Understanding How The Social Security Appeals Council Works

If following your hearing before an administrative law judge (ALJ), your Social Security disability (SSDI) claim is again denied, the next step in the appeal process is to request that the Social Security Appeals Council review your case. Although you may decide to handle this level of appeal on your own, an attorney experienced in filing disability claims can help you understand how the process works so that you have a better chance of winning your case.

What the Appeals Council Does

The primary job of the Appeals Council is not to review your claim to determine disability, but to look for errors that the ALJ may have made in rendering his or her decision. An attorney can help you submit a written request for review by completing the required Form HA-520 and submitting additional evidence and/or legal argument.

Before reaching its decision, the Appeals Council will review your case file and any other evidence your attorney submitted when requesting an appeal. The Council will examine the case records to determine if the ALJ considered all the evidence you submitted at the time of your ALJ hearing and if he or she made any procedural or legal errors in deciding your case.

Once your case is reviewed, the Appeals Council has the authority to:

  1. Deny your request for review, which means the Appeals Council won't approve your claim for disability benefits or send your case back for a second hearing before the ALJ because it believes the judge's decision is correct. You then have the option of filing an appeal in federal district court.

  2. Remand your case back to the ALJ for a new decision, in which case you will be scheduled for another hearing before the administrative law judge. This may be the case if the Council feels the ALJ did not consider some of the evidence you submitted or made an error regarding the legal procedures required in deciding your case. In some cases, the Appeals Council may uphold the ALJ's decision but clarify an issue that was not adequately explained in the ALJ's final summation in the case.

  3. Overturn the ALJ's decision and issue a new decision, awarding you disability benefits.

Granting Your Request for Review

The Appeals Council may grant your request to review your case if the ALJ failed to:

  • Properly consider your physical and/or mental limitations.

  • Give sufficient weight to the medical source statement or residual functional capacity (RFC) forms that your treating doctors and mental health professionals completed regarding your medical condition(s).

  • Provide an adequate assessment of your RFC based on the medical evidence you submitted.

  • Consider certain limitations noted in your RFC when presenting hypothetical questions to the vocational expert on what kinds of jobs you could perform.

  • Count side effects of your medications that may impose additional limitations on your ability to work when making his or her decision.

  • Include details you gave in your testimony and instead summarized evidence in a broad sense.

  • Take into account the observations and opinions of non-physician medical professionals.

You also may have grounds to request that the Appeals Council review your case if the ALJ incorrectly classified one or more of your impairments that significantly limit your ability to work as non-severe rather than severe.

For more information, contact Gomez May LLP or a similar firm.