Appeals Council: Standard of Review; What Happens next

If someone’s case has been denied by an Administrative Law Judge (“ALJ”), he or she may appeal that decision with the Appeals Council (A/C). The Appeals Council is a centralized body in Falls Church, VA which handles all disability appeals throughout the US.

The Appeals Council does not review a case the same way an Administrative Law Judge does. The ALJ reviews a case as “de novo”, meaning “fresh,” “new,” “starting over.” The ALJ is not bound by any prior determinations made before at the state agency levels of review.

The Appeals Council, however, will apply a more deferential standard once the ALJ has made his/her decision. The A/C typically does not review the case “de novo.” Therefore, some say, that it may be more difficult to win at the Appeals Council level of review than to win at the ALJ level of review.

If your case has been denied by an ALJ, and legitimate mistakes were made by the Judge, or, if significant evidence was missing, then often, the best next step is to appeal your case to the Appeals Council for review. For additional questions about your, or a friend or family member’s disability case, please feel free to contact us at 404-373-1649.

The regulation concerning Appeals Council Review is 20 CFR 416.1470 and states:

(a) The Appeals Council will review a case if—

(1) There appears to be an abuse of discretion by the administrative law judge;

(2) There is an error of law;

(3) The action, findings or conclusions of the administrative law judge are not supported by substantial evidence; or

(4) There is a broad policy or procedural issue that may affect the general public interest.

(b) In reviewing decisions based on an application for benefits, if new and material evidence is submitted, the Appeals Council shall consider the additional evidence only where it relates to the period on or before the date of the administrative law judge hearing decision. In reviewing decisions other than those based on an application for benefits, the Appeals Council shall evaluate the entire record including any new and material evidence submitted. It will then review the case if it finds that the administrative law judge’s action, findings, or conclusion is contrary to the weight of the evidence currently of record.

One Reply to “Appeals Council: Standard of Review; What Happens next”

  1. I would also love to add that when you do not actually have an insurance policy or you do not remain in any group insurance, chances are you’ll well reap the benefits of seeking the help of a health insurance agent. Self-employed or people who have medical conditions normally seek the help of one health insurance dealer. Thanks for your post.

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