The Social Security Secrets Episode 9: What Happens at the Appeals Council?

Applicants for SSI and SSDI benefits who have been denied three times – once at the initial level a second time at the reconsideration level, and a third time at the ALJ/OHO level – can file an appeal to the Social Security Appeals Council (AC). This time, however, the types of issues you can raise are dramatically different than what you could raise before.

You have 60 days from receipt of the ALJ decision to send a Request for Review to the Appeals Council.

Once you get to this level of the appeals process, the game changes. While the prior three levels concerned the merits of a claim for SSI or SSDI benefits, i.e., whether you were disabled under SSA’s criteria, the AC focuses instead on whether the ALJ who denied your claim made a legal or procedural mistake. The AC is looking for errors in how the ALJ decided your claim: whether s/he reviewed all of the evidence, whether s/he followed all of the required procedures, whether s/he evaluated medical opinions appropriately, etc.

Upon review, the Appeals Council can make one of three decisions:

• Deny the Request for Review. This means they are not approving you for benefits, and will not remand your case (see #2). If this happens, you will have 60 days to file an appeal in federal district court.
• Remand the case. This means that the AC found some error in the prior proceedings, and is sending the case back to the ALJ who denied your claim. The ALJ will then make a new decision, which usually means that you will have another hearing.
• Overturn the Denied Claim. If the AC finds that the ALJ’s decision was completely wrong, the AC can overturn the decision. This means that your claim is approved, and you will not need to have another ALJ hearing. However, this rarely happens.

Because the AC focuses on procedural and legal mistakes, it can be much harder for an applicant to file an appeal without the help of a lawyer. Applicants understandably focus on why they cannot work, and how their conditions impact their day-to-day life. At this point, most applicants have been waiting for years for a decision, and are frustrated, exhausted, and have just about given up. However, none of this matters to the AC. The AC will review the applicant’s Request for Review for any signs that something procedurally went wrong in the prior stages of review. If the Request focuses instead on the applicant’s medical condition, chances are the AC will deny the Request outright. This is why it is important to speak to a disability attorney who can review your case and write a brief that will persuade the AC to at least remand your case, if not overturn it.