What is a “Fully Favorable” Decision and What Would That Mean For My SSDI Claim?

What is a “Fully Favorable” Decision and What Would That Mean For My SSDI Claim?

A “fully favorable” decision is rendered by an administrative law judge (ALJ) after evaluating a second appeal filed by a SSDI claimant. This means the ALJ has essentially overturned the denial handed down during the first appeal (reconsideration) and the claimant will now begin receiving monthly disability benefits. In addition, a fully favorable decision also means the ALJ has determined the onset date of a disabling medical condition included in the claimant’s original application is correct. In other words, the individual receiving an ALJ’s fully favorable will receive back pay starting when their medical condition made it impossible for them to work.

What is a “Partially Favorable” Decision?

When an ALJ delivers a partially favorable decision, this indicates the judge did indeed find the individual is fully disabled but that the disability did not begin on the alleged onset date. The ALJ will instead determine the onset dateafter examining the claimant’s medical documents and work records. Partially favorable decisions means claimants won’t receive any retroactive payments dating back to the onset date they asserted in their original disability application.

Neither a partially favorable nor a fully favorable decision impacts the amount of SSDI monthly benefits you expect to receive. The primary difference between fully favorable and partially favorable decisions is an ALJ accepting the original onset date or replacing that date with one the judge considers to be more accurate.

Can I Appeal a Partially Favorable Decision?

Yes, you can. Depending on how much retroactive pay you lose when an ALJ renders a partially favorable decision, you might want to consider appealing this decision to the Social Security Appeals Council. Always consult with an experienced disability attorney before filing an appeal to the Appeals Council.

The Social Security Appeals Council doesn’t automatically accept all requests for appealing an ALJ decision. However, they will review your case and decide to take the case or send it back to an administrative law judge for additional review.

An example of the possible difference between a fully favorable decision and a partially favorable decision might go something like this:

  • You submit your first application for SSDI to the Social Security Administration. You claim the onset date of your disability is May 1, 2018
  • The SSA denies your application. You file an appeal to an ALJ.
  • On May 1, 2020, the ALJ approves your SSDI application and gives you a fully favorable decision
  • You begin receiving monthly benefits plus receive retroactive pay dated from May 1, 2018

If your SSDI monthly benefits are $2000, then you should receive 24 months of retroactive pay. This amounts to $48,000.

Now, what happens if the ALJ hands down a partially favorable decision and determines your disability onset date is May 1, 2019 instead of May 1, 2018? What it means is that instead of receiving $48,000 in retroactive pay, you will only be entitled to half of that amount, or $24,000.

Any disability lawyer will strongly urge SSDI applicants who have received a partially favorable decision from an ALJ and want to appeal to consult with a seasoned disability attorney who can give you solid legal advice regarding your ability to win an appeal.

What Happens If I Want to Appeal a Social Security Appeals Council Decision?

If the SSA, administrative law judge and Appeal Council has either denied or give you a partially favorable decision that you do not agree with, a final appeal can be made at the federal level. At this point, your appeal becomes a civil suit that must be filed in a Federal district court. It cannot be filed online and there is a fee to file an appeal with a Federal district court. You may have this fee waived if you can show you are unable to pay the fee.

SSDI appeals filed at the federal level are considered “complaints” rather than appeals. Essentially, you are suing the Social Security Administration and associated appeal level entities for denying your disability benefits. Attorneys representing the SSA will defend the denial in court. If you take a denial this far, be aware it could take a year or longer to receive a final determination from a Federal district court judge.

What is the Definition of a Disability Onset Date? 

The date on which you became physically and/or mentally unable to work is the disability onset date. For example, if you were in a terrible car accident and sustained permanent paralysis of your legs, the date of your accident is your disability onset date. Alternately, if you had been working as a paralegal for the past five years and began experiencing worsening symptoms of COPD, your disability onset date would be the last day you were able to work, whether it was eight hours or four hours. In other words, a person diagnosed with mild COPD symptoms on May 1, 2019 who continued to work until May 1, 2020 cannot assert their disability onset date was the day they learned they had COPD.

To determine if they agree with a claimant’s disability onset date, the SSA will look at the following:

  • Statement of applicant regarding onset date that is included on the official disability report
  • The applicants Work Activity Report indicating when they could no longer work
  • Medical documentation proving the progressive worsening of symptoms that prevent the applicant from working (should include doctor’s reports of physical exams, lab tests and anything else supporting the disability onset date claim)

SSDI claimants with severe mental illnesses need to put the onset date of their psychological disability on a special form called the “Report on Individual with Mental Impairment”. Evidence evaluated by the SSA for determining accuracy of onset date for mental illnesses include:

  • Comprehensive medical reports written by psychiatrists, physicians and psychologists
  • Medical history documenting when symptoms first appeared (specifically, when the person first sought help for symptoms)
  • Hospitalization records (length of stay, medications prescribed)
  • Detailed statements by one or more hospital staff members describing patient’s behaviors (these statements could support the earliest onset date of the disability)

In some cases, the SSA may contact an applicant’s parents, siblings, previous employers and other relevant individuals when they are unsure of a disability onset date. However, they can only do this with the applicant’s permission.

How Will I Be Notified of a Fully Favorable Decision?

The Social Security Administration will also notify you of an approval or denial by sending a letter to your address through the mail. They will never call or email claimants to inform them of a decision. If your appeal is approved, your award letter will contain the following information:

  • How much your SSDI monthly benefit will be (this amount may change on a yearly basis depending on Congressionally-passed increases due to inflation, cost of living, etc)
  • When your first disability payment will be direct deposited into your account
  • List of online services provided by the Social Security Administration

With the SSA being such a vast and sometimes unpredictable federal department, you could receive a payment before you receive an actual approval letter in the mail. When a fully favorable decision involves remittance of retroactive pay, you will receive your back pay as a lump sum separate from your monthly disability payment.

Should I Hire a Disability Lawyer to Handle My Appeals Case?

Over half of all SSDI claims are initially denied due to paperwork errors and lack of sufficient medical documentation proving an applicant is disabled. If you applied for SSDI and receive a denial letter, contact Joel Thrift as soon as possible to schedule a consultation appointment. At this point in the appeals process, you need the legal expertise of an experienced disability attorney like Joel Thrift to ensure the best possible outcome of appealing to an administrative law judge–a fully favorable decision. Mr. Thrift will manage your case from start to finish so you don’t have to worry about filing court papers, filling out complicated forms or gathering pertinent medical documents. Disability attorneys also present records of your daily activities and cross-examine medical and vocational experts when necessary.

Don’t wait any longer to appeal your denied SSDI claim. Contact Joel Thrift Law today for immediate assistance.