Have You Received an Unfavorable ALJ Decision? Follow Our SSD Denial Appeal Guide

If you receive an unfavorable decision from the Administrative Law Judge (ALJ), you can face ongoing financial strain and be limited in the treatment you can receive to overcome your impairment. While this might feel like the final step in your fight to receive the social security disability benefits you deserve, we are here to tell you there are further steps you can take to ensure your denial is reversed. This is our comprehensive SSD Denial Appeal guide with all the information you need to know the hows and whys behind an unfavorable ALJ decision and steps you can take to see the favorable decision you deserve.

What Does an Unfavorable Decision From the Administrative Law Judge Mean?

If you receive notice of an unfavorable decision, the unfavorable decision definition basically means the ALJ has considered the evidence presented and determined you do not meet the Social Security Administration’s (SSA) definition of disability. Your notice must include the judge’s explanation outlining why they found you did not meet the criteria at any time before or during your application process. Your notice will include your name, Social Security number, and whether your unfavorable decision is SSI or SSDI. There are then five sections covering the details of the claim and denial:

1. Jurisdiction and Procedural History outlining the date you filed your initial application, your alleged onset date (AOD), and if your claim was for SSDI claim, the date you were last insured.
2. Issues describing whether you meet the legal definition of disability.
3. Applicable Law outlining the SSA’s sequential evaluation in the approval process for the benefits you applied for.
4. Findings of Fact and Conclusions of Law with a detailed explanation telling you the exact legal reasons the judge came to their decision, based on the applicable laws and the facts presented for your case.
5. Decision with a brief conclusion stating the final decision of the ALJ dated and signed by the judge.

The accompanying cover letter will state “Notice of Decision – Unfavorable” explaining how you can appeal your denial. In some cases, the cover letter is not included, in which case you can contact your local Social Security Administration field office.

Understanding Your “Notice Of Decisions – Unfavorable”

While section #1 is only the basic information, you might have more difficulty in sections 2 to 5. Here we explain more about the information included.

2. Issues

This section addresses the SSA’s definition of “disability”:

“the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

Here the judge might point out details such as your condition has not lasted 12 months or that you are able to engage in substantial gainful activity (SGA).

3. Applicable Law

In this section, the judge considers the sequential process that provides proof you are considered disabled. The judge will list the steps with any relevant information that led to their decision at each step of our assessment. We can into more detail about this below.

4. Findings of Fact and Conclusions of Law

As mentioned, this is the most detailed section, and the findings are easy to spot because they are usually bolded. The ALJ will provide the following explanations:

Your Work Status: If you are working at or above the level of substantial gainful activity (SGA) since your alleged onset date and earning more than $1,350 per month (in 2022), the judge will disregard claims of impairments and instead find you are not eligible since you are able to earn an income above the legally allowed limit.

Impairment Severity: The ALJ considers any severe impairments that you claim impact your ability to work. They review the evidence and will then explain why they found your claims of severe impairment untrue.

Medical Disability: If you claimed you suffer from medical disabilities, but the ALJ finds the conditions and symptoms you experience do not fit the criteria in the SSA blue book, they explain why your condition does not meet the criteria, whether it is based on an approved SSA condition, or you claim you have a condition equaling the listing requirements.

Physical and Mental Restrictions: This is where the ALJ explains the very specific reasons they find you have the residual functional capacity (RFC) to perform certain tasks. The RFC outlines your limitations, and the judge will explain why they feel your limitations are not severe enough to perform work physically or mentally. They also include a detailed discussion of the medical evidence and your testimony and why they feel your activities of living demonstrate your limitations are not as severe as you claim.

In the case where the ALJ disagrees with aspects of a doctor’s opinion, they must refer to the specific evidence they find objectionable and why. They also cover why they might rule based on the opinion of one medical professional over another. Other considerations covered in this section might include an assessment of substance use if you have a history of drug or alcohol abuse. The judge might find that substance abuse is the cause and/or worsening of your symptoms and rule against you.

Past Jobs: A major part of the decision is based on your RFC to determine your ability to work. For example, if your current job calls for standing but your RFC shows you can sit or vice versa, and past jobs have the skills to perform this work, they will explain this is why they ruled against you.

Other Work: If you can’t do past work but can learn new skills and fill new roles, the judge will explain what these skills might be and why they find you are able to perform them.

Why Did the Administrative Law Judge Deny My Disability Claim?

To better understand why the judge made an unfavorable decision, you can review how your application fared throughout the sequential evaluation process. The judge outlines why they made their decision at each step of the process. The ALJ must base their decision on the legal term of disability and all the steps the adjudicator follows to determine if you qualify for disability. In a typical unfavorable decision, the judge’s decision is based on the following five steps and elements of the sequential evaluation process:

1. Ability to Perform SGA and Earn An Income

The first step is considered the non-medical step of the assessment. Here the judge looks at when and if you have stopped earning income at or above the level of substantial gainful activity (SGA). This amount changes yearly and was set at $1,350 per month for 2022. Income above the threshold is an automatic denial.

