Conservative and liberal federal judges now order remands in about 60 percent of the cases they review. The high rejection rate has transformed what was once a Hail Mary pass into a legitimate strategy for SSI lawyers near you, to provide a defendable case. Those of us in the greater Memphis, Tennessee area and surrounding states of Arkansas, Mississippi, and Louisiana, now have all the more reason to “hang in there” after a SSD/SSDI claim denial. Heermans Social Security Law Firm founder, Mr. Heermans, says that he is, “glad to see that the higher courts are looking at SSD claimant case histories more carefully than ever. This is very encouraging to those who are disabled and need financial and medical assistance.” More simply said, if your SSD claim has been denied, seek out the assistance of a qualified attorney to represent you in your claim.
In one case, Clinton-appointed Northern California District Judge Susan Illston wrote that a denied disability claim which ignored key physician records was “so vague as to be essentially unreviewable.” The judge reversed the decision and ordered the agency to pay benefits to the claimant, a woman who suffers from delusions, depressive disorder and schizophrenia. One lawyer said the overall environment is responsible. “The system has become one of ‘how do we deny this claim’ rather than ‘what is the right answer in this person’s case?,’” she remarked.
An SSA spokesperson denied that the system was stacked against applicants. “The agency evaluates the totality of the evidence and decides cases based upon the issues and evidence in the particular case,” she said in a statement. “The process has always been and continues to be non-adversarial,” she added. While this is true, and all disability cases begin with the same initial questions – not all cases are evaluated the same. Some go through more questions and review than others, and all are evaluated independently and with some level of subjectivity.
Initial Disability Claims
The road that leads to a federal court appeal begins with an initial disability review by a state Disability Determination Services officer. At first, the road is bumpy. It gets bumpier.
SSI disability lawyers in Memphis, including Heermans Social Security Disability Law Firm, have limited input during DDS hearings. Instead, DDS officers generally only review disability applications, medical records, and other paperwork in the file.
A disability claim may even appear incomplete right from the start if you take into consideration that a doctor doesn’t just come into a patient’s exam room with bad news saying, “you have a disability.” Instead, a disability diagnosis must also include many other pieces of evidence and vocational information. According to the Social Security Administration, people are disabled if their medical conditions prevent them from working. And, without adequate employment information, the DDS officer may only be able to see half the puzzle.
Making matters worse, state agencies, not the SSA, oversee DDS officers. As a result, there’s very little uniformity and potential fluctuating claim expectations that can differ from region to region. What a DDS Officer may expect to see during the claim review process from a claim in Washington D.C. may be quite different from what a DDS Officer in Hattiesburg, Mississippi would be looking for and expect to see. Furthermore, the Civil Service Act, which guarantees job security for many government workers, doesn’t apply to state workers. So, turnover and the complications that come with it, is common in DDS offices. Because of all these and other variables, the initial disability claim approval rate is a little over 30 percent.
First Level Appeal
Statistically, DDS officers approve benefits about a third of the time. The approval percentage is even lower at the next level, which is usually a senior DDS officer review.
In a handful of cases, 15 percent to be precise, the initial DDS officer made such a grievous error that a senior DDS officer cannot ignore it. These grievous errors include:
- Disregarding certain evidence (e.g. “I know a medical report says X but I’m ignoring that report),
- Looking at the wrong file,
- Refusing to let applicants speak on their own behalf, and
- Drawing conclusions the evidence cannot possibly support (e.g. “I think s/he’s faking it”).
Additionally, a reversal isn’t usually a reversal. Instead, the senior DDS officer typically sends the applicant back for another initial review.
Administrative Law Judge Hearings
The approval rate skyrockets at the next level, from about 15 percent to over 50 percent. ALJ hearings, which are basically private trials (no court reporter present), feature attorney arguments and additional evidence.
Attorneys are like bakers and law firms are like baking companies. We can all bake a cake, but the Hostess Baking Company can bake any cake perfectly and as many as you need. Bakers know how to combine flour, sugar, water, eggs, and other ingredients and make something special. Attorneys and law firms like Heermans, know how to combine evidence and build a compelling case. They also make compelling legal arguments because they went to law school and have the backing and expertise of other lawyers in their firm.
Additional evidence at ALJ hearings includes independent medical reports and vocational reports. Independent doctors who may be needed during the disability claim process, much like senior DDS officers, review prior work and assess its accuracy. Unlike senior DDS officers, medical experts aren’t afraid to call a spade a spade. Vocational experts might be even more important because, as mentioned, they provide missing puzzle pieces. Vocational experts basically consider the applicant’s medical condition and give a statement as to the applicant’s realistic employment prospects in the current job market.
Occasionally, if an ALJ reverses prior denials, the ALJ sends the matter back for another review, usually with instructions that favor the applicant. Generally, however, the ALJ erases the prior reversals and grants benefits.
Since an SSA law firm, such as the Heermans Law Firm, serving the greater mid south area and beyond, has such a strong advantage in representing their clients at this level, many claims settle with negotiations prior to the ALJ hearing.
The Appeals Council has three main offices, all of which are in the Northern Virginia area. Senior DDS officers review initial DDS officer determinations, and the Appeals Council reviews ALJ decisions. For the reasons explained above, the senior DDS officer reversal rate is typically low. For the reasons explained below, the Social Security Appeals Council reversal rate is also typically low.
Largely, appeals council reviews are paper reviews. The council basically grades the ALJ’s homework. But instead of A, B, C, D, or F, the grading scale is pass-fail. ALJ’s only fail these reviews if they make clear and indefensible errors. If they do poorly, but the Appeals Council sees any way the result might be accurate, ALJ’s typically pass these reviews.
A federal case is a whole new world. At the first four levels, the same rules of procedure and evidence apply. At this level, the rules are completely different. For example, during reviews, federal judges don’t use an egregious error standard. Instead, they use an abuse of discretion standard. That’s a slightly lower standard, which accounts for the higher remand rate.
We say “remand” instead of “reversal” because federal appeals courts hardly ever reverse lower court decisions. Instead, they send them back to their origin points, which in this case is usually an ALJ hearing, with special procedural instructions. As we stated at the beginning, Federal Judges these days are trending toward taking a critical look at SSD benefit claims cases when presented by professional attorneys, like the award-winning Heermans Law Firm serving those living in the mid south region.
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