After a claimant’s application is denied by an ALJ, the claimant has 60 days to file an appeal with the Appeals Council.. The Appeals Council may decide to hear the applicant’s appeal or it has the option to refuse to hear it at all. If the Appeals Council declines to hear the claimant’s appeal, he or she may appeal the case directly to the federal court.
The Appeals Council itself is made up of over 70 administrative appeals judges. When the Appeals Council takes an appeal, it first reviews the claimant’s case and considers all the evidence of record from the hearing with the ALJ. This is because the Appeals Council will only reconsider decisions made by an ALJ when it is clear that the evidence that was available at the hearing did not support the ALJ’s decision or if the ALJ made a procedural error.
As a result, in order for the Appeals Council to overturn an ALJ’s decision, it must find clear cut evidence that the ALJ’s decision was incorrect. If it is determined that the ALJ acted in error, the Appeals Council will reconsider the claimant’s case. In doing so, the Appeals Council will review the original evidence, as well as any additional evidence from the claimant and the ALJ’s findings.
After reviewing the claimant’s case, the Appeals Council has the ability to uphold, change, or reverse the ALJ’s original decision. The Appeals Council may send the case back to the ALJ to reconsider his or her original decision, or the Appeals Council may decide the case on its own. Whatever the Appeals Council’s decision, the claimant is kept informed by the Council of what they have decided.
What’s the difference between the Appeals Council and an ALJ?
While a hearing with an ALJ and SSD review by the Appeals Council may seem similar, there are some pretty notable differences between the two. In a hearing before an ALJ, there is only one ALJ reviewing the claimant’s application and making a decision. During review by the Appeals Council, there are multiple administrative appeals judges working together to make a decision.
The time it takes to complete review of a claimant’s case also differs greatly between a hearing with an ALJ or review by the Appeals Council. A hearing with an ALJ can be extremely short and can last anywhere from 15 minutes to one hour. While the time it takes for an ALJ to make a decision varies from case to case, claimants can generally expect to receive a decision within 60 days of the hearing. On the other hand, the Appeals Council process can be quite lengthy. Across the nation, the average processing time for appeals at this level is 345 days.
Should I appeal to an Appeals Council?
There are numerous advantages and disadvantages for claimants to consider before deciding to move forward with their appeal to the Appeals Council stage. The SSA reports that at the Appeals Council stage, 72 percent of requests for review are denied. Of those cases that are reviewed by the Appeals Council, 22 percent are remanded to the ALJ and only 3 percent of the cases result in the Council issuing a new decision.
While that may seem discouraging, most cases that are sent back to an ALJ are ultimately awarded disability benefits, and if the review is denied the claimant can automatically move forward with his or her appeal to federal court where chances of receiving disability benefits are much higher.
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