Why the Appeals Council Can Overturn a Fully Favorable Disability Decision

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0:52 Welcome to another edition of Q and A Social Security Disability Today. Let's get to your questions. I got a fully favorable Disability Today decision, yet the Appeals Council pulled it and said the judge got it wrong and sent it back to the judge. Will that hurt my chances of keeping my benefits going okay? And this is something that I try to tell everybody when they come to me and they get approved of benefits before judge. In your initial decision, you'll have the first three pages. There'll be discussions about you can appeal this. You got to day and most people say they're so happy they got a proved a gloss over all that, but one of the things I like to specifically highlight to people is

1:34 a section that says that the Appeals Council may on their own motion review your a file. What does that mean, Well, the most people don't realize that there's another court within the social security system that's higher than that is higher than the alj that's the Appeals Council. They are responsible.

1:52 They have the responsible for reviewing all the judge's decisions. One of their responsibilities is to ensure that judges are not overly approved, are overly denying cases. So they will randomly randomly pull cases for review on their own, whether they be unfavorable or favorable. So in your case or the course to the question that was pose, they looked, they found your case, they looked at the judge's decision, something in that decision they had a problem with, and they sent it back to the judge for further review.

2:23 But it could be a lot of things. It could mean basically, you know, the rationale was a little law, or they had a problem about some evidence that they believed needed further clarifications. It could be a variety of different things. Most people want to know, well, what does that mean for me? Well, typically if they pull it for review, typically they have a certain period of time when they have to process. I believe it's one hundred and twenty days to where they have to make a decision whether to affirm the judge's decision and say yeah, he got it right or she got it right, or send it back to the judge for further development. Now here's the kicker. After about one hundred and twenty days, if they haven't made a decision, your benefits will start. Now.

2:59 One of the things that I tell people is one of the dangers about the on motion review is that any money that's given to you during this review process, and more importantly, if the alj gets it again, you may be responsible for reimbursing. What does that mean, Well, that means that if they send it back to the judge and the judge reconsiders and now determined you're not disabled, guess what you owe the government back every dollar you got.

3:21 And some of you may say that is jacked up ass just the nature of the beast. Let me stress this that doesn't happen too often. And what I mean that doesn't happen too often. What I mean is the appeals counselor they don't review a lot of cases. But here's the problem. It's in retrospect. You got to look at it over the course of millions of decisions that go out every day. They pick a sampling of them, and it may be a small percentage. It only sucks when you're in that percentage. So what I tell people is this, just be aware and be advised that if the Appeals Council pulls your case for a review, there's a possibility it could be sent back to the judge and the judge could deny you. It has happened. The

3:59 judge could do one of three things. The judge could say, you're right, I got it wrong, You're denied. Or two, I don't think I got it wrong. I think I got it right and send a decision back. Or three they could modify and say you know what, I don't think you were disabled that far back. So the answer to your questions is there a possibility that your disability benefits may be kept going absolutely, but there's also a possibility those benefits could be discontinued as well. So what do you need to worry about? Well, if the Appeals Council sends it back, what you want to do. And this is why representative is helpful to you because they can review the reason by which the appeals Council reviewed the case. And this is where it gets helpful for

4:37 a person like me, because I have people come to me with cases like this and I look, first thing I'm looking for is what did the appeals council have a problem with? What do they have a problem with? Okay, once I've identified what they had a problem with, I want to fix that problem. Why is it important because in my mind I may be wrong. In my mind, I have a judge who has saw fit within this scope of the evidence to find in my client's favor.

5:04 I have an interest and my client has an interest to not have that decision overturner. So if there is something that the appeals counsel saw that was problematic that they need addressed, I'm going to make every effort in my power to address that issue so that the judge does not So this way, I can say, hey, they had a problem with this. Like if I had a client who had drugs and alcohol and the judge determined that they were material, but the appeals Council thinks we think they are material. Look at it again. I'm going to go to that client, say you got a doctor that can write a statement with regards to that. And if a doctor gives me a statement saying yes, I've treated them, I'm ware of the drugs and alcohol. They

5:38 have no bearing on their disability. They are clearly disabled. They've been treating with me for about two three years and I've reviewed all the evidence. Has no impact. Prof I is the judge. Judge is happy we've addressed the issue. Pretty good chance he's probably or she's going to probably a reaffirm or decision. But there, like I said, it's not an absolute and I always tell people the reason why it representatives. We always say the magic word depends is because we don't know how it's going to shake out.

6:04 The only thing we can do is zealously do we can't to make sure that if the appeals counsel pulls your case for review, that we address any issues that they had, So this way your benefits can keep going for We welcome you again and thank you for joining us for another edition of Q and A So Security Disability Today