts are private medical doctors who are on a list used by SSA to review medical records and consult on behalf of the agency. While this is supposed to be an independent examination not influenced by SSA, many of these doctors do not have a private clinical practice and if they regularly found in the favor of disabled claimants, it is unlikely they would be picked all that often to do future consults or even remain on the consult list. This is also how insurance companies get doctors to review medical records and examine plaintiffs when they are defending a personal injury lawsuit.
In addition to the issues pertaining to the credit-as-true rule, there was also questions at whether the appellate court should limit the scope of the remand as is common in situations such as this.
If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at (617) 777-7777.
Leon v. Berryhill, November 3, 2017, U.S Court of Appeals for the Ninth Circuit
More Blog Entries:
SSDI Appeal Results in Affirmation of Denial, Feb. 15, 2017, Boston SSDI Attorney Blog