There are four levels of appeals in SSI and SSDI cases, and the Appeals Council Review is the third level, after the ALJ hearing.
The Appeals Council reviews decisions made by administrative law judges (ALJs) at disability appeal hearings. Every request for appeal that comes in gets looked at by the Appeals Council, but the Appeals Council does not 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 per 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 will receive a letter from the Social Security Administration (SSA) explaining the denial.
If the Appeals Council does decide to review your case, it may decide the outcome of your claim or it may send your case back to an ALJ for additional review. The SSA will send you a copy of the decision if the Appeals Council decided your case itself. If the Appeals Council sends your case back to an ALJ, the SSA will let you know that as well. You will then receive the decision after the ALJ has completed the review.
There are several factors the Disability Appeals Council looks at when deciding whether or not it will review an appeal from an ALJ's decision. If any of the following are true, the Appeals Council is likely to grant an appeal.
The most common decision the Appeals Council makes is to deny 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 makes a decision itself in fewer than 5% of all appeals.
You must make a request for appeal to the Appeals Council in writing within 60 days after you receive notice of the ALJ's decision.
The Office of Disability Adjudication and Review (ODAR) is in charge of disability appeals at both the ALJ hearing level and at the Disability Appeals Council level. Within ODAR's Office of the Chief Administrative Law Judge, ALJs across the country hear appeals from people who have applied for disability and have not been satisfied with the SSA's initial determination or reconsideration decision. ODAR's Office of Appellate Operations houses the Appeals Council.
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 will 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.