Friday, December 7, 2012

What is the Appeals Council?

When a disability claimant goes before an Administrative Law Judge (ALJ) at a hearing and subsequently receives an unfavorable decision, this does not necessarily mean this is the end of the claim. If a disability claimant and/or his representative feel the ALJ made any errors in his judgment, that unfavorable decision can actually be appealed to the Appeals Council.
Located in Falls Church, Virginia, the Appeals Council (AC) consists of approximately 70 Administrative Appeals Judges, 56 Appeals Officers, and hundreds of support staff. There are also offices in Crystal City, Virginia, and Baltimore, Maryland. The original AC, created on March 1st, 1940, consisted of a three member staff. Since then, the number of requests for review and the complexity of cases increased dramatically over time. The AC reviewed over 173,000 cases in 2011 alone.
The main responsibility of the AC is to review unfavorable decisions and partially favorable decisions to determine whether an ALJ was correct in his ruling. Other responsibilities of the AC include quality review, policy interpretations, and court-related functions.
How is an appeal filed with the AC? As with any other denial from SSA, you have 60 days from the date if the Appeals Council’s decision, plus five days mailing time, to appeal.  If you miss this deadline because your mail was lost, you were hospitalized, you moved, or a similar reason, good cause for late filing may be pursued.
You must request this review in writing by using form HA-520-U5, along with any additional evidence you may have to submit that was not originally considered by the ALJ. Once received, the AC will review the decision in order to determine whether or not they agree with the ALJ’s ruling. However, the AC can also deny requests for review if they believe a hearing decision was correct.
If the AC does decide to review your case, which takes approximately 9 months to one year, it will either decide your case itself or it will return the case to the ALJ for further review. When it is returned to the ALJ, it is referred to as a remand, and a new hearing is scheduled.
During review, the AC looks at the same issues the ALJ did originally, including issues that were decided in your favor. Once the AC is finished with the review, a decision is issued in writing to the claimant and his representative (if the claimant has representation). They will either issue a fully favorable decision, remand the case back to the ALJ for further review, or they may agree with the ALJ and deny your claim.
If the AC does agree with the ALJ’s decision, the claim can still continue. The next step in the appeals process would be to file a complaint with Federal Court. This step in the appeals process is one that not many disability claimants know about, and not very many disability attorneys deal with Federal Court. This is another reason why Paulette F. Balin & Associates is exceptional. In our next blog entry, we will explore appeals to Federal Court and how we can help you in this aspect of your disability claim.
In the meantime, if you have received an unfavorable or partially favorable decision from an ALJ in the last 60 days, please contact us as soon as possible. We represent claimants every step of the way in the appeals process, and if the AC does deny your claim, we will be right by your side to appeal to Federal Court right away so you get the justice you deserve.
 Written by Anna Westfall & edited by Paulette F. Balin

Contact us today about your Appeals Council decision by clicking here!  We would be happy to meet with you in Akron, Canton, Youngstown, Toledo, Lorain, Ashtabula, Cleveland or Mentor to discuss your case!

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