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I Have Been Denied at Both the Administrative Law Judge (ALJ) and Appeals Council Levels. Where do I go from Here?

If you have reached the point in the denial process where your Social Security disability claim has been denied by the Appeals Council, all is not lost. As a Maine Social Security lawyer, having handled these matters throughout Maine, Massachusetts and New Hampshire for the past 34 years (and with offices in ME, MA and NH), we have routinely assisted individuals in these very circumstance obtain the Social Security disability benefits they need and deserve

First, it’s important to understand that while the administrative proceedings may be over with, your ability to pursue justice is not. While claimants typically remain unable to pursue a new application during the course of the administrative proceedings, once the administrative appeals processes are over with, one may now be able to file a new claim. However, a new application is not the same as appealing your last denial to Federal District Court and valuable benefits may be lost should one fail to do so.

If one is denied by an ALJ, this decision becomes final unless one appeals the decision timely (within 60 days) to the Appeals Council. In turn, an additional denial at the Appeals Council will cause one’s Social Security disability claim to become final unless there is a timely appeal within 60 days to Federal District Court. An appeal of the ALJ denial can result in a remand (or sending back) of the case to an ALJ for additional proceedings in accordance with instructions from the Appeals Council in Virginia or from the Court. However, if the decision is allowed to become final (that is, all appeal deadlines are over and all appeals right have been exhausted through the agency), it then becomes necessary that you think about filing an appeal to Federal District Court and/or a new claim.

When pursuing a new claim, however, your individual circumstances will dictate whether 1) we’ll be able to get you Social Security disability insurance (SSDI) and/or Supplemental Security Income (SSI) benefits and 2) whether such receipt of benefits will include retroactive benefits (and to what extent: that is, whether it might go back to a period of time already decided by an ALJ or, perhaps, would involve benefits after the point in time of the ALJ unfavorable decision.

A final decision, wherein an ALJ determines you are not “disabled” under Social Security’s rules, will cause the Social Security Administration (SSA) to understand that there is a limit as to what they can provide on a new application or on reconsideration. The earliest date that SSA could find one disabled in such a circumstance would be the day after the ALJ decision (as all past periods of time have been determined finally) based on the doctrine of Res Judicata (which means the matter having been decided). Options do remain available at the hearing level, however, for one to argue that there are reasons why the judge decision should not be deemed binding for the earlier period of time: see below.

One should understand that even if an ALJ has determined finally that one has not been “disabled” through their date last insured (DLI) under the SSDI program, there remains the possibility of pursuing an SSI claim assuming one meets the income and assets guidelines for the program.

As mentioned above, at the hearing level, arguments can be made as to why a prior decision should not bar a claimant from arguing that they have remained disabled during the period previously determined by the ALJ. The Social Security regulations provide that Res Judicata only applies to the same facts and issues previously decided by the ALJ. Thus, if there is new evidence that relates to the prior period of time that would suggest one was in fact disabled, or if there were issues that were not raised during the prior claim (for example, certain condition(s) was (were) not previously raised and determined at the time of the prior decision), this can form the basis for establishing disability while still insured (and may even allow there to be a reopening of a prior claim). Moreover, if there has been a change in the law since the time of the prior ALJ denial, this can likewise form the basis for allowing an ALJ to award benefits going backwards in time prior to the date of the prior ALJ decision.

If you have been denied by an ALJ following hearing and you’re wondering what benefits you may still be entitled to pursue, contact the Law Offices of Russell J. Goldsmith at (800) 773-8622 so we can evaluate your individual circumstances.