Judges Are Fallible

I received a partially favorable decision from a Social Security Administrative Law Judge (the “ALJ”) today, which provided the claimant with 80% of the benefits sought. When the client called to pick up the file, I asked why. The answer, “Because the Judge said I wasn’t entitled to anything more.” The claimant was also concerned about the decision being reversed if appealed.

I explained that there were four different grounds for reversing the ALJ’s decision. The ALJ failed to follow the rules for: (1) assessing testimony, (2) determining if the claimant was presumptively disabled under a “listed” impairment, (3) evaluating medical evidence under the “treating physician rule,” and (4) using a medical expert to determine the disability onset date. I explained that additional benefits were dependent on just one of those grounds being accepted. After the claimant understood why the ALJ’s decision was faulty, and that ALJ decisions are rejected on appeal a substantial percentage of the time, the claimant decided to appeal the decision.

A claimant should insist on a detailed explanation if their hearing decision is not fully favorable. If the attorney does not think there are grounds for an appeal, get a second opinion.