Appeals Council Remand After a Favorable Hearing

Case Study: Social Security Disability Appeals Council

This blog article will focus on a recent case that our firm had. Early in 2019 a client had a hearing that with the assistance of our law firm representation resulted in a fully favorable decision with an onset date of 10/1/2012 in her Social Security Disability case. She suffered from many physical and some mental health impairments that together resulted in a finding that she was unable to perform any job that existed in the national economy. Specifically, the ALJ in the case found that the Claimant would be absent at least 2 days per month as a part of her residual functional capacity. The decision was received in April 2019 and all seemed well.

Then, a decision from the Appeals Council was sent down in August 2019 that remanded the case for another hearing to address certain aspects of the record that were not covered in the decision. The Appeals Council is the level of authority that is a level higher than an Administrative Law Judge that presides at an administrative hearing (they are also who a case is sent to when a Claimant wants to appeal a hearing decision). First question, how did this happen? While it isn’t published anywhere, I have been told by ALJs that have sat on the AC that approximately 1 in 7 fully favorable cases is selected for random quality control reviews. Rarely do they ever get remanded for a hearing. For our firm, which handles hundreds of hearings per month, I would say it happens less than 3 times per year.

The specific issue in this case was that in the AC’s analysis of the medical record, there was an indication that the Claimant was potentially cleaning houses for cash after her onset date. Specifically, when visiting her medical providers notes were taken that stated she had been self employed or had worked on housekeeping 3-4 houses as part of her schedule. The Claimant adamantly denied these allegations and contends that they are false. While she had cleaned a house for a friend, she never did that work or any other since 10/1/2012 (around the time she had a significant surgery).

Nonetheless, we had a hearing in January 2020. The Claimant was forced to come back and refute this claim. Additionally, I argued that even if the ALJ finds/contends that work was done as reported it is difficult to ascertain that the work would’ve or could’ve risen to a level of substantial gainful activity AND that the prior ALJ likely DID take this into consideration with the one sentence ruling in the decision stating that the Claimant had not worked above SGA since 10/1/2012. The new hearing decision is still pending.

There are other reasons why fully favorable decisions are remanded such as incorrect application of the law, typographic errors with dates or impairments, improper medical justification for a decision, etc. that will be addresses in future blog articles. At the end of the day there is really nothing a Claimant or attorney can do to prevent this. It comes down the thoroughness of the ALJ’s decision and the detail required by the AC to uphold it.