An Inside Look at the Appeals Council (AC) Review Process

Once made, every unappealed, hearing-level, fully or partially favorable disability decision by an administrative law judge (ALJ) or a senior attorney adjudicator (SAA) goes into a common pool. From that pool, a computer randomly selects 1-2% of those decisions for review by the Appeals Council’s (AC) Division of Quality (DQ), a 60-person oversight taskforce comprising appeals judges, appeals personnel, and attorneys. Once it has been selected for review, a decision works its way through the AC’s 60-day oversight process, during which time DQ staff examine the decision to ensure that it was made according to law, based on sufficient evidence, and with no indication of impropriety by the deciding judge. Assuming the AC finds no errors or discrepancies in the decision, the case is sent on to the proper offices for distribution of benefits. If, however, the AC finds an error of law or a discrepancy of some sort in the decision, the claimant and his representative are notified of the AC’s proposed next steps, which may include a remand or a corrective decision. Once notified, the claimant and his representative have 25 days to submit further evidence to the AC. If they choose to submit material, the AC will review it and then render a final decision. The purpose of the AC’s review process is important on both micro and macro levels; the review process not only corrects errors of judgment that may affect individual claimants, but also helps the Social Security Administration (SSA) hone in on problem areas of agency policy and implementation, as well as provide appropriate training for staff.