What Does the Social Security Administration (SSA) Appeals Council Do?

Most people who file for Social Security disability benefits have their best shot of winning at a hearing with an administrative law judge (ALJ). But if you received an unfavorable decision from the ALJ, it doesn’t have to be the end of the road for your disability claim. You have the option to file a “request for review” by another administrative body, the Social Security Appeals Council.

Unlike lower levels of review, the Appeals Council doesn’t look at your case with fresh eyes. Instead, the role of the Council is to see whether the ALJ who denied your claim made a legal error when evaluating your claim. Before you request review by the Appeals Council, it’s important to know which legal errors have the best chance of being remanded (sent back to the judge) and what you can do to increase your chances of success at this high level of appeal.

What Is the Appeals Council?

The Appeals Council is the highest level of administrative appeals available for Social Security disability claimants. That means that any further appeals won’t take place within the Social Security Administration (SSA), but rather will need to be filed in federal district court, which follows a different set of rules and procedures.

The Appeals Council is composed of administrative appeals judges and attorney advisors who evaluate requests for review of unfavorable ALJ decisions. Unlike hearing offices, which are spread out across the country, the Appeals Council is headquartered in Virginia and reviews decisions made nationwide.

How Does the Appeal Council Review Social Security Disability Appeals?

Once the Appeals Council receives your request for review, they will review the judge's decision along with your entire case file and any additional evidence that you submit. The Council will look to see if the ALJ committed any legal or procedural mistakes that would have affected the outcome of your case. These mistakes are known as “reversible errors.”

Not all unfavorable decisions contain reversible errors. The Appeals Council gives the ALJ a lot of deference as the “finder of fact” who actually met you and talked to you at your hearing, so just because you disagree with the judge’s decision doesn’t mean the Appeals Council will find that the ALJ made a reversible error.

After the Appeals Council has received your request for review, they can do one of the following three things:

• deny your request for review
• grant your request and remand the case to the ALJ for a new decision, or
• issue a decision on your claim and award you disability benefits (this is rare).

The specific action taken by the Appeals Council depends on whether the ALJ made a reversible error or not.

The Appeals Council Can Deny Your Request for Review

The Appeals Council isn't required to review all the claims they receive, and most often they won’t review a claim. If that happens, you'll get a letter saying, "Your request for review (of the administrative law judge's decision) has been denied." That means the Appeals Council doesn’t think there’s evidence showing that the ALJ committed a reversible error, so they won’t send your case back for another hearing to allow the judge to fix their mistakes.

The Appeals Council Can Remand Your Case

If the Appeals Council finds that the judge did make a legal or procedural error, they will remand your case to the ALJ with instructions on how the judge should re-evaluate certain aspects of your claim. (Essentially, this is the Appeals Council giving the ALJ a “do-over” and an opportunity to correct their mistakes.) About 15% of the cases the Appeals Council receives are remanded. If your case is remanded, it usually means you'll have another hearing with the ALJ and another chance to argue your case.

The Appeals Council Can Overturn a Denied Claim

The Appeals Council can decide that the judge’s decision was completely in error and overturn the denial, issuing an approval directly without having to remand the case back for further development. While this is probably the best possible outcome for a claimant who is appealing an unfavorable ALJ decision, keep in mind that this happens very rarely.

What Types of Errors Can Be Appealed?

Not every mistake made by the ALJ is “reversible error.” The error must be so important that if it were corrected, it could mean the difference between getting benefits or not getting benefits. Whether an error is reversible will depend on the facts of the case, but there are some general categories of errors that the Appeals Council is unlikely to find necessary to correct. Below is a chart that should give you a better sense of what errors will be considered reversible or not.

Before you submit your request for review, you should take the time to carefully review your unfavorable decision and check for any important mistakes that the ALJ made. (If you already have a lawyer, ask them to go over the decision with you and point out any potentially reversible errors.) You or your lawyer can then address these in your letter to the Appeals Council.

How to Appeal to the Disability Appeals Council

You have 60 days after you receive the unfavorable ALJ decision to request a review by the Appeals Council. This request must be made in writing, and you must use Form HA-520, Request for Review of Hearing Decision/Order. This is a short form that only requires the following information:

• your name and contact information
• if you have a representative, their name and contact information
• your Social Security number (SSN) and your claim SSN, if it's not your own (like a parent's or spouse's), and
• a statement as to why you're asking the Appeals Council to review the ALJ's decision.

You should also let the Appeals Council know if you plan to submit additional evidence from the date on or before the ALJ hearing decision. You can submit additional evidence to the council too. You'll want to be sure you do so ahead of your review date, so the council members have time to consider it.

Social Security prefers that youfile the request for review online. But you have other options if you don't have internet access or aren't comfortable filing paperwork online. You can also submit Form HA-520 by bringing the completed form to your local Social Security office, faxing it to 833-509-0817, or mailing a hard copy to the Appeals Council at SSA/OARO, 6401 Security Blvd., Baltimore, MD 21235-6401.

How Long Does the Appeals Council Take?

As with every other step of the disability process, there's no way to know exactly how long it'll take. But you should expect the Appeals Council to take a fairly long time to evaluate your case. Review times average about one year, but some cases wait as long as 18-24 months for the council to make some kind of decision. Other times, the Appeals Council decides a case in as little as four months.

Post-Appeal Council Options

If the Appeals Council declines to review your case, you have two options: you can choose to proceed with a federal district court appeal or you can start over from square one and file another initial disability claim. At this stage, it’s a smart idea to get in touch with a disability attorney, if you haven’t already. An experienced lawyer can help you understand the pros and cons of further appeals or filing a new claim.

Disability attorneys work on contingency, meaning they don’t get paid unless (and until) you win, and many offer free consultations. If you’re in the market for an attorney and you think federal court is an appealing option, make sure that you find a lawyer who is admitted to practice in the district court where you reside.