4 Things A Disability Administrative Law Judge Looks For When Making A Benefit Decision

Posted on : March 16, 2016Posted By : Russell & Hill, PLLCPosted In : SSD

Going through the process of obtaining social security disability benefits can be complicated. Unfortunately, a significant percentage of initial applications are denied. The first step to obtaining benefits after a denial is to appeal the decision and ask for a reconsideration. However, reconsideration efforts are not always successful. It may be necessary to continue the appeals process to the level of an administrative law judge. At Russell & Hill, PLLC, our social security disability attorneys in Everett have extensive experience handling these claims, and we want to discuss some of the important factors to take into consideration if your case is going to need to go before an administrative law judge.

Since many claimants are denied at the Application and Reconsideration levels of the disability process, it is important to know what the administrative law judge (ALJ) is looking for when making a decision at the Hearing level.

Generally speaking, ALJs look for:

  1. Credible claimant testimony
  2. Sufficient medical records
  3. The claimant’s efforts throughout the process to get better and the medical treatment the claimant has undergone, and
  4. Opinion evidence from a treating provider.

Let’s look at these in more depth:

Credible Claimant Testimony

Claimants are sworn under oath when giving testimony, so honesty is imperative. Inconsistent or exaggerated statements can lead an ALJ to find the claimant not credible.

Other issues may influence a judge’s perspective on a claimant’s credibility as well, such as a claimant’s work history prior to her disability, activities of daily living, compliance with medical treatment, substance abuse, and criminal history.

If a claimant’s impairments are largely subjective in nature, credible testimony is even more important.

Sufficient Medical Records

The primary source of evidence in a disability claim is the claimant’s medical records. The Social Security Administration (SSA) orders a claimant’s medical records at the Application and Reconsideration levels. The claimant and her social security disability attorney develop the medical record at the Hearing level.

Judges like to see consistent medical treatment from the start of a claimant’s disability. If a claimant does not talk openly with her doctors about her symptoms, pain, and limitations, then the medical records will not include this information. Any complaint a claimant makes on testimony should be corroborated by her medical records. This means a claimant must get regular medical treatment and she needs to discuss her problems with her doctor so there is documentation of her limitations.

The effort from the Claimant

Judges expect effort from the claimant. They expect a claimant to cooperate with the system. Seeking disability is a long and difficult process, but a claimant’s failure to cooperate (e.g., does not fill out necessary paperwork or does not go to a consultative examination), can cause problems for the claimant.

Judges also like to see claimants making efforts to get the treatment they need to improve. If a claimant is not following a doctor’s recommendation, it is important to have a good reason why. Judges often want to see more than conservative treatment. For instance, if a claimant’s case focuses on her mental health, and she is receiving medication for her impairment from her primary care doctor, the judge may wonder why the claimant is not also involved in regular mental health counseling.

Opinion from Treating Doctor

Opinion evidence is very important in a disability case. Medical records provide information regarding the claimant’s symptom complaints, examination findings, treatments, and recommendations for future treatment, but they typically do not include a doctor’s opinion regarding a claimant’s functional limitations.

Judges like to see opinions from medical providers who are treating the claimant regularly and know the claimant well. It is important for a claimant to build a good relationship with her medical provider(s) so hopefully, the provider will support the claimant in her disability claim.

Time limit to appeal disability claim denials

Any person who has received a disability denial needs to know that they have a limited amount of time to file an appeal. According to information from the Social Security Administration, you are entitled to an appeal. However, the SSA says that you have 60 days after receiving a notice of a denial decision to ask for any type of appeal.

You are on this page because you are looking for information related to an administrative law judge hearing concerning your social security disability. However, this is only one of the levels of appeal for the disability denial process. There are a total of four levels of appeal, including the following:

  1. Reconsideration,
  2. Hearing by an administrative law judge,
  3. Review by the Appeals Council, and
  4. Federal Court review

A request for reconsideration, a hearing by an administrative law judge, and a review by the Appeals Council can be made online. Please refer to the guidance in your denial letter. If you have any questions, an attorney will be able to assist you through this process.

Is the judge on the side of the SSA?

A hearing will be conducted by an administrative law judge who had no part in the original determination or the reconsideration of your case. In general, these hearings will be held within 75 miles from your home, though you can also have the hearing by video. A video hearing will have the same look and feel like a traditional in-person hearing.

An administrative law judge will not have a bias towards one side or the other. The judge is there to listen to the facts of the case and render the decision that they think best serves the situation.

Help From Social Security Disability Attorneys in Everett

At Russell and Hill, PLLC our social security disability attorneys in Everett can assist a claimant by providing an effective questionnaire for her doctor that will ask specific questions relevant to the claimant’s disability claim. This will help develop the type of opinion evidence judges like to see.

Our team of attorneys in Snohomish County would love to help you obtain social security and disability benefits. If you’re looking for qualified, experienced legal assistance, we’re your reliable team. Give us a call at 888-399-0921 or fill out our contact form.

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