The Appeals Council comprises the third step in the Social Security Disability system's appeal process. This step in the process is different from the other steps before it in that it's purpose is not to evaluate the merits of a case, but, rather, to determine if the Administrative Law Judge who denied the claim was in error.
The Appeals Council review process generally begins after an application for benefits has been denied at the initial, reconsideration, and hearing levels. If you disagree with the decision of the Administrative Law Judge, you may file a request for review with the Appeals Council.
The Appeals Council is made up of approximately 34 Administrative Appeals Judges and 27 Appeals Officers, who must review and sign each final action. The Council receives about 96,000 requests for review each year and has a current pending workload of 53,163 requests for review (September 2007). The Council must give each of these cases proper consideration. (ssa.gov)
Currently, the average processing time for a request for review is about 24 -30 months from the date the request is filed until the Appeals Council releases its final action. Any case pending more than 30 months will be considered for expedited processing. (ssa.gov)
Generally, you have 60 days after you receive the notice of our decision to ask for any type of appeal. In counting the 60 days, it is presumed that you receive the notice five days after we mail it unless you can show that you received it later.
If you are unable to meet this deadline, explain your reasons for missing it in your request.
If you do not appeal on time, the Administrative Appeals Judge may dismiss your appeal. This means that you may not be eligible for the next step in the appeal process and that you may also lose your right to any further review.
Submit any additional evidence and/or comments you have with the request for review, if possible.
Either the claimant or their representative should make requests for duplicate hearing tapes and exhibits only if you really need these items in your case.
You must have a good reason if you wait more than 60 days to request an appeal. If you file an appeal after the deadline, you must explain the reason you are late and request that Social Security Administration extend the time limit. The Appeals Council will consider your request and decide whether to extend the time limit.
The Appeals Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an Administrative Law Judge for further review. When the Appeals Council reviews your case it may consider any of the issues considered by the Administrative Law Judge, including those issues that were favorably decided in your case. You will receive a copy of the Appeals Council's final action on your case.
In most instances, an appeal sent to the Appeals Council will simply result in a letter mailed to a claimant that states "the request for review (of the administrative law judge's decision) has been denied". This, of course, translates as a denial.
However, there are many instances in which the Appeals Council may conduct a thorough review of the ALJ hearing proceedings and do one of the following:
1) Decides that the judge made a technical error or failed to consider medical evidence, resulting in the need for a remand.
or
2) Decides that the judge's decision was completely in error and overturns the decision---resulting in an approval.
A good attorney or representative should write a brief to the appeals council and point out the areas where the ALJ has made reversible mistakes. The arguments that can be made to get a decision reversed or remanded are numerous and differ from case to case. A good argument to make in your brief is that the Administrative Law Judges decision was not supported by substantial evidence. This basically means that the ALJ’s decision was not supported by the medical evidence in the file.
If you disagree with the Appeals Council's decision not to review your case or if your appeal was denied, you may then file a civil suit in the federal district court. You must commence this civil action by filing a complaint in the United States District Court for the judicial district in which you reside within sixty (60) days from the date you receive the Appeals Council's notice. The Social Security Administration assumes that you received the notice five (5) days after the date on it, unless you can show them that you received it later. The complaint should name the Commissioner of Social Security as the defendant and should include the Social Security number(s) shown at the top of your denial notice.
To file this civil action, the claimant must either represent themselves (Pro Se) or hire an attorney. A non-attorney representative cannot represent the claimant at this level or above.
References
Social Security Administration Representative Web site located at http://www.ssa.gov/representation/ last accessed on September 19, 2008
Social Security Administration Web Site – Hearings and appeals questions– located http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_alp.php?p_sid=ddZL3ZRi&p_lva=&p_li=&p_accessibility=0&p_redirect=&p_page=1&p_cv=2.135&p_pv=&p_prods=&p_cats=50,135&p_hidden_prods=&cat_lvl1=50&cat_lvl2=135&p_search_text=&srch_btn_submit= Searchttp://ssa-custhelp.ss last accessed on September 21, 2008
Wolfe, J.S. and Proszek, L.B. (2003). Social Security Disability and the Professional. Clifton Park, New York: Thomson Delmar Learning.
