Saturday, January 11, 2014

Appealing Partially Favorable Decisions

The State agency regularly issues a partially favorable decision (“PFD”) when making initial determinations on Social Security Disability (“SSD”) applications. A PFD should almost always be appealed as this could result in the receipt of substantial additional benefits. 

The first step in appealing is to check all the documents in the eFolder to see if there is a document explaining why a later onset date was chosen. Many times it seems that there is absolutely no reason for the delayed onset date, and that the SSA is simply trying to avoid having to pay additional benefits. Sometimes there is no document in the eFolder that provides a reason why the State agency issued the PFD. I received a fully favorable decision today from administrative law judge (“ALJ”) Seymour Rayner that illustrates this point. 

The claimant’s alleged that she became disabled on February 1, 2011 (the “AOD”). The State agency’s said the claimant became on July 1, 2012 (the “EOD”). The ALJ asked what evidence the State agency relied upon as the basis for the EOD. I stated that there was no medical record in the file that was created on July 1, 2012, or referred to that date, and that it appeared as if the State agency analyst arbitrarily plucked the EOD out of thin air because it failed to correspond to any evidence. 

The ALJ then asked what evidence the claimant was relying upon to support the AOD. I stated that there were two medical reports from the claimant’s psychiatrist that supported the AOD, by describing why the claimant met the listed criteria for an anxiety disorder no later than the AOD. The claimant also testified that her anxiety did not change on or about the EOD, and had been the same level of severity since the AOD. 

The ALJ agreed that because the claimant’s condition was the same at the AOD as it was at the EOD, the claimant’s onset appeal should be granted. As a result, the claimant received over half a year of additional benefits. 

As a related matter, I submitted a fee agreement stating that, “If the Social Security Administration (“SSA”) decides the claim favorably at the initial, reconsideration or initial Administrative Law Judge (“ALJ”) hearing stage, then Claimant will pay Attorney a fee that is equal to the lesser of twenty-five (25%) of the past due benefits.” (emphasis added). The agreement has been approved countless times where an ALJ issued a favorable decision following a State agency partially favorable decision. ALJ Rayner incorrectly denied the fee agreement on the grounds that it “is only valid if the claim is favorably decided at the initial level.” I’d say that ALJ needs to learn how to use a dictionary, but who doesn’t know the meaning of the word “or”?

No comments: