Most initial claims for Social Security Disability Insurance (SSDI) benefits get rejected. So, it’s common for applicants to apply for an appeal to challenge the Social Security Administration’s (SSA) decision and schedule a hearing with an Administrative Law Judge (ALJ). But what happens after the ALJ rejects your appeal?
If you are unsatisfied with the ALJ’s decision, your next step should be to apply for an Appeals Council Review. However, keep in mind that the approval rate at this stage is quite low.
This article discusses the procedures and processes involved in the appeals council review.
What is the Appeals Council Review?
If the Administrative Law Judge does not approve your claim for Supplemental Security Income (SSI) or SSDI benefits, you have the option of appealing to the Social Security Administration’s Appeals Council.
The Appeals Council does not review every claim it receives. Instead, they pick cases where it can be demonstrated that the ALJ made an incorrect decision, the ruling is not supported by substantial evidence, or there is a major problem with the current policies or procedures.
It’s rare for the Appeals Council to rule in favor of a claim presented through the Social Security Disability appeals process, but it is possible.
Time Limit to Request Appeals Council Review
It’s important to note that if your disability benefits—SSI and/or SSDI—are not approved at the hearing level, you have 60 days to ask the appeals council to review the ALJ’s decision. This is similar to when you request a reconsideration.
How the Appeal Council Review Works
The Social Security Appeals Council does not look into your disability claim like a hearing does. The Council’s sole function is to review the ALJ’s decision and determine whether or not the process used to arrive at the decision complied with federal law.
The Appeals Council review may result in one of the following decisions:
The Appeals Council may send you a letter stating that it agrees with the ALJ’s denial judgment. A disability attorney can help you file a civil suit in Federal district court if you receive a notice affirming the ALJ’s decision.
The Appeals Council may ask for a new hearing to be held on your claim. Your disability claim may be sent to the hearing level for re-examination if the Appeals Council finds that an error was made or specific pieces of medical evidence were not properly evaluated. Typically, the new hearing is handled by the same ALJ.
In some cases, the Appeals Council can reverse the ALJ’s ruling and award the person Social Security benefits. It is, however, highly unlikely that the Appeals Council will entirely reject the ALJ’s ruling and grant you benefits. Without a skilled disability attorney, winning at the Appeals Council level is very challenging.
Appeals Council Review Timeframe
If you have an attorney representing you and there is no backlog at the Social Security office, the time it takes for the appeals council to issue a ruling can be significantly reduced.
The time it takes for the Appeals Council to rule on a claim can vary from 180 days to two years. A Social Security disability lawyer can help you get a better sense of time frames based on your specific claim.
How the Appeals Council Selects Cases for Review
The Appeals Council does not look at every claim for SSI or SSDI. It may not entertain claims for a variety of reasons. You may lose your claim if you submit it late, don’t give enough proof, if the claimant dies, or if the council agrees with the Administrative Law Judge’s ruling.
If your ALJ hearing was not conducted properly, if there is strong evidence supporting your case, or if your case brings to light a greater issue surrounding Social Security disability benefits, the council is considerably more likely to review your hearing result.
There is a small chance for success at this level of appeal, as the Appeals Council will not overturn the rejection for most claimants.
Should One Go for an Appeals Council Review?
Claimants for SSI or SSDI who are appealing should think about all the benefits and drawbacks of going to the Appeals Council stage before making a decision.
The Social Security Administration states that the Appeals Council turns down 72% of appeals. Out of the cases that the Appeals Council looks at, 22% are sent back to the ALJ, and only 3% end with the council making a new ruling.
Although that may be discouraging, most cases that are sent back to an ALJ end up getting disability benefits. If the review is refused, the claimant can take their case to federal court, where they have a much better chance of getting disability benefits.
How to File an Appeals Council Review
You have two months (plus the five days the SSA assumes it takes you to receive your notification) to file for an Appeals Council review with the Social Security Administration. Your case will likely be dismissed by the Appeals Council if you do not request an appeal within this timeframe.
You can find a request review form online or call the Appeals Council and ask them to send it to you. The Appeals Council is located in Falls Church, Virginia, with additional offices in Baltimore, Maryland, and Crystal City, Virginia. You can also obtain hearing records if required. As part of your appeal, you may want to look back over the testimony presented to the Administrative Law Judge.
Include any supporting documentation you may have in your request for a hearing review. Cases with convincing evidence or those that contain an improperly handled hearing before an Administrative Law Judge are the ones most often selected for reconsideration by the Appeals Council.
Make sure all of the required documentation and past paperwork you have submitted are included in your appeal.
Disability lawyers have years of experience with all stages of the disability process, even the Appeals Council Review and therefore are more versed in appeals and navigating the SSA’s system. People who don’t regularly interact with the SSA may find it difficult to understand how to file a proper appeal with the Council.
Conclusion
While the chances of winning disability benefits at the Appeals Council stage are very slim, it is still important to try if your benefits were denied and you suspect an error was made. Additionally, working with a disability lawyer may increase your chances of getting the benefits you need.
