Fornes v. Commissioner of Social Security Administration

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA

9 Joseph Edward Fornes, No. CV-24-03610-PHX-KML

10 Plaintiff, ORDER

11 v.

12 Commissioner of Social Security Administration, 13 Defendant. 14 15 Plaintiff Joseph Edward Fornes was found disabled but now seeks review of the 16 amount of his monthly social security benefits. The Commissioner moved to dismiss the 17 complaint, arguing Fornes did not exhaust his administrative remedies before bringing 18 suit. Because the court had to consider evidence outside of the pleadings, it converted the 19 Commissioner’s motion to dismiss into a motion for summary judgment and called for 20 supplemental briefing which is now complete. 21 Fornes did not exhaust his administrative remedies regarding the amount of 22 benefits he was awarded, so he may not yet bring this lawsuit. The Commissioner’s 23 motion for summary judgment is granted and Fornes’s complaint is dismissed. 24 I. Background 25 Fornes was found disabled in January 2024 after a hearing before an 26 Administrative Law Judge (“ALJ”). (Doc. 9 at 11, 12.) The Social Security 27 Administration Office of Central Operations (“OCO”) then calculated his monthly 28 benefits award. (See Doc. 12-1 at 3–4.) In February, he filed a request with the Appeals 1 Council for a review of that award “because it’s not enough money to start a family.” 2 (Doc. 9 at 16.) The Appeals Council denied his request for review and “alerted the field 3 office that services [Fornes’s] zip code of [his] request.” (Doc. 9 at 19.) The field office 4 found that Fornes was “getting the highest benefits based on [his] earnings,” so it could 5 not raise them. (Doc. 9 at 25.) Fornes then appealed the amount of his benefits award to 6 this court. (See Doc. 1.) 7 II. Analysis 8 Fornes seeks review of his benefits award under 42 U.S.C. § 405(g), which only 9 permits judicial review of a “final decision of the Commissioner of Social Security made 10 after a hearing.” 42 U.S.C. § 405(g). A final decision is deemed to have been rendered 11 after a claimant has “taken all necessary administrative steps” which are seeking an initial 12 determination, reconsideration of that decision, a hearing before an ALJ, and Appeals 13 Council review. 20 C.F.R. § 404.900(a)(1)–(5). By regulation, an initial determination 14 that a claimant is disabled is separate from an initial determination of a claimant’s 15 monthly benefit amount. See 20 C.F.R. § 404.902(a), (c). 16 Because the OCO—not the ALJ—calculated Fornes’s monthly benefits, the 17 Commissioner claims Fornes had to go through the subsequent three-step administrative 18 review process for that decision before filing a complaint challenging the benefits amount 19 in federal court. (Doc. 12 at 3.) The Commissioner contends Fornes’s earlier appeal to the 20 Appeals Council was of no consequence to his monthly benefits award because that 21 appeal was from the ALJ’s disability determination. (Doc. 12 at 3.) Recognizing Fornes 22 sought to challenge a different determination, the Appeals Council sent Fornes’s local 23 field office his request for reconsideration of benefits. Fornes does not argue he appealed 24 the field office’s subsequent determination that he was not entitled to more benefits. 25 The question at the heart of this case is whether a claimant needs to restart the 26 administrative process when seeking review of the amount of a monthly benefits award. 27 Regulations and case law suggests a claimant must do so. See 20 C.F.R. § 404.900(a)(1)– 28 (5); 20 C.F.R. § 404.902(a), (c). 1 The four-step process for review of the amount of benefits a claimant is awarded is 2 independent from the four-step process for review of a claimant’s request for disability 3 benefits. See Scott v. Astrue. No. A-08-CA-480-LY(AWA), 2009 WL 1789239, at *1 4 (W.D. Tex. June 23, 2009). Several cases describe the process leading up to the district 5 court’s review of the amount of a benefits award, and all confirm that process requires a 6 request for reconsideration of the decision, another hearing before an ALJ, and Appeals 7 Council review before a district court case is filed. See id.; see also Maqsood v. Comm’r 8 of Soc. Sec., No. 10 CIV. 8943 PGG, 2013 WL 4010254, at *1–2 (S.D.N.Y. July 30, 9 2013), aff’d, 597 F. App’x 28 (2d Cir. 2015); Lyublinsky v. Barnhart, 360 F. Supp. 2d 10 497, 498–99 (E.D.N.Y. 2005). 11 Fornes does not meaningfully argue otherwise. He claims he was told he could ask 12 for judicial review of the ALJ’s decision by filing a civil action, but that was regarding 13 his disability determination: the ALJ made no decision regarding his benefits award. (See 14 Doc. 9 at 5, 7–11.) Fornes even acknowledges he was told he had “the right to appeal [his 15 benefits award] which would start the appeal process all over again.” (Doc. 13 at 2.) 16 Fornes appears confused by that statement because it came after the Appeals Council told 17 him he could file a civil action for judicial review of the ALJ’s decision. 18 The discrepancy is that Fornes was indeed entitled to appeal the ALJ’s decision 19 finding him disabled in federal court, having exhausted that question. But if he wanted to 20 appeal the amount of benefits he was awarded—which was calculated by the OCO, not 21 the ALJ—he had to file a motion for reconsideration first (which he did), then request a 22 hearing with an ALJ, then request Appeals Council review, before bringing this action. 23 See 20 C.F.R. § 404.900(a)(1)–(5); 20 C.F.R. § 404.902(a), (c); Maqsood, 2013 WL 24 4010254, at *1–2; Scott, 2009 WL 1789239, at *1; Lyublinsky, 360 F. Supp. 2d at 498– 25 99. Because a federal court may only review a “final decision of the Commissioner of 26 Social Security made after a hearing,” 42 U.S.C. § 405(g), and Fornes is not appealing a 27 final decision by the Commissioner, he is not yet entitled to bring this civil action. The 28 Commissioner’s motion for summary judgment is granted and Fornes’s complaint is 1 || dismissed without prejudice. 2 Accordingly, 3 IT IS ORDERED the Commissioner’s motion for summary judgment (Doc. 8.) is GRANTED. 5 IT IS FURTHER ORDERED directing the Clerk to enter final judgment of || dismissal without prejudice and close this case. 7 Dated this 28th day of May, 2025. 8 9 “/ □□ Vo A.) 4 / , 10 AA ACA EA HAA Honorable Krissa M. Lanham 11 United States District Judge 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

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