What Is Negligence
Negligence in Social Security disability claims refers to a failure by the SSA, your representative, or a medical provider to exercise reasonable care in handling your case or evidence. In the disability benefits context, this typically means the SSA failed to properly develop your medical record, lost submitted evidence, or missed filing deadlines that harmed your claim.
Negligence in SSA Decisions
The SSA denies approximately 66% of initial SSDI applications and 80% of SSI claims. Many denials occur because the SSA insufficiently developed the medical evidence despite a claimant's clear inability to work. This can constitute negligence if the agency failed to request necessary medical records from treating physicians, order consultative examinations when medically appropriate, or adequately weigh existing evidence of your condition.
When an ALJ (Administrative Law Judge) finds the SSA negligently handled evidence development, this can form grounds for remand back to the agency for proper reconsideration. A remand does not guarantee approval, but it gives your case a second evaluation with correct procedures.
Evidence Handling and Back Pay
The SSA maintains detailed file requirements for disability claims. If your representative submitted medical records through the online portal and the agency lost them, this constitutes actionable negligence that can delay your claim by 6 to 18 months. Lost evidence directly impacts back pay calculations. SSDI back pay accrues from your alleged onset date until approval; SSI back pay typically begins the month after application. A negligent loss of evidence that extends processing time directly reduces your lump-sum back payment.
You can file a separate administrative complaint with the SSA's Office of the Inspector General if negligence occurs. Document all submissions with dates, methods, and any SSA acknowledgments.
Negligence by Your Representative
Your disability representative (attorney or non-attorney representative) has a duty to act in your best interest. Failing to meet the ALJ hearing date, submitting your brief after the deadline, or failing to raise material evidence at the hearing constitutes negligence that may warrant case reassignment. The Social Security Administration allows you to request a new hearing before a different ALJ if your representative's negligence materially harmed your case presentation.
Common Questions
- Can I sue the SSA for negligence? Not directly. The Federal Tort Claims Act provides limited avenues. Your remedy is typically a request for case remand through the Appeals Council or federal court review under 42 U.S.C. Section 405(g), which requires showing the agency's error caused demonstrable harm to your claim.
- What counts as negligence versus normal processing delays? Standard processing takes 3 to 5 months for initial claims. Negligence involves lost documents despite proof of submission, missed deadlines not explained by workload, or failure to follow explicit instructions you provided in writing regarding evidence submission.
- Does negligence automatically win my case? No. Finding negligence in the process grants you reconsideration or a new hearing, but your underlying medical eligibility for benefits must still meet SSA criteria. Negligence corrects procedural failures, not medical determinations.