Q&A: The Social Security Administration Appeals Council
Friday, April 22, 2011
Q: What is the “APPEALS COUNCIL”?
A: The Appeals Council is the administrative appeal body within the Social Security Administration that is responsible for reviewing the decisions of the Administrative Law Judges. They are responsible for handling appeals of Administrative Law Judge decisions and handle reviews of decisions on their OWN motion.
Q: What does it mean to be ‘Reviewed by the Appeals Council’ on its OWN Motion?
A: Most people don’t realize that even if you get approved by an Administrative Law Judge for benefits, that decision is subject to review by the Appeals Council. In any judicial process, every judge must answer to a judge who is higher than he/she. The Appeals Council reviews all decisions (randomly) to ensure that the judges are rendering the proper decision.
Q: What happens after this review by the “Appeals Council”?
A: Four things can happen after their review.
One, the Appeals Council can determine that the Judge made the right decision.
Two, the Appeals Council can determine that the Judge made a PARTIALLY right decision and send the decision back to the Judge to correct it.
Three, the Appeals Council can determine that the Judge made a wrong decision and send the decision back to the Judge to correct it.
Four, the Appeals Council can make its own decision and not send the case back to the judge.
Q: If the Appeals Council pulls the case for review on its own, how long do they have to make a decision?
A: Typically, the AC will indicate that they must make their decision within 110 days. During those 110 days, your ability to obtain any benefits approved by the SSA will be held until they make their decision.
Q: How long after getting a Favorable decision from SSA will you have to wait in order to determine if the AC will pull it for review?
A: The AC can pull a case for review at any time. However, the AC recognizes that people have waited for a long time to obtain benefits so they tend to move quickly in making their decision.
Q: What happens after 110 days if they haven’t made their decision?
A: After 110 days, the claimant has the option of requesting the SSA to go ahead and process their favorable decision from the Administrative Law Judge. This way, the claimant can receive their benefits while waiting for their review from the AC.
Q: Can the AC reject the ALJ decision and take the benefits back?
A: It is possible. If the AC determines that the ALJ was wrong and sends the case back to the ALJ, the ALJ can reverse his/her decision. Unfortunately, this means that you may have to reimburse Social Security for any benefits that you may have obtained.
Q: What if the Judge denies my case, can I appeal to the AC?
A: The AC is the final administrative decision maker. If the judge denies your case, the next level is to ask for a Review of the Judge’s decision with the AC.
Q: How long will it take to get a decision from the AC regarding my appeal of my denial from the judge?
A: Unfortunately, this question doesn’t have a simple answer. Most people don’t realize that the Appeals Council handles decisions for the entire country. As a result, it takes a while (6 to 12 months) for the Appeals Council to make their decision.
Q: If the AC denies my appeal, is that the end of my case?
A: No, you can file a Civil Action in the United States District Court. In essence, you would be suing the Social Security Administration for getting the decision.
The Social Security processes can confusing. Call (916) 442-5835 if you have been denied SSDI benefits.
Tags: administrative appeals judge, administrative law judge, appeals council, civil action, continuing disability review, favorable decision, fully favorable decision, partially favorable decision, social security administration, unfavorable decision, united states district court
(adapted from http://legalbeat.an … y-favorable-decision)
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