A person whose Social Security disability benefits claim is denied generally has the right to appeal the decision in a federal court. But what about when the bureaucrats charged with reviewing disability claims drag their feet? Can the claimant sue to force a decision? The Seventh Circuit explains in McDonald v. Astrue.
Plaintiff Michelle McDonald filed a claim for Social Security Disability Insurance and Supplemental Security Income benefits in late 2008. In her claim, Plaintiff asserted that she's unable to work due to back injuries stemming from a medical procedure. After the Social Security Administration (SSA) denied her application initially and on reconsideration, Plaintiff appeared at an administrative hearing before an SSA Administrative Law Judge (ALJ) in September 2010. Following this hearing, the SSA informed Plaintiff that it would hold a supplemental hearing in April 2011, at which time she could present the results of a consultative examination (performed by an independent physician contracted by the SSA) and other medical evidence.
One day before the scheduled hearing, Plaintiff filed a complaint against the SSA in federal district court asking the court to order the SSA to approve her claim and begin paying her disability benefits. On motion by the SSA, the district court dismissed the action, ruling that its power is limited to reviewing final decisions by the SSA and that the ALJ had not yet reached a final decision on Plaintiff's claim. The district court did, however, grant Plaintiff leave to refile once she received the Commissioner's final ruling.
Plaintiff subsequently failed to appear at the supplemental administrative hearing. The ALJ dismissed her request for a third hearing, finding that Plaintiff did not establish good cause for failing to appear at the previous hearing. At this point, Plaintiff filed a motion in district court arguing that the ALJ's dismissal of her third hearing was misconduct and retaliatory. The district court denied this motion.
The Seventh Circuit upheld the district court's dismissal on appeal, rejecting Plaintiff's argument that she has a Constitutional due process right to have her benefits claim adjudicated by the SSA in less than 270 days, the agency's stated benchmark for reaching a decision in a hearing case. In so doing, the court noted that although a plaintiff must exhaust all administrative remedies - in other words receive a final decision from the SSA - before filing an action for benefits in federal court, this requirement is waived "when the claimant presents a colorable constitutional challenge" regarding the SSA's claim review. Citing the Supreme Court's decision in Heckler v. Day, however, the court further ruled it does not have the power to impose mandatory deadlines for processing a Social Security claims. Furthermore, the 270-day period, according to the court, is merely a goal, not a hard deadline. As a result, the court held that Plaintiff does not have a Constitutionally protected tight to have her claim decided on within 270 days.
The Social Security disability claims process is complex and, even for those individuals who are clearly eligible for benefits, often requires multiple appeals. An experienced Social Security disability lawyer can help a client prepare a benefits claim and supporting information to ensure that it is reviewed by the SSA in the most efficient possible manner and follow up throughout the claims process to ensure that the SSA has all of the necessary information and documentation.
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