11-1p Ruling Limits Disability Benefits Options After Denial

Author: Shifrin Newman Smith Inc.
Published: 2011/10/21
Topic: U.S. Social Security - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: Those who file for Social Security disability benefits may not file a new claim under the same title for the same benefits while an appeal on a previous claim is still pending.

Introduction

Main Item

The Social Security Administration (SSA) announced that as of July 28, 2011 those who file for Social Security disability benefits may not file a new claim under the same title for the same benefits while an appeal on a previous claim is still pending. The SSA is now forcing applicants to choose between filing a new claim and pursuing his or her right to go through the appeals process regarding the decision on a previous claim, whereas before applicants could file new claims while waiting for decisions on appeals if their circumstances warranted it. The SSA's new policy could have a huge impact on people who file for disability benefits.

The Disability Benefits Appeals Process:

Many who file for disability benefits get rejected on their initial applications. A person who is denied then has the option of filing a Request for Reconsideration and submitting any new medical evidence that he or she has to see if the SSA will grant benefits. If the SSA still decides an applicant does not meet eligibility requirements, an applicant has the right to request a hearing in front of an Administrative Law Judge (ALJ) to try and win a benefit award. If the ALJ does not grant an award, the applicant has the right to appeal the ALJ's decision to the Appeals Council, where the Council will review the ALJ's decision to see if it was against the weight of the evidence and needs to be sent back to an ALJ for review. If the Appeals Council denies the applicant's appeal, the applicant can then petition for an appeal in federal district court.

Changes in the Process:

A great deal of time passes between each stage of the appeals process. Prior to the SSA's recent decision, many would file new applications for benefits while old applications were at various stages of the appeals process if their conditions changed for the worse and it was likely that the SSA would award benefits with the information provided in a new application. The new SSA policy means that people may no longer choose to pursue appeals and file new claims for the benefits under the same title and of the same type.

The SSA stated in its press release that the policy change allows applicants to forward information about a new or worsening medical condition to the SSA after the initial application is filed but before the SSA has not issued a decision, if the applicant is waiting for a decision on a Request for Reconsideration or if the applicant is awaiting a hearing. The SSA, however, will not process new applications.

When the appeal has reached the Appeals Council and the applicant chooses to pursue an appeal rather than a new application, the applicant may submit new information if the information is dated on or before the date of the ALJ decision and the Council will consider that information when making its determination. If the information is dated after the ALJ decision date, then the Council will return the information and the applicant may choose to drop the appeal with the Council and file an entirely new application.

The SSA clarified that there are limited cases when a person may file a new application for the same type of benefits:

If the applicant has a new disabling condition with an onset date after the ALJ's decision date

The applicant wishes to file an new application

The Appeals Council agrees that the applicant may file a new application before it issues a decision on the previous application

Impact on Those Filing for Disability Benefits

The SSA's new policy will make things more difficult for those filing for disability benefits. Applicants must now decide whether to pursue an appeal but miss out on benefits that they may have received from filing a new claim while waiting for the appeals on the old claim or drop the appeal altogether and file a new application, foregoing any back benefits that they may have won by pursuing the appeal from the earlier filing date. The new procedure puts applicants in an incredibly difficult situation.

The Social Security disability application and appeals processes can be incredibly confusing and the SSA's new policy only adds to the complexities that filers face. If you are filing for disability benefits or looking to appeal a decision on your application, meet with an attorney who can explain all of your options and help you make the best decision for your situation.

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