The appeals council are the next legal stepping stone if the claimant still disagrees with both the Social Security Association’s (SSA) decision, has been denied their request for reconsideration, and disagrees with the administrative law judge’s (ALJ) decision. If you’re seeking retribution for an SSA decision, or “determination”, you’ll need to enlist the services of an experienced supplemental security income (SSI) lawyer who will guide you through the legal proceedings with an appeals council.
What is an Appeals Council?
An appeals council is made up of administrative personnel from the SSA to handle claims that have been denied by an ALJ. They’re considered the third level of appeal for SSI claims, with the last line of appeal being federal court. An appeals council is meant to be impartial just like an ALJ, but their review is much more focused on figuring out the reasons why an ALJ denied the claim and what new evidence or arguments you or your lawyer come up with.
You and your legal defense will have 60 or so days from the time of the ALJ decision to file a claim with an appeals council. This is done in writing via Form HA-520, which is a request for review of a hearing decision.
It’s also highly recommended you have a lawyer/legal defense. Requests made without a lawyer get denied a majority of the time. A lawyer can help spot errors made on the part of the ALJ, which is the most crucial factor to the appeals council when it comes to making a favorable decision.
An appeals council is almost much more than just the team that makes the decisions, but under them are defense attorneys and legal staff, caseload support staff, medical and vocational experts, and writers who prepare the documents for claimants. Together they form the council at large.
The core job of an appeals council is to make sure decisions are consistent with the law and honor precedents set by the judges and council before them.
What Should I Expect When An Appeals Council Reviews My Claim?
If you are a claimant seeking review from an appeals council, there are a few things you should expect.
Firstly, there will not be a hearing. Unlike an ALJ review, a new hearing is not necessary as the council will be reviewing the record of the case that’s already on file and go from there. They’ll issue a written decision to outline its findings, rationale, and actions to be taken.
Now, you and your attorney will have opportunities to send them written statements and new evidence to help bolster your case, but ultimately, it will not be a hearing or a courtroom-style deposition where you will be sworn in and asked to testify.
The only thing the claimant will be able to do is try and strengthen the case as much as they can, but it will mostly be a wait-and-see game with the review board. Your SSI lawyer will also provide any necessary legal guidance or reassurance during this period.
It will not be a short period either, as the appeals council can sometimes take up to four months to a year to reach a decision. That can be quite some time.
What Does the Appeals Council Actually Do?
The appeals council will be looking to spot any flaws in the ALJ’s decision making process. Your attorney can help spot these as well in a written statement made to the council. While ALJs are experienced officials who are well-versed in administrative law and handle hundreds of cases, they are still prone to human error and may draw the wrong conclusion. Where the ALJ operates as the checks and balances for the SSA, the appeals council checks and balances the ALJ.
The council will look to see if the ALJ may have possibly misinterpreted any medical evidence, possibly overlooking certain regulations, or disregarding bits and pieces of the claimant’s testimony. There is also the instance that an ALJ may have abused their power as a judge and this led to a false decision. There may also be something within your case that could curry favor from the general public and thus lead to new law making decisions.
While this council is made up of personnel affiliated with the SSA, it is still a different level of administration from the ones who worked on your first initial claim and are still impartial to the interests of the SSA.
The appeals council will make one of three decisions on your claim:
Denial is, unfortunately, the most common outcome in these scenarios. This is likely due to the fact that most appeals are resolved at the ALJ stage, but in this case, there is still one last resort you and your lawyer have, and that is to file a case for review to a Federal Court. Much like the other stages, you will have 60 days or so to appeal.
The appeals council will deny your claim if they deem that the ALJ made the right decision and that any new found evidence was not enough to overturn the initial decision.
However, if they do feel there was a technical error or overlooked piece of information on the part of the ALJ, they will “remand” the case, meaning it will be relegated back down to the ALJ and you will undergo the hearing process all over again, and thus you’ll have a second shot at making an argument. About 22% of cases get remanded by the appeals council, sources say.
The claim is granted if the council finds that the ALJ was totally in the wrong and they will overturn the judge’s decision. Sources say this only happens 3% of the time, but with the right council and good behavior, who knows?
So there you have it, this is the third stage of the appeals process when disputing an SSI claim, and hopefully it should not have to be taken this far and the ALJ approves your claim, but at least there are two higher levels of appeal in which you can still make your argument. A claimant should always exhaust all legal resources to protect their rights and claim the assistance they need.
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