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Should I Appeal My Denied Disability Claim to the Appeals Council?

June 14, 2021

appealing denied disability claim to the appeals council

If your disability claim is denied again after a hearing in front of an administrative law judge (ALJ), you have the right to file an appeal with the Appeals Council. This must be done within 60 days from the date of the ALJ’s decision. The Appeals Council will either grant, deny or dismiss your request for review.

Read on to learn more about the Appeals Council review process, the pros and cons of requesting another review and why you should consider retaining legal representation at the appeals level. An initial consultation comes at no cost or obligation to you. Our firm works on a contingency fee basis, so there are no upfront fees to represent you and no fees unless we help you obtain benefits.

Get the legal help you need. 1-800-503-2000

How the Appeals Council Reviews Denied Disability Claims

The Appeals Council will review the ALJ’s decision along with your entire case file and any new evidence that may be submitted. The Appeals Council will look at whether the ALJ was biased in his or her decision. Were there legal or procedural errors? Was all the evidence submitted properly considered?

If the Appeals Council does not agree with the decision made, either of the following will happen:

  • The case will be sent back to the ALJ for reconsideration, or
  • A new decision will be issued and disability benefits awarded

However, more often than not, the Appeals Council sides with the ALJ. The Appeals Council needs to find solid proof that the decision was not right in order to overturn it.

For instance, if the ALJ denied disability but did not properly take into consideration medical records from a claimant’s treating doctor, the Appeals Council may reconsider the decision. If the medical records provided were enough to render a decision, the appeal will be denied.

If this happens, you will need to file a new claim for disability benefits or proceed to the final step of the appeals process – file an appeal in federal district court.

Things to Know Before Filing an Appeal with the Appeals Council

If you request another review, you are able to continue pursuing Social Security Disability benefits under the same claim. New medical evidence can also be taken into consideration. The Appeals Council will review any new materials as long as they were submitted before or on the date of the hearing decision.

Medical evidence could include new records from your treating doctor that detail additional physical limitations you may be experiencing due to your condition. For instance, if you are claiming that your rheumatoid arthritis prevents you from going back to work, detailed notes from your treating doctor that report your condition has worsened could be considered material in your case.

The downside in appealing to the Appeals Council is that you will have to wait longer for a decision. If your case is denied and you file a new one, it can cause further delays and may impact your onset date – the date you claim you became disabled – and back pay from the Social Security Administration (SSA).

Additionally, any new medical evidence dated after the hearing decision will not be permitted. The Appeals Council will return this evidence and explain why it cannot be considered material in your case.

Ways to Request an Appeals Council Review

There are three ways you can request an Appeals Council review:

  • Submit an online appeal through the SSA website – You will need decision notice from the SSA and supportive documentation (i.e. forms, legal documents, written statements). If you hire a lawyer – which is highly recommended – you must also submit his or her contact details.
  • Download the request form and mail it in – You will need to provide your full name, Social Security Number, claim number and additional evidence. You and your lawyer will also need to sign the request form and mail it directly to the Appeals Council address on the form.
  • File an appeal with your local Social Security office – There are two field offices in Phoenix (16241 N Tatum Blvd and 250 N Seventh Ave).

Do I Have the Right to Appeal a Partially Favorable Decision?

A partially favorable decision means that you were approved for benefits but the onset date determined by the ALJ may be later than the date you filed for disability. This will result in less backpay from the SSA.

If you do not agree with receiving a partially favorable decision, you have the right to appeal it to get an earlier onset date. However, you will be able to obtain benefits throughout the appeals process.

If the Appeals Council disagrees with the ALJ’s decision, your entire case will be reviewed. The Appeals Council could decide to do any of the following:

  • Keep the established onset date 
  • Change the onset date to the date noted on your claim
  • Change the onset date to a later, meaning even less backpay
  • Deny you disability benefits together

How Long Will It Take to Reach a Decision?

The appeals process can take quite some time before a decision has been reached. The average review time is about one year. Some cases can take as long as 18 to 24 months. It depends on each case. 

Need Help Getting Benefits? Call Us Today

Claimants who request Appeals Council reviews without a lawyer are often denied. A Phoenix-based Social Security Disability lawyer at our firm is ready to help you file an appeal to get the disability benefits you need. An initial consultation is 100 percent without any legal obligation involved.

Available 24/7. Call 1-800-503-2000 today.

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