If an administrative law judge (ALJ) denies your Social Security disability claim at the hearing level, you have 60 days to appeal to Social Security's Appeals Council. This is the last administrative appeal in the disability appeal process (before federal court). The Appeals Council (AC) is responsible for reviewing decisions for significant legal or factual errors committed by the ALJ. If the Appeals Council finds an error that may have affected the decision on the claim, it will "remand" (send back) the case to the ALJ for another hearing, or in rare instances, it may even award benefits on its own. (Learn more about Appeals Council reviews.)
After filing Form HA-520 to request that the Appeals Council review the ALJ's decision, you should send the Appeals Council a short letter (called a "brief") containing your arguments that the case should be sent back to the ALJ for another hearing. Here's a rundown of some best practices for writing briefs to the Appeals Council.
Your Appeals Council brief should be written in letter format, with the salutation "Dear Appeals Council Member." The heading should contain your name, date of birth, and Social Security number. Because it can take anywhere from three to twelve months for the Appeals Council to review your case, it's best to submit your brief no more than three months after filing your request for review. Three to four pages is usually sufficient length for an Appeals Council letter.
Social Security should provide you with a CD containing the evidence used to decide your case. The CD will include your medical records and the ALJ's decision on your case. In your brief, you should provide citations to the particular exhibit and page number that supports your arguments. For example, you might say:
The ALJ erroneously stated that the claimant's cane was not prescribed by a doctor. (ALJ Decision, p. 6.) In fact, the evidence shows that the claimant's treating physician wrote a prescription for the cane on August 13, 2012. (Exhibit 18F/4.)
You may also cite parts of the audio recording of the hearing if, as often happens, the ALJ mischaracterized your hearing testimony in his or her decision. Social Security will provide you with the hearing audio upon request.
When writing your brief, keep in mind that the Appeals Council finds certain kinds of arguments more persuasive than others. What kinds of arguments work? Here are some of the best.
Minor mistakes. Disability claimants sometimes devote too much attention to pointing out relatively minor errors and trivial arguments that, even if accepted, wouldn't affect the outcome of the case. Better to focus your attention on the two or three most critical mistakes and ignore the rest.
Credibility. In the past, ALJs were entitled to a lot of leeway in evaluating the credibility of the claimant and any witnesses. Thus, the Appeals Council was virtually guaranteed to ignore arguments that the ALJ incorrectly assessed someone's credibility. However, an ALJ who didn't find certain testimony or evidence credible was still supposed to provide specific reasons for this, and failure to do so could be "reversible error." In 2016, Social Security actually removed mentions of "credibility" from its regulations and rulings. Today, ALJs are instructed to concentrate on whether a claimant's symptoms are consistent with objective medical evidence and their own statements. A judge's decision must contain specific reasons for the weight given to the individual's symptoms.
Social Security disability is a highly specialized field of law, and the SSA's regulations fill many volumes. If you've gotten to the hearing level of appeal and have still been denied, you may want to consider hiring a lawyer. An experienced disability attorney will be able to review your ALJ decision and craft a persuasive argument to the Appeals Council. Attorneys can be especially helpful in spotting errors by the vocational expert or judge.