Should I Appeal an Unfavorable Disability Hearing Decision to the Appeals Council?

appeals council reviewIf you receive an unfavorable decision after your disability hearing with an administrative law judge (ALJ), you may be able to appeal your claim to the Appeals Council. You must generally appeal 60 days from the date you receive the ALJ’s decision. The SSA will assume that you received the decision in five days from the date of the decision. The Appeals Council may approve or deny your appeal request.

An Appleton-based Social Security Disability lawyer at our firm is ready to help you appeal a denial notice. We understand how challenging the claims and appeals process can be. Find out about your rights during a risk-free, zero-obligation consultation. There are zero upfront fees for our services.

Below, we discuss factors the Appeals Council considers, the advantages and disadvantages of filing an appeal, and how an experienced lawyer may be able to help with your appeal.

Call (877) 888-5201 for trusted legal help.

What is the Role of the Appeals Council?

Once your appeal is received, the Appeals Council’s role is to evaluate the ALJ’s decision and decide if the decision was adequately supported. The Appeals Council will determine if the ALJ abused his or her discretion. Were any clerical errors made? Was all relevant medical evidence properly considered?

For instance, if the ALJ denied your claim but did not take into consideration medical records from your treating doctor before deciding, the Appeals Council may grant your appeal.

Should the Appeals Council disagree with the ALJ’s decision on your application:

  • The case may be resent to the ALJ to reconsider; or
  • The council may make a different decision on the case

However, the Appeals Council often agrees with the ALJ’s decision. The Appeals Council is unlikely to overturn a decision if it can be validated based on the evidence provided. If your appeal is denied, a new disability claim must be filed, or you can file a civil suit in federal court.

Before Appealing to the Appeals Council

There are advantages and disadvantages to appealing to the Appeals Council. By requesting an additional review, you can continue pursuing disability under your current claim. New medical evidence may also be considered if it was submitted on or before the date of your hearing decision.

Examples of medical evidence include the latest records from a doctor that show further physical or mental limitations that limit your ability to work or work in the same capacity as before. If new medical evidence shows a critical or disabling condition, the Appeals Council may expedite a review.

Appealing means a longer wait time for a decision. However, if a new claim must be filed, you are likely to experience more delays. Your onset date (date you say your disability began) and back pay may also be affected.

A licensed attorney with experience in appealing disability claims can help represent your best interests to the Appeals Council. He or she can prepare a strong case on your behalf, which may help improve your chances of the Appeals Council reaching a favorable decision.

Requesting an Appeals Council Review

An Appeals Council review can be requested in one of three ways:

  • Submitting an appeal online – You must submit your decision notice and supporting documentation. If you have legal representation, you must submit your lawyer’s contact details.
  • Downloading and mailing the form – The form must be sent to the Appeals Council headquarters.
  • Contacting a Social Security field office – The one in Appleton at 607 W. Northland Ave.

What If I Get a Partially Favorable Decision?

Disability benefits are awarded in partially favorable decisions, but the ALJ will set the onset date later than the date listed on your claim. You will receive fewer back payments from Social Security.

This decision can be appealed. However, it is risky. The Appeals Council may agree with the ALJ or even determine that you are not disabled and no longer eligible for benefits. Other decisions may include:

  • Making no changes to the set onset date
  • Changing the onset date to the one you listed
  • Giving you a later onset date, further reducing your back pay

Denied Disability Benefits? Reach Out to Our Firm

At Sigman Janssen, we have decades of experience representing claimants at the appeals level. We are prepared to guide you through the entire process all while advocating for your rights.

Our initial consultations are free of charge. You are not obligated to hire our firm after this meeting. If you do have a viable claim, we charge zero upfront fees. Our firm only gets paid if you get benefits.

No fees unless we win. Ph: (877) 888-5201.