If an Administrative Law Judge denies a claim for Social Security Disability or SSI after a hearing, then the claimant has sixty days to appeal to the Appeals Council (AC). 20 C.F.R. §§ 404.967, 416.1467, 404.955, 416.1455. The request for review must be in writing in the form of a letter or on a Form HA-520-U5. 20 C.F.R. §§ 404.968(b), 416.1468(b). The claimant may submit new evidence that relates to the period of disability prior to the ALJ’s decision. 20 C.F.R. §§ 404.976(b), 416.1476(b). The appeals should be supported through a brief or memorandum of law.
The Appeals Council first decides whether it will even hear an appeal. If it grants a review, it has the power to affirm, reverse in whole or part, and it can remand for a new hearing. 20 C.F.R. §§ 404.967, 404.979, 416.1467, 416.1479. A decision by the AC may be very timely (usually affirming an unfavorable ruling) or it may take months upon months filled with anxiety, frustration, and anger by the claimant. Even though the representative and the claimant may believe strongly in the merits of the claim, the AC is not predictable and dependable in overturning unjust opinions.
The scope of review at the Appeals Council is limited. The Appeals Council will review a case if:
there is an abuse of discretion by the ALJ;
- there is error of law;
- the action finding or conclusions of the ALJ are not supported by the substantial weight of the evidence; or
- there is a broad policy or procedural issue that may affect the general public interest.
Common ALJ errors often sighted on appeals to the Appeals Council are:
- ALJ bias;
- unfair hearing including failure to ask essential questions or refusal to give claimant time or opportunity to respond;
- failure to grant adjournment of a hearing date when there was good cause to do so;
- failure to grant additional time to submit new evidence where the request was appropriate and the amount of time requested was reasonable;
- ALJ committed an error of law;
- ALJ committed procedural error;
- erroneous dismissal;
- rejecting medical evidence in favor of the ALJ’s own observation of the claimant;
- failure to inform claimant of his right to obtain counsel;
- failure to give proper weight to unrebutted medical evidence;
- failure to give proper weight to claimant’s subjective complaints or pain or other symptoms;
- failure to consider findings of disability by other government agencies;
- failure to properly apply Circuit Court law and properly evaluate evidence;
- relying on opinions of non-examining physicians to the exclusion of opinions by treating or examining physicians;
- improperly applying the grids;
- failure to consider all relevant evidence; or
- failure to follow proper procedure such as not proffering evidence subsequently obtained after the hearing to the claimant or claimant’s representative.
See Hallex I-3-125 and Hallex I-3-303.
If the AC affirms the unfavorable ruling of the ALJ, then all administrative remedies under the Social Security Administration have been exhausted and the only remedy is to file a claim in Federal District Court or start over (if possible due to DLI issues). 20 C.F.R. §§ 404.981, 416.1481. The claim must be filed within 60 days of the denial by the AC or else a request in writing must be made to the AC and must demonstrate good cause for the late filing. 20 C.F.R. §§ 404.982, 416.1482.
If you need more information about a Social Security Disability/SSI matter, personal injury matter (car wreck, boating accident, slip and fall, etc.), EEOICPA claim, long or short-term disability, VA disability, or a workers compensation matter, please contact the Law Offices of Tony Farmer and John Dreiser for a free case evaluation. We can be reached at (865) 584-1211 or (800) 806-4611, through Facebook, or through our website. Our office handles claims throughout East Tennessee, including Knoxville, Chattanooga, Kingsport, Bristol, Johnson City, Morristown, Maryville, Rogersville, Dandridge, Tazewell, New Tazewell, Jefferson City, Strawberry Plains, Sevierville, Gatlinburg, Loudon, Kingston, Halls, Maynardville, Crossville, Cookeville, Jamestown, Sweetwater, Lenoir City, Athens, Oak Ridge, Clinton, LaFollette, Lake City, Jacksboro, Bean Station, Cosby, Newport, White Pine, Mosheim, Wartburg, Sunbright, Pigeon Forge, and Deer Lodge.
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