Many times, somebody will apply for Social Security Disability Insurance benefits, only to be denied. For various reasons, a claimant may decide to abandon the application, and not file an appeal within the required 60 day time limit. There are many reasons somebody may choose not to appeal. Some people, due to their condition, do not fully appreciate the applicable time limit for filing an appeal. Other claimants may get bad advice from friends, family members, even representatives of the Social Security Administration. However, prior applications, in some cases, can be reopened. In other cases, a new application can be filed, and the old application cannot act to prevent reconsideration of the disability claim.
Let’s start with reopening a prior claim. Generally, the statute and the rules provide that if a new application is filed within four years of the date of the prior application’s initial denial, there may be grounds to reopen the prior application. However, the applicant must show “good cause” for the reopening of the prior application. Examples of "good cause" could be the discovery of new and “material” medical evidence showing an inability to perform work activity within the time period of the prior application. This typically occurs with discovery of medical records that were not provided to the Social Security Administration during the consideration of the prior application.
Even if the time has elapsed for reopening a prior application for disability benefits, a claimant can file a new application for disability insurance, but faces the challenge of “res judicata.” This is a Latin term that stands for the proposition that once an administrative agency or a court makes a decision with a particular set of facts, that decision is final, and cannot be appealed or considered a second time. This doctrine is also often referred to as “claim preclusion.” However, new and material evidence can overcome this barrier to filing a new application.
A hypothetical case based on actual experience in our office helps to illustrate how to overcome the “claim preclusion” of a prior application. Let’s assume that a claimant applied for benefits, and was denied on June 30, 2005. Let’s also assume that the claimant was last insured for disability insurance benefits on June 30, 2004. In other words, in order to obtain disability insurance benefits, the claimant would have to show that he or she was disabled prior to the middle of 2004.
The claimant then decides to file for disability benefits on June 1, 2010. The problem this claimant faces is that a final determination has already been made that claimant was not disabled any time up until the date that she was last insured for disability benefits. The only way for this claimant to have her new application considered is if she can produce “new” and “material” evidence of her condition prior to the date she was last insured for disability benefits in the middle of June 2004.
The term “new” is self-explanatory. The information would have to be something that the Social Security Administration did not have in its file to consider in the prior application. “Material” refers to the type of new evidence. Stated another way, the evidence would have to speak directly to the alleged disabling condition. For example, if the claimant had a disabling low back condition, new medical evidence regarding treatment for the low back condition prior to June 2004 showing significant limitation would be material evidence because it speaks to the alleged disabling condition. This would allow the new application to go forward.
If the claimant established new and material evidence prior to the date she was last insured for disability benefits, and her claim was approved, this claimant would not receive retroactive benefits all the way back to 2004. Instead, the claimant would receive retroactive benefits going back one year from the date of the most recent application.
Reopening prior applications, and overcoming the issue of claim preclusion is challenging. If you have a denied claim, and you are facing these issues, call us at 503-325-8600. We have extensive experience researching these issues and successfully reopening prior applications.