WHAT IS THE APPEALS COUNCIL (AC)?

WHAT IS SOCIAL SECURITY'S APPEAL COUNCIL? HOW DOES IT WORK? WHY WOULD YOU EVER USE IT?

The Appeals Council ("AC") is a branch of the Social Security Administration that reviews decisions made by administrative law judges. If you go to a hearing and the judge denies your Social Security benefits, the next appeal is with the Appeals Council ("AC") -- a group of appeal judges headquartered in Falls Church, Virginia.

This review is the final administrative appeal with Social Security. It may only be used after an administrative law judge (ALJ) has heard and denied your case.

What are your chances with the AC appeal?

Only 1% of cases at the Social Security Appeals Council are approved—worse than any other level of appeal. Another 9% of cases get sent back ("remanