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Reopening of Prior Claims to Obtain Additional Retroactive SSDI and SSI Benefits

Given the difficulties one can encounter with attempting to pursue a Social Security disability income (SSDI) or Supplemental Security Income (SSI) claim, it is not unusual for one to face an initial denial or a denial on reconsideration and become frustrated with the process. Many times, we hear from individuals who have attempted to pursue a claim either on their own or with an attorney, only to give up on the claim: whether it is because of an attempt to return to work that goes bad, or simply frustration with the system, there are mechanisms available for reopening a prior claim for benefits (and for obtaining retroactive benefits that precede one’s prior application for benefits). We have obtained significant retroactive benefits by understanding the complex rules associated with a potential reopening of a prior claim for benefits and utilizing those rules to our clients’ benefit.

In order to understand one’s rights when it comes to reopening, it is helpful to first understand when SSI and SSDI benefits are payable to claimants who are found to be disabled under Social Security’s rules. For purposes of SSI claims, there is no entitlement to retroactive benefits: that is to say, benefits are payable in the first month after all requirements are met (both the disability portion, or that is to say, the medical portion of the claim and the non-medical, that is to say, the income and asset limitations for the program, first need to be met). For purposes of SSDI benefits, however, a claimant must first meet a five (5) full month waiting period before benefits are payable. However, in the case of SSDI benefits, payment of retroactive benefits may go as far back as one (1) year prior to one’s application date (with the application date being the protective filing date: the date one first contacts the Social Security Administration (SSA) with their intent to file a claim for disability benefits, assuming an application is then completed and filed within six (6) months of that date). Thus, assuming one has remained disabled for at least 1 year and 5 full months (given the need to meet a 5 full month waiting period), SSDI benefits can be payable going back one (1) year prior to their application date.

In the event that one has filed previously, the Social Security rules provide a basis for reopening of past claims under certain, very well-defined sets of circumstances. See 20 C.F.R. §§404.987 et. seq. and 416.1487. These rules provide that “for any reason” a claim may be reopened (whether it be SSI or SSDI) within 12 months of the date of an initial denial. See 20 C.F.R. §§ 404.988(a) and 416.1488(a). Reopening would allow one to use the date of the prior application as the date before which retroactive SSDI benefits could be awarded as set forth above (up to a year in back money, assuming a 5 full month waiting period has been met) and, for SSI purposes, reopening would allow benefits to be awarded from the month after the prior application versus the current application. An even more generous period of reopening is allowed (2 years for purposes of SSI claims and up to 4 years for purposes of SSDI claims) if the present application contains new and material evidence that relates back to the prior period of time (evidence that was not available at the time of the prior agency review during the course of the first application). Such new evidence may be in the form of medical evidence that was not available for consideration, medical reports obtained from doctors that relate to the prior period of time, or may even include the testimony of the claimant at hearing (assuming the claimant did not testify at hearing previously). Evidence may even include statements from you or others, who may have not been heard from previously, who are able to comment as to how your condition has been impacted your ability to function over time.

The reopening rules set forth above apply to situations where the claimant has not proceeded to the hearing level and obtained an unfavorable decision at a hearing before an Administrative Law Judge (ALJ). In this circumstance, the decision is considered to be a final determination and the doctrine of Res Judicata (which means the “the matter having been decided”) applies. In this set of circumstances, you may still be able to pursue a claim, and a reopening may still be possible: however, a much different set of rules applies in determining whether that unfavorable determination may be overcome (and is beyond the scope of what can be addressed on line).

Given the above, it is always a good idea to obtain the advice of an attorney who has been handling Social Security disability claims and appeals for many years so as to advise you of your rights with reference to bringing a claim, and potentially reopening a past claim of yours. We have been handling such matters for more than thirty (30) years and would be happy to discuss your rights with you for no charge. Call the Law Offices of Russell J. Goldsmith at (800) 773-8622 for a free consultation at this time.