Hearing Decision by ALJ: Favorable, Unfavorable, Partially Favorable
A hearing decision by the ALJ will result in a favorable, unfavorable, partialy favorable or dismissed. I will talk about what each of these types means and what to consider if you want to appeal.
The first thing you should keep in mind is that no matter what the outcome your case is not necessarily over. These case can be appealed by you, your lawyer or by own motion of the appeals council. Depending on what your decision says and how the ALJ decided your case you may or may not want to appeal. I hope this page can give you some guidance.
Fully Favorable Decision
I will first address the fully favorable decision. This is the one you want. It means you got everything you or your lawyer has asked for. In a typical SSDI or SSI case it means you won your benefits from the date you asked for at the hearing. It does not necessarily mean you will get paid all your benefits from the date the ALJ found you disabled. This is because in a Social Security Disability case you can only get paid one year back from when you applied for benefits. So if you applied in 1/05 you are payable back to 1/04 even if the ALJ found you disabled at an earlier date than 1/04. In SSDI cases they also do not pay you for the first 6 months of disability sometimes called the waiting period. In an SSI case you can only get paid back to the date of your application but there is no 6 month waiting rule. However, if you were collecting welfare your past due benefits for SSI will be used to pay back welfare and you would get what is left over. There are some exceptions to how far back you can get paid such as when you are successful in re-opening a prior claim that can give you an earlier payment period. This is rare and beyond the discussion of this page. You should also know that even if you do not appeal a favorable decision and you most likely will not want to, the Appeals Council can review the decision on their own motion. This is very rare so don’t be to concerned that this will happen.
Another type of decision you can get back is a dismissal of your claim. There can be many reasons for this. The most common are that you did not show up for a hearing and you were unable to show good cause for not showing. You may also have your case dismissed if the ALJ decides that the claim has already been decided on the same issues with the same facts. These types of decisions can also be appealed to the Appeals Council.
Another type of decision you can get back is a dismissal of your claim. There can be many reasons for this. The most common are that you did not show up for a hearing and you were unable to show good cause for not showing. You may also have your case dismissed if the ALJ decides that the claim has already been decided on the same issues with the same facts. These types of decisions can also be appealed to the Appeals Council.
Partially Favorable Decision
Another type of decision you can get from an ALJ is a partially favorable decision. This usually means the ALJ found you disabled but not from the date you alleged you became disabled. These decisions should be read carefully because you may lose some past due benefits you were entitled to. If the partialy favorable decision found you disabled after your date of last insured (DLI) this can result in you only being eligible for SSI benefits and not SSDI benefits which could make a big difference in the amount of money you get and whether you are entitled to medicare as compared to medicaid. This type of decision could also just mean the evidence was strong enough at a certain point after you claimed you became disabled and you would still be disabled under SSDI just with less past due benefits. I recommend you have a lawyer look at the decision to help you determine if you should appeal this type of case. There is always a slight possibility the appeals council could decide you were not entitled at all or send it back for a review of the whole issue all over again. In these types of decision I recommend caution. If the result is close to what you were looking for it may be better to let it go.
Unfavorable Decision
An Unfavorable Decision is the one we all don’t want to see. It is not the end of the world and can be appealed to the Appeals Council. It is recommended you get a lawyer to help you with your appeal because it takes a careful eye and understanding of the regulations to get these case reversed or sent back for a new hearing with instructions to the ALJ on what they are to consider. The Appeals council will review cases were there is an abuse of discretion by the ALJ, there is an error in law, actions findings or conclusions of the ALJ are not supported by substantial evidence, or there is a broad based policy procedural issue that may affect the general public interest. Sometimes the best course of action is to just file a new claim or to file a new claim and appeal. Again good idea to talk to a lawyer about your particular case.