The Appeals Council Review

DeniedIf you are denied Social Security disability (SSDI or SSI) after a hearing with an administrative law judge (ALJ), the next level of appeal is a request for an Appeals Council Review.

The Appeals Council consists of over 50 Administrative Appeals Judges and over 50 Appeals Officers who handle Appeals Council (AC) reviews for the whole country.

It is important to note that, according to recent changes in SSA regulations, if you request an Appeals Council review you cannot file a new claim for Social Security Disability benefits until the AC makes a determination on your claim; and that could take a year — maybe longer.

And the odds of filing a successful appeal at this level are not good. According to the Social Security Administration:

72% of the Requests for Review are denied

— 22.5% of the cases are remanded to an ALJ and only 3% of the cases
result in the Appeals Council issuing a new decision, and

— 2.5% of the cases result in a dismissal (because the request for
review was not filed by the deadline).

Here are some common reasons why the Appeals Council would remand or award benefits in a case. These include situations where:

  • The ALJ ignored an important medical condition. For example, if you had been diagnosed with depression and the ALJ failed to mention this condition in the decision, or failed to find it to be a significant or “severe impairment.
  • The ALJ failed to consider the opinion of a treating or examining doctor, or failed to give the opinion any weight. For instance, your treating doctor said you were limited to two hours of walking and standing each day but the ALJ ignored this opinion in the decision.
  • There was no vocational expert (VE) at the hearing. If the ALJ denied your claim there was other work you can do (besides your past work), but there was no VE at your hearing, your case should be remanded to a new hearing so that a VE can be present for questioning.
  • There is additional evidence that was not in your file or the ALJ did not consider. If there are any medical statements or evidence about your disability that the ALJ did not consider in the hearing decision (especially any opinions from doctors), then you should send that evidence along with the request for a review.

In most situations filing a new claim is a better option than requesting an Appeals Council Review.  If you win your new claim it opens the door to the possibility of re-opening your prior claim.  If the AC denies your request for a review the door closes on reopening your prior claim.

The bottom line is: do not request an Appeals Council Review until you have discussed the issue with your representative.

Advertisements

2 responses to “The Appeals Council Review

  1. Please help. I have an attorney I am asking to no longer be my representative. I need. Someone knowledgeable to review. My ALJ hearing there are inaccuracies and blatant lies. I’m not sure what to do?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s