What Does the Disability Appeals Council Do?

The Appeals Council is the third level of appeal for Social Security claims. There are four levels of appeals in Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) cases. They are:

• reconsideration
• hearing by an administrative law judge (ALJ)
• review by the Disability Appeals Council, and
• federal court review.

It's at the ALJ hearing level that most disability appeals are won, but it's not your last chance to make your case for Social Security disability benefits. If the ALJ denies your appeal, you have the right to take your claim to the Social Security Appeals Council, the third level of the disability appeals process.

The Role of the Social Security Disability Appeals Council

The Appeals Council reviews decisions made by ALJs at disability appeal hearings. The Appeals Council looks at every appeal request it receives, but it doesn't always grant requests for appeal. (There are about 115 administrative appeals judges and officers on the Appeals Council, and they process around 150,000 cases each year.)

If the Appeals Council decides the ALJ's decision was right, it will deny your request for review, and the ALJ's decision will stand as is. In that case, you'll receive a letter from the Social Security Administration (SSA) explaining the denial.

If the Appeals Council does decide to review your case, it can either:

• determine the outcome of your claim, or
• send your case back to an ALJ for additional review.

The SSA will send you a copy of the decision if the Appeals Council decides your case itself. The SSA will also let you know if the Appeals Council sends your case back to an ALJ. You'll then receive a decision after the ALJ has completed the review.

Factors the Disability Appeals Council Considers

There are several factors the Disability Appeals Council will look at when deciding whether or not it will review your case after an ALJ has denied your appeal. If any of the following are true, the Appeals Council will likely grant an appeal.

• The ALJ's decision and conclusions aren't backed up by substantial evidence.
• The ALJ applied a law incorrectly.
• The ALJ abused their discretion.
• The Appeals Council thinks your case involves some kind of general procedural issue or policy that might impact the general public interest.
• You submit new and material evidence from before the ALJ made the decision, and the ALJ's decision isn't supported by the evidence in the record (including the new evidence).

The most common action the Appeals Council takes is to deny the review of an appeal. The next most common action taken by the Appeals Council is to send the case back to an ALJ. The Appeals Council actually decides the case in fewer than 5% of all appeals.

When Should You Request a Review by the Appeals Council?

You have the right to ask the Disability Appeals Council to review your case if the ALJ denied your claim at your disability hearing. But don't delay. You must file your request for appeal to the Appeals Council in writing within 60 days after you receive notice of the ALJ's decision.

What Is the Office of Appellate Operations?

The Office of Appellate Operations houses the Appeals Council. (The Office of Hearings Operations (OHO) is in charge of disability appeals at the ALJ hearing level.)

The Appeals Council is made up of the Executive Director, administrative appeals judges (AAJs), and appeals officers (AO).

Getting Help with Your Appeal

You might want to consider hiring a representative to help you with an appeal to the Appeals Council. A disability lawyer will know which issues to raise in your case to get the Appeals Council to grant a request for appeal and can make a good argument that your case deserves an appeal.

Many areas have legal aid clinics that assist low-income people in filing and appealing disability claims. Additionally, attorneys practicing in this area of law are paid on contingency, making legal representation available to everyone.