As advanced as medical technology is, it is not perfect. There are many people who suffer physical or mental ailments with no clear cause. Even trained doctors may look at the same patient presenting the same symptoms and reach different conclusions. But how does Social Security deal with such lack of consensus when assessing disability benefit applications.

Magistrate Orders New Disability Hearing After ALJ Failed to Consult Any Medical Experts

As is often the case with Social Security, their first instinct is often to declare the applicant is not disabled. In some situations, a Social Security administrative law judge (ALJ) may simply make guesses about the applicant's actual medical condition. Such an approach is not only unscientific, but it also goes against how the law is supposed to work in this area.

A recent decision from a federal magistrate judge here in Illinois offers a helpful illustration. In this case, a 43-year-old woman applied for disability benefits four years ago. In her application, the plaintiff described a variety of impairments that have rendered her unable to return to full-time work.

Many Social Security disability applicants often get tripped up by the process. They may assume they qualify as “disabled” based on a prior doctor's diagnosis or state-agency decision. But Social Security has its own standards for assessing disability. And if you proceed without fully developing the record in support of your claim, you are likely to be denied benefits, even if your case has merit.

Appeals Court Upholds Social Security Decision Despite ALJ's Failure to Fully Develop the Record

A recent decision from the U.S. Seventh Circuit Court of Appeals, Elder v. Berryhill, helps illustrate the hurdles that disability applicants face. The plaintiff in this case applied for disability benefits in 2012, alleging he had been unable to work since 2010 due to a number of physical impairment.

The plaintiff presented his own case to an administrative law judge (ALJ) without the assistance of a qualified disability attorney. At the hearing, the plaintiff said the Illinois Department of Human Services “deemed him disabled and provided him with a home-care assistant.” The plaintiff further testified he suffered from “excessive pain” and required constant medication.

There are typically four stages to the Social Security disability application process. First, the applicant receives an initial determination of their eligibility. If the initial determination finds the applicant is not disabled, they may ask for reconsideration of that decision. If Social Security still rejects the claim, the applicant may request a formal hearing before an administrative law judge (ALJ). If the ALJ rejects the application, the fourth and final step is to ask for a review from the Social Security Administration's Appeals Council.

If even after all four steps, Social Security still denies a disability claim, the applicant can then seek “judicial review,” i.e., file a lawsuit in federal court. The Social Security Act expressly guarantees the right to judicial review of “any final decision … after a hearing.”

When Is a Social Security Decision Final?

The U.S. Supreme Court recently weighed in on what exactly the law means when it says “any final decision” can be appealed to the court. More precisely, if the Appeals Council dismisses a fourth-step appeal due to a procedural issue, is that a “final decision” that can be reviewed by a judge.