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Step 4: Appeals Council Review By Appeals Judges
If you were denied once again during the appeals hearing with an administrative law judge (ALJ), the next step in the appeal process is to file an appeal with the Social Security Administration’s (SSA) Appeals Council. The Appeals Council is the last administrative decisional level of the appeals process and consists of approximately 71 Administrative Appeals Judges, 46 Appeals Officers, and hundreds of support personnel. You have 60 days from when you receive your hearing denial letter to file a request with the appeals council. The council reviews the administrative law judges’ (ALJ) decisions and ensures national consistency in decision-making.
The appeal council will review your disability claim and determine whether or not your administrative law judge made a legal mistake while evaluating your claim. The council will give one of the following decisions:
Denial of Request
Most of the time, the council will uphold the judge’s original decision and the applicant will be denied again. You will receive a letter stating your request has been denied and will not be sent back to another administrative law judge for a second hearing.
After this denial, you have the option to file an appeal with the federal district court (not the SSA) and you must file this request within 60 days of the appeals council denial.
Remand Case
In some instances, the council will request a remand case, which is a second hearing that follows the same guidelines as the original appeals hearing with the same administrative law judge. This typically occurs when the appeals council finds out that the administrative law judge didn’t take into consideration all of your medical documentation or made a technical error while making his or her decision. Here are some common mistakes an ALJ can make that will lead to a remanded case:
- ALJ did not give enough weight to your treating doctor.
- ALJ falsely labeled your condition as “non-severe.”
- ALJ left out crucial information in the summary of your testimony.
- ALJ did not take into consideration the significant side effects of your medication.
- ALJ did not take into consideration all of your conditions (severe and non-severe).
- ALJ ignored some of your limitations listed in your residual functional capacity.
- ALJ did not have a vocational expert present during the appeal hearing.
- ALJ did not have a medical expert present during the appeal hearing.
New Decision
Although rare, it is possible to have the council to completely change the decision the administrative law judge made during the appeals hearing if the council finds the judge did make a legitimate complete error. This generally results in applicants being approved for disability benefits of some degree. However, this occurs so infrequently (2-3% chance) that you should expect not to get this decision from the council and hope for a remand case.
How long will it take to receive a decision?
The appeals council can take anywhere from three months to two years to receive a decision. The amount of time it takes depends on how backed up the council is and the complications involved in your appeal. If you are denied, you have 60 days to file an appeal with the federal district court.
Do I need representation?
Having representation during the appeals council is not necessary. However, most applicants who apply for an appeal review with the appeals council by themselves are typically denied. Only disability attorneys, lawyers or advocates are allowed to assist applicants during this part of the appeal process. Disability advocates, attorneys or lawyers will show the appeals council how the ALJ (who reviewed your case) made a legal mistake. Showing how the ALJ made an error is necessary to get a positive decision.