By Eric Michael, Supervising Attorney, Public Benefits Unit
In terms of public benefits advocacy, the statistically rarest form of victory is when the Social Security Administration’s (“SSA”) Appeals Council overturns a judge’s disability denial and awards a claimant benefits without requiring a new hearing.
Martin (fictious name) was 36 years old, living in a temporary shelter, and suffering from severe complications with HIV and other infections, when he came to Community Legal Aid SoCal (CLA SoCal) in March 2021 seeking help with an upcoming disability hearing. Given SSA’s slow appeals process, which was only exacerbated by the Covid-19 pandemic, Martin had been waiting nearly two years to have the appeal of his Supplemental Security Income (“SSI”) denial heard. The Public Benefits Unit eagerly agreed to provide Martin with full representation at his hearing, including pre- and post-hearing advocacy. Additionally, medical records from numerous healthcare facilities were obtained and submitted on Martin’s behalf.
An advocate from the Public Benefits Unit presented a compelling case for why Martin could no longer work due to his severe medical conditions, and underscored why the judge should find Martin disabled and eligible for monthly SSI benefits he so vitally needed. Unfortunately, the judge issued an unfavorable decision that, among other errors, relied upon findings of a government disability examiner who omitted 168 pages from their review of the medical records; Pages that extensively detailed one of Martin’s several lengthy hospitalizations.
The Public Benefits Unit advised Martin of his options to appeal the judge’s egregious decision. He was informed of the lengthy time it takes to get a decision from the Appeals Council (up to 24 months), and the statistical likelihood of potential outcomes. The reality is that the Appeals Council grants review of very few decisions (14 percent). Of those they review, the vast majority are upheld, with only 13 percent remanded for a new hearing, and less than 1 percent reversed with benefits granted to the claimant. Despite the unfortunate timetable and dismal odds, Martin agreed with our recommendation to appeal the judge’s decision.
The Public Benefits Unit prepared a legal brief that was submitted in support of their request for Appeals Council review. It outlined three material errors committed by the judge, and requested the Appeals Council reverse the judge’s unfavorable decision. In March 2023, after 18 agonizing months of waiting, the Client received fantastic news. The Appeals Council reversed the judge’s decision! Not only would Martin begin receiving more than $1,000 in monthly SSI benefits, but he would be awarded backpay dating back to March 2019, totaling $51,000.
Lesson learned? You can throw out the statistics when a client with disabilities has been denied justice and the CLA SoCal Public Benefits Unit is on the case.
