Issues Raised By A Partially Favorable Decision
After a hearing, an ALJ can issue an Unfavorable, Fully Favorable, or Partially Favorable decision. While the first two options may make sense to most, a Partially Favorable decision requires explanation. This guide addresses the meaning of such a decision and your options in responding to it.
Different Kinds Of ALJ DecisionsThere are four possible dispositions of a Social Security Disability case after an Administrative Law Judge hearing. Those four options are:
DISMISSAL: A claim can be dismissed for technical reasons with no consideration of the medical merits of the case. For example, this might happen if a social security disability appeal was not filed in a timely manner and there is not *good cause* to justify the late filing of the social security disability appeal.
UNFAVORABLE DECISION: A claim is denied because the judge decides the evidence does not meet the medical and legal criteria for the person to be found disabled at any point during the period at issue in the decision. In this case, your disability attorney can either help with an appeal or a new claim.
FULLY FAVORABLE DECISION: A claim is approved because the judge decides the evidence does meet the medical and legal criteria for the person to be found disabled for the entire period at issue in the decision.
PARTIALLY FAVORABLE DECISION: A judge finds that the person is currently disabled but that the disability did not begin on the date alleged by the person. In other words, the person is awarded benefits going forward and for some period of back pay, but their back pay may not go as far back as it would have with a fully favorable decision. Your disability attorney could potentially file an appeal.
Consequences Of A Partially Favorable DecisionThe loss of anticipated back pay is not the only downside of a partially favorable decision. In some cases for Title II benefits where there is a date last insured and the established onset is after this date, this may prevent a person from receiving benefits under that provision of the Social Security Act. In other words, it may rule out an award of Disability Insurance Benefits (DIB) (a.k.a. SSD, SSDI), but allow for an award of Supplemental Security Income (SSI).
The difference in the monthly amounts paid in benefits for these programs can be substantial and eligibility for Medicare is only possible with an award under Title II.
Considerations Regarding Appeal Of A Partially Favorable DecisionAny decision by an Administrative Law Judge can be appealed by asking the Appeals Council of the Social Security Administration to review the decision. There are many issues to consider, however, in determining whether you should file an appeal of a partially favorable decision.
An appeal involves risk regarding the favorable aspects of such a decision. In other words, if you appeal a partially favorable decision one of the possible outcomes is that the award of benefits may be set aside.
Even with a successful result on an appeal, any appeal will obviously take time. Some disabled persons find themselves in a financial situation such that an appeal of a *partially favorable* decision is not just a risk they cannot afford or it is a delay they cannot consider. In such cases, a practical decision may be made regardless of the legal risks or benefits of an appeal.
While there can also be exceptions to any rule, the general and prudent policy would be to not appeal a partially favorable decision. There is wisdom in the old saying: "A bird in the hand is worth two in the bush."