Filing to the Appeals Council

The Yoyo of a Social Security Appeal to the Appeals Council or Federal Court

A yoyo is an ancient toy that has been in existence since 440 BC and, while we probably played with one as a child, the ups and downs of a Social Security Disability claim aren’t child’s play.

The Ups and Downs of the Appeals Council Appeal

If your Social Security disability claim was denied by an administrative law judge (ALJ), one of your choices is to take an appeal to the appeals council, which can uphold the ALJ’s denial, or send it back to the ALJ for a redetermination of your claim.

That is just one yoyo in the Social Security Disability claims process, but there is a second yoyo.

The Ups and Downs of a Federal Court Appeal

If you are not successful at the appeals council, we may recommend we file a lawsuit in federal court to further challenge the ALJ’s claim denial. Unfortunately, we can’t go right to federal court, and first have to file an appeal with the appeals council. If the appeals council upholds the denial, you can give up, start all over again, or appeal to the federal court.

A federal judge can uphold the denial, remand the denial back to the ALJ, or award benefits. Up and down and back down to the ALJ.

It’s the second yo-yo.

At Cavey Law, we don’t give up. If we think we have a chance to win, we will recommend an appeal.

That is what we did in the case of AK. AK was a high-powered insurance risk manager in New York who had a stroke on April 1, 2015, that resulted in cognitive and physical issues. We represented her in both her Long-Term Disability and Social Security Disability claim.

At the first Social Security hearing, the ALJ awarded her benefits as of the date she turned fifty on July 27, 2017 – almost two years after the stroke. The ALJ made a number of errors in denying benefits from April 1, 2015, through July 27, 2017, and there was almost $ 75,000 worth of benefits in dispute.

With AK’s approval, we took an appeal to the appeals council and lost. We weren’t going to give up, and some three years into the claim, we filed a lawsuit in federal court.

Fortunately, the SSA was paying her monthly SSDI benefits, since benefits had been awarded from July 28. 2017.

The federal judge agreed with us and sent the claim back to the ALJ to determine her entitlement to benefits from the date of the stroke to her fiftieth birthday. By this time, the original ALJ retired, and a new one was assigned.

I spent a great part of my legal brief explaining procedurally to the new ALJ what had gone on, and the ping pong back from federal court, the appeals council, and back to him. The ALJ couldn’t figure out what was going on.

AK testified regarding her cognitive and physical symptoms from the time of the stroke until her fiftieth birthday. She had difficulty remembering basic things, staying on task, and would quickly become both physically and cognitively fatigued. We both thought the hearing went well, but months passed without a decision. Finally, the ALJ’s office called us to tell us that the hearing recording equipment had failed during the hearing, and we would have to retry to case all over again.

Really.

So, we retried the case for a third time.

On January 8, 2024, we got a fully favorable decision awarding benefits from April 1, 2015, through July 28, 2017. It took almost eight and a half years to get the benefits AK deserved.

Cases rarely take this long, but it does go to show how dogged we are at Cavey Law. We thank AK for her patience and faith in us.