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Appeals Council or Decision Review Board
You have sixty (60) days from the date that you receive an unfavorable ALJ decision to file an appeal with the Appeals Council. To appeal, you must file a form with the Appeals Council entitled, Request for Review of Hearing Decision. SSA will extend the time if you have good cause; for not filing on time.
Usually, the Appeals Council does not change the agency's decision. The Appeals Council examines the record and either denies or dismisses the request for review, or grants the request and either issues a decision or remands the case to an ALJ. If your case is remanded for another hearing, it generally goes back to the same ALJ that denied the case.
The Appeals Council reviews your case for abuse of discretion, error of law, and substantial evidence. If the Appeals Council decides to review your case, it may remand the case back to the ALJ for more evidence. After filing the request for review, your case is evaluated by an analyst who works for a member of the Appeals Council. Analysts consult with physicians who are employed by the Appeals Council. The analyst summarizes the disability issues and makes a recommendation to the Appeals Council.
The Appeals Council considers new and additional evidence only where it relates to the period on or before the date of the hearing decision. If evidence is submitted that does not relate to the period on or before the date of the hearing decision, the Appeals Council will return the evidence with an explanation to file a new application.
The decision of the Appeals Council after review, or its decision to deny review, is binding unless you commence court action in the proper United States District Court within sixty (60) days after you receive the Appeals Council decision. If the Appeals Council denies review, the ALJ hearing decision itself becomes final and binding.
You have the right to obtain copies of all documents used in the hearing decision or dismissal. This includes written evidence and a copy of the hearing cassette. If you request a written transcript of the hearing itself, you will be asked to pay the cost of providing this written transcript, unless you have good reason for not paying.
The Appeals Council must provide a reasonable opportunity for the submission of briefs or other written statements about the facts and law pertaining to the case. The Appeals Council may consider additional evidence which it believes is material to an issue being considered. You may request to appear before the Appeals Council to present oral argument. The Appeals Council will permit oral argument if it determines that your case raises an important national question of law or policy.
On its own motion, the Appeals Council has the authority, within sixty (60) days after the date of a hearing decision or dismissal, to review whatever action is taken, even if you did not request the Appeals Council to review your case. This may happen even when a decision is favorable. The Appeals Council can reverse a favorable decision even after you have been notified of a favorable decision. |