Appeals Court Awards Claimant 30 Years Worth of Past Due Benefits
Posted Nov 14 2011 11:06pm
A federal circuit court of appeals has awarded a widow 30 years worth of past due benefits on her late husband’s claim. The case involved the claim of Dr. Richard Frusher, a Rhode Island resident who applied for benefits based on mental illness in 1975.
Social Security denied his claim in 1975 and again in 1978. Disheartened, Dr. Frusher and his family gave up.
Fast forward to 2003, Dr. Frusher was approaching age 62 and he applied again, although this time for SSI only since he had long ago run out of SSDI credits. Noting that there was evidence in the file confirming that his mental health issues dated back to the early 1970′s, Dr. Frusher’s lawyer filed an appeal to the Appeals Council arguing that “good cause” existed for the Appeals Council to reopen his 1978 application on the grounds that Dr. Frusher’s schizophrenic condition prevented him from understanding his appeal rights, and that those rights were still available to him.
Example: Tom files Claim #1 on March 1, 2008, and it is denied July 12, 2008. Tom does not appeal, but files a new claim on April 3, 2009.
Tom can move to reopen Claim #1 because it was filed within 1 year of July 12, 2008 (the date of Claim #1 denial). Tom would have to show some reason to reopen (i.e. there was evidence in existence that was not considered by SSA in claim #1) but he would not have to show “good cause.”
If Tom filed Claim #2 on August 1, 2009, he could not move to reopen “for any reason” since Claim #2 was filed more than 1 year after the initial denial of Claim #1.
Tom could ask SSA to reopen Claim #1 within four (4) years of the initial denial if he can show “good cause” (the time limit is 2 years in an SSI case). In my experience, Social Security judges consider “good cause” to be a very high standard and they rarely reopen on that basis.
The Frusher case is rare because Claim #1 was reopened well after the 4 year statute of limitation. SSA does allow a claim to be reopened “at any time” in the case of fraud or similar fault. The 1st Circuit found that Dr. Frusher’s failure to appeal was both not his fault (because of his mental illness) and that SSA acted wrongfully in denying him the opportunity to appeal.
What should you learn from all of this?
when you file for disability benefits, you are generally better off pursuing your appeal as opposed to dropping your case and starting over
if you do drop your appeal, or fail to appeal timely, generally it does not benefit you to wait to reapply
if you are confused about your insured status for SSDI or about your appeal rights, contact a lawyer sooner rather than later