Receiving an unfavorable decision on a Social Security disability benefits claim after enduring the extremely long wait to have a hearing before an Administrative Law Judge can be devastating. However, there is one final option.
If an Administrative Law Judge chooses to side with the original determination of the state agency who issued a denial of benefits, he or she will issue an unfavorable decision after a claimant has appeared before the court and presented their case. Many claimants do not realize that, even after this second denial, there is still one more appellate step that can be utilized. During this step, the claim is considered by the Appeals Council.
A claimant must file an appeal with the Appeals Council within 60 days of receiving a decision from an Administrative Law Judge. The rare exception to this rule is when the claimant can prove that there was very good cause for missing that deadline. He or she may then be given special permission to file.
At this stage, the Appeals Council will review the case to determine if the judge made a procedural error, or if there was insufficient or contradicting evidence to support the decision. In order for the decision to be overturned, there must be clear evidence in the medical records that the decision was unsubstantiated. If the evidence provides support for both a favorable or unfavorable disability determination, then the Appeals Council will not take the case under review and will not overturn the judge’s decision. If it is decided that the judge’s decision was incorrect, then the case will either be returned to the judge for reconsideration, or the Appeals Council will make a decision on its own.
If a Social Security disability claimant does not file an appeal prior to the 60-day deadline, the current application is considered closed and will no longer be considered. At that point, if a claimant wishes to further pursue disability benefits, he or she will be required to complete a new application and begin the process again from the start. A Social Security Disability attorney can be vital to obtaining medical records and other pertinent information to prove a claim, so it is therefore of critical importance that disabled individuals work closely with their attorneys to give their claim the best chance of success, whether at the initial claim stage or on appeal.