Federal Court Says it Can Review Social Security Administration Appeals Council Decisions...Sort of - Taylor v.

Commissioner of Social Security
inShare | Share

December 7, 2011

Federal Courts have the power to review Social Security disability claims decisions, but just what, exactly, are the courts reviewing? The Ninth Circuit takes a stab at this question in Taylor v. Commissioner of Social Security. Plaintiff Steven Taylor filed a claim for Social Security Disability Insurance (SSDI) benefits, asserting that he's unable to work due to physical and mental impairments, including thoracic spine and lumbar spine degenerative disc disease, a panic disorder with agoraphobia and a personality disorder. The Social Security Administration (SSA) denied Plaintiff's benefits claim and an SSA Administrative Law Judge (ALJ) upheld this decision on appeal. Plaintiff then filed a request for review by the SSA's Appeals Council, which reviews ALJ decisions on benefits claims. Plaintiff included in the request a psychiatric evaluation noting his panic disorder with agoraphobia diagnosis and finding Plaintiff "markedly limited in his ability to perform several work-related functions," according to the court. The Appeals Council denied the request to review the ALJ's decision as untimely. The Council later re-opened its consideration of the matter, but again denied Plaintiff's request to review the ALJ's decision finding no basis for such action. Once the matter eventually made it up to the Ninth Circuit, the SSA argued that the Appeals Council's decision is not subject to review by the court. Generally, as the court pointed out, "[w]hen the Appeals Council denies a request for review, it is a non-final agency action not subject to judicial review because the ALJ's decision becomes the final decision of the Commissioner." As a result, the court can neither uphold nor overturn an Appeals Council decision. In this case, however, the court concluded that Plaintiff did not seek to overturn the Council's decision, but rather to overturn the ALJ's decision based on the new evidence submitted to the Council. Thus, according to the court, the matter was akin to Ramirez v. Shalala, 8 F.3d 1449, (9th Cir. 1993), in which it held that it could consider a physician's opinion that was rejected by the Appeals Council in order to determine whether the ALJ's underlying decision was supported by substantial evidence in light of the record as a whole. As such, the court was authorized to review the new evidence presented to the Council in the present matter and consider whether the ALJ's decision denying Plaintiff's claim was supported by the record.

but failed to do so. As experienced disability lawyers what we are really wondering is why the United States Attorney defending this claim felt the need to jump through procedural hoops to avoid having the claim decided on its merits with the new medical evidence? Isn't it the fundamental goal of the Social Security Act's administrative and court appeal process to reach the correct decision concerning whether or not the claimant is disabled? . remand to the ALJ is appropriate so that the ALJ can reconsider its decision in light of the additional evidence. chiding the Council for failing to consider the psychiatric evaluation.Nevertheless. drawn out and quite confusing. it makes clear that the disability claims process is often long.1) the Appeals Council must consider new evidence if it is material to the claim and 2) that the decision of the Appeals Council upholding the ALJ makes the ALJ determination the "final" decision." the court ruled in remanding the case to the ALJ for further consideration. Reading between the lines. While the court's ruling leaves the limits of judicial review of Social Security disability claims murky at best. however. which IS appealable. what the Court appears to be saying is not new at all. "Where the Appeals Council was required to consider additional evidence. the court went on to consider the Appeals Council's handling of Plaintiff's request for review.