There are three types of decisions you can receive after a Social Security Administrative hearing: Fully Favorable, Partially Favorable, and Unfavorable. Fully Favorable and Unfavorable are straightforward, either you won or you lost. However, Partially Favorable decisions are not so easy to interpret. A Partially Favorable decision means that the judge found you disabled, but either not for the time period you alleged in your application or for a closed-period of disability.
A Partially Favorable decision that grants benefits but not for the time period you alleged in your application just means that the judge agrees that you are disabled but believes that you did not become disabled until a later date. All the judge has done in this case is change the onset date of your disability. This affects your benefits in two ways:
- You are not awarded any benefits for the time period prior to the new onset date in your decision; and
- The new onset date in your decision will be used to determine when you are eligible for Medicare (in SSDI cases only).
A Partially Favorable decision that grants benefits for a closed-period of disability means that the judge agrees that you were disabled for a definite period of time, but that since then, you have improved to the point that you are able to return to work. This affects your benefits in two ways as well: (1) you are only awarded benefits during that time period and will not receive any more benefits going forward; and (2) you are not going to be eligible for Medicare except in the most rare of occasions, and it will not be current Medicare coverage, but eligibility for those services in the past.
As with any Social Security Disability Decision, the claimant has the option of appealing a Partially Favorable Decision. However, when deciding whether to appeal a Partially Favorable decision, you must keep a few things in mind. First, you are not just appealing the “Partially” part of the decision, you are appealing the entire decision. The Appeals Council will not look at only the amendment of your onset date, but your case as a whole. This means that the Appeals Council could determine that you are not disabled and take away all of your benefits. Second, any benefits which you have received or receive while the Appeals Council is determining whether the Partially Favorable decision was correct will have to be repaid to Social Security if you are found to be not disabled by the Appeals Council or at a subsequent hearing. Third, there must be a plain error of law or new and material evidence to justify overturning the prior judge’s decision. It cannot be that you are just dissatisfied with your decision. Therefore, you should carefully evaluate the evidence in your case with your attorney to determine if your case warrants an appeal.
If you receive a Partially Favorable decision, you should consider the risk involved in appealing that decision versus the benefits that you are currently receiving or will receive. While it is oftentimes hard or seemingly impossible to wait for Medicare coverage, the risk of appealing these decisions is sometimes not beneficial. While there are obvious cases wherein the administrative law judge has made an error, not every case will warrant an appeal. Therefore, if you receive a Partially Favorable decision, you should weigh your relative options and make an informed decision as to whether you will appeal that decision or not.
To better understand your case and find quality legal representation, call the Nevada SSD benefits lawyers at Shook & Stone for a consultation at (877) 910-2220.