2. The Severity of Your Impairment(s)

If you passed the non-medical criteria, the ALJ next discusses the severity of your impairments. They use Social Security’s definition of disability based on whether your condition significantly restricts your activities of daily living for at least one year. If this is not the case, your decision is unfavorable with an explanation as to why this determination was made. If the ALJ finds any of your impairments are severe, they move on to the next step.

3. Whether Your Impairment Meets a Disability Listing

The AJL provides their opinion on whether they find your impairment meets or equals one of the medical listings in the SSA’s blue book. These conditions automatically qualify for approval as long as there is supporting medical evidence. If you don’t have a listed condition, you can also prove you have a condition equal to a disability listing. The judge will list why you do or do not meet this criterion and refer to specific medical evidence you provided to substantiate their decision. In the case they find you don’t meet the criteria, they will move on to the fourth step of the analysis.

4. Your Ability to Perform Past Work

This step determines your ability to perform any of the work you have done in the past 15 years. Your past work is classified by the ALJ based on the physical demands and exertion/skill levels of this work to determine your ability to perform SGA in any of these positions. They include a Department of Labor (DOT) number for the jobs you’ve performed and discuss their opinion on whether they think you can or can’t perform these listed jobs. This is where they review your RFC and also consider any testimonials made by a vocational expert at your hearing. They will explain their opinion on whether they feel you can or cannot perform past work. If you can, this is the reason for the denial. If you can’t, they move on to the final step.

5. Your Ability to Perform Other Work

Here the ALJ’s analysis considers your medically documented symptoms, statements from your treating medical team, consultative examiner opinions, lab tests and imaging, and all hearing testimonies to discover inconsistencies. They need to make a final decision based on all the evidence provided to decide if it supports your claim of being as physically or mentally limited as you claim.

They also must determine if your evidence shows there is a possibility you can perform other work based on your age, education, and skills from your past work to see if the medical-vocational grid rules say that you’re disabled. They also consider the vocational expert’s testimony before deciding whether you are disabled or not. Their entire analysis and findings must be explained in full detail, addressing inconsistencies, vocational expert opinions, and why they do not feel you should be awarded benefits or how all the evidence points to your eligibility.

What Are My Options If I Received An Unfavorable ALJ Decision?

When you receive an unfavorable decision based on non-medical criteria, you really don’t have any recourse to change the SSA’s mind. These decisions are based on income and cannot be disputed. However, if the decision is based on medical criteria and work ability, you have a right to appeal the decision before the Appeals Council. When filing an appeal, you can work with a disability representative to put together solid evidence to establish that the severity of your impairment and work history keeps you from finding work. However, in some cases, it is easier to simply file a new claim instead of a social security disability hearing. A free consultation can help you decide which steps to take and whether an appeal to the appeals court is worthwhile.

Should I Contact An Attorney Or A Disability Advocate?

When your claim is denied, you can try to present your appeal to the Appeals Council on your own or hire a representative for assistance. The appeal council will review your case, and a disability advocate or licensed attorney experienced in social security disability law can help. Here we compare the two to help you decide which makes more sense if you appeal the decision.

Disability Advocate

A disability advocate has legal training and expertise to help you win your appeal. Their job is to find medical evidence that proves you qualify for SSDI. They have extensive training and certification, allowing them to review your application, all the medical evidence you included, expert testimonies and look for a more solid and organized way to present the evidence to win your case. They also consider the AJL’s explanations and look for holes and gaps in their findings so they understand where your evidence requires further information. They represent your best interests and know how to overcome common challenges faced following denial of your SSDI claim.

Disability advocates have the training, college degrees, or experience equal to a college education as well as certification by passing a rigorous examination on SSA disability rules and regulations. They also undergo continuing education regulated by the SSA to ensure they are up to date on the latest rules, regulations, and processes so they are very capable at successfully winning appeals.

Disability Attorney

You can also hire a social security disability lawyer to represent you. They have extensive education, including a bachelor’s degree and a law degree. As lawyers, they are familiar with the litigation process and presenting an argument and evidence to support your claim. However, their focus is often on many different types of cases, so they might not have the same intimate knowledge as an advocate whose only job is to represent disability applicants.

When to Choose an Attorney vs. an Advocate

When choosing a representative, both attorneys and advocates offer equal knowledge. However, a disability advocate is more likely to understand the intricacies of ALJ decisions and can help you refile a claim before deciding to file an appeal before an administrative law judge. If you do decide to go with a lawyer, this is best for appeals. However, a disability advocate is equally able to represent you as disability clients are the only people they represent.

Appeals Council Requests for Review (RRs) are appeals of Administrative Law Judge (ALJ) decisions with 84,935 receipts, 88,635 dispositions, and 46,934 pending requests for review reported in 2022, according to disability appeals council statistics. You have a right to receive SSDI and appeal a decision made by an ALJ, so an appeals council will review your case.

At Princeton Disability, our job is to ensure you have all the required information to receive the maximum benefits you deserve, including all retroactive and back pay owed to you as a result of the delay of your approval. Reach out to our team today.