Question of the Month: What is the Social Security Appeals Council?

May 10, 2022

If you get an unfavorable, or only partially favorable, decision on your Social Security Disability benefits after a hearing by an Administrative Law Judge (ALJ) , you may file an appeal with Social Security’s Appeals Council.

There is no hearing at this stage. Rather, the Appeals Council will look at the reasons why you or your disability attorney believe that the ALJ made mistakes in denying your disability claim.

There are several factors the Appeals Council will consider when deciding whether or not it will review an appeal of an ALJ’s decision. The Appeals Council may grant an appeal if any of the following apply:

  • The law was applied incorrectly.
  • The ALJ made an error of judgment, creating a ruling that is clearly unreasonable, erroneous, or arbitrary—and not justified by the facts or backed up by the evidence in the case. (This is called “abuse of discretion”).
  • The action, findings or conclusions of the ALJ are not supported by substantial evidence—what a reasonable mind might accept as enough to support a conclusion.
  • You submit new and material evidence that originated before the date the ALJ made their decision, and the ALJ’s decision is not supported by ALL the evidence in your record—the original evidence and the new evidence.
  • Your disability claim raises a procedural issue or policy question that the Appeals Council thinks may affect the general public interest.

If the Appeals Council finds no reason to review the ALJ’s decision in your case, your request for review will be denied, and the ALJ’s decision will stand as is. If this happens, you will have 60 days to file civil action in federal district court.

If the Appeals Council does decide to review your case, it usually issues what’s called a “remand,” meaning that it sends your case back to the same ALJ for additional review and another hearing.

The most common Appeals Council decision is to deny a review. This means that the Appeals Council won’t approve an award of benefits and it won’t send your case back for another hearing.

The next most common outcome of an Appeals Council review is to send the case back to the ALJ for additional review. In less than 5% of cases, the Appeals Council makes a decision about your benefits itself. And in only about 1% of cases does it award benefits outright.

So, what can you do to improve your chances of success at the Appeals Council?

A disability lawyer will know how to document issues that give you grounds for appealing a disability denial and which issues to raise in your attempt to get the Appeals Council to grant a request for review.

Your disability attorney can make the best argument that your case deserves to be reviewed. In the end, an Appeals Council appeal is a legal argument, and having a local Chicago Social Security Disability attorney can increase your chances for success.

Additionally, it is important to remain in treatment with your doctors.

If the case is remanded for another hearing, you will want to have ongoing evidence of your conditions and symptoms. It will also be very helpful to have your updated doctor’s opinions about your limitations and inability to work at least through the time of the judge’s decision (see “The Secret to Winning Your Disability Case”).

The process of winning the disability benefits you have earned can be frustrating, confusing and difficult, particularly after a denial by an ALJ.
If you are looking for help, CONTACT YOUR LOCAL CHICAGOLAND SOCIAL SECURITY DISABILITY LAWYERS AT NASH DISABILITY LAW today to discuss your unique situation.