Res Judicata and Social Security Disability Benefits

 Posted on August 16, 2011 in Social Security Disability

You went through the Social Security disability benefits process and unfortunately lost your hearing in front of an Administrative Law Judge. After you receive the letter of denial, although your medical condition is the same, you decide not to give up and start a brand new claim.

You apply for Social Security disability benefits and your new claim is now denied. You later appealed that decision by filing a Request for Reconsideration, and that was denied. You then filed a second appeal, also known as a Request for Hearing by Administrative Law Judge, hoping to eventually have your second day in court and that was denied as well. This time, your denial letter from the Social Security Administration states that your claim has been denied because of something called res judicata. As you read the letter, you see the Latin words and have no idea what they are talking about. What is res judicata and why are you unable to have your second day in court?

Res judicata is a Latin term meaning "a thing adjudged" and in the legal field is a case that has had a final judgment and is no longer subject to appeal. One of the biggest reasons for incorporating res judicata into the legal system has been to avoid unnecessary resources in the court system. And yes, the arm of res judicata has reached decisions under the Social Security Act. What this means for you is that if you have already had your day in court and lost your case and now have a new claim that meets the conditions of res judicata, the Social Security Administration can legally reject it from proceeding to court for a second hearing.

What are the conditions that must be met for administrative res judicata to apply? There are three conditions that all must be met under 20 CFR 404.957(c)(1) and 416.1457(c)(1), they are:

1. There has been a previous determination or decision under the same subpart with respect to the same party.

2. The previous determination or decision was based on the same facts and on the same issue (s).

3. The previous determination or decision has become final by either administrative or judicial action.

If all three of the conditions are met, the Administrative Law Judge should apply res judicata.

In the scenario above, for your Social Security disability benefits claim to have been denied based on res judicata, the Social Security Administration must have determined that your new case has no new and material evidence. In other words, you probably did not submit any medical records demonstrating that your condition(s) have gotten worse since you previous applied for disability benefits. Since you lost your case previously in front of a judge, it counted as a final determination. And you, being the same party to the previous hearing, lost the case. Therefore, you will be prevented under this doctrine from proceeding unless your condition gets worse or you develop new medical conditions for which you can apply for disability benefits.

Are there ways around res judicata? In the example above, probably not. There are indeed ways around the doctrine, the easiest being to prove that your medical conditions are new and have gotten worse, preferably using a medical source statement with attached progress notes to do so. In general, res judicata can become a very complex matter and should be handled by a Social Security disability lawyer. Examples of these situations are when there is a substitute party to the matter or a change in a statute or regulation. There are other exceptions as well.

If you applied for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits and received notice that your claim was denied due to the doctrine of administrative res judicata, feel free to contact a Social Security disability attorney for more information.