Social Security Disability Appeals and Partially Favorable Decisions

AdminSocial Security Disability

social security claim decision

There 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 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 usually file a social security disability appeal.
  • 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 a social security disability appeal

Deciding Whether a Social Security Disability Appeal Is the Right Choice

There are many issues to consider in determining whether you should file a social security disability appeal because a partially favorable decision was reached. An appeal, however, involves risk even to 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.

The loss of anticipated back pay, however, 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.

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, 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.