Third Level of Appeal for Disability: Appeals Council & Remands

If you've had a hearing with an administrative law judge (ALJ) only to have your disability claim denied again, you have the option to file an appeal with the Social Security Appeals Council. The Appeals Council is the third step in the Social Security disability appeals process.

This part of the appeals process differs from the other appeals levels—both in the way it's conducted and its purpose. The purpose of an Appeals Council review isn't to evaluate the merits of your disability claim, but merely to determine if the ALJ who denied your claim made an error.

This article will discuss how to appeal to the Disability Appeals Council, what the council does, and how long it takes to get a decision on your disability claim.

How to Appeal to the Disability Appeals Council

You have 60 days after you receive the 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.

The Appeals Council review request is a short form requiring only the following information:

• your name and contact information
• your lawyer's name and contact information (if you have one)
• 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 you file 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 in any of the following ways:

• take it to your local Social Security office
• submit it by fax to 833-509-0817, or
• mail it to the Appeals Council at:

SSA/OARO
6401 Security Blvd
Baltimore, MD 21235-6401

How Does the Appeal Council Review Disability Appeals?

The Appeals Council 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 errors and whether all of the evidence was properly considered.

Upon review, the Appeals Council can act in one of three ways:

• deny your request for review and take no action on your case
• remand (return) the case to the ALJ for a new decision, or
• issue a decision on your claim and award you disability benefits (this is rare).

Appeals Council Can Deny Your Request for Review

The Appeals Council isn't required to review all the claims they receive. Most often, they will refuse to 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."

If you get such a letter, it means that the Appeals Council won't approve your benefits and won't send your case back for another ALJ hearing. In other words, it's a denial. If you disagree with this decision, you can file an appeal in federal district court (within 60 days).

But there are many times when the Appeals Council conducts a thorough review of the ALJ hearing proceedings and "remands" the case.

Sometimes the Appeals Council Will Remand Your Case

The Appeals Council can decide that the judge made a technical error or failed to consider some of your medical evidence. If that happens, the council can remand your case (send it back to the ALJ to reconsider).

About 20% of the cases the Appeals Council sees 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—approving the disability claim. This happens very infrequently, however.

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.

The most recent figures show that the average review time was almost a year—345 days. Sometimes, 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.

Does an Appeal to the Appeals Council Require a Lawyer?

You're allowed to handle this type of appeal on your own. But claimants who request Appeals Council reviews without a lawyer's help are often denied. So, you're much more likely to get favorable results if you have a lawyer when you request an Appeals Council review.

An experienced disability attorney knows how to find any errors the ALJ made during your first hearing and how to point them out to the Appeals Council. This is why you need a lawyer's help—if you can't show the ALJ made an error, you won't win your appeal to the Appeals Council.

But it's your decision. If you're going to try to appeal to the Appeals Council without a lawyer, you'll need to submit a brief. For more information, see our article on writing a brief to the Appeals Council.