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IL disability lawyerMany 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.

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IL disability lawyerThere 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.

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IL disability lawyerAlthough Social Security disability insurance is a federal program, it relies on state agencies to evaluate claimants. In Illinois, the office of Disability Determination Services within the Department of Human Services will assign medical experts to review an applicant's medical history. The state reviewers' opinions are then submitted to a Social Security administrative law judge (ALJ), who must consider the record as a whole before making a final decision as to whether the applicant meets the legal criteria to receive disability benefits.

Social Security Failed to Consider 400 Pages of Records in Illinois Man's Disability Case

The state agency reviewers can only do their job properly, however, when they actually have access to all of the relevant medical evidence. Unfortunately, that is not always the case. For example, an Illinois federal magistrate judge recently ordered Social Security to conduct a new hearing for a disability applicant after it came to light the state agency reviewers never considered 400 pages of medical records relevant to the case.

The plaintiff in this case, George K. v. Berryhill, suffers from a number of physical impairments. Initially, the plaintiff's problems revolved around his back, which he seriously injured at work in 2011. But starting in 2015, the plaintiff also began to suffer from seizures and other “seizure-like activity.”

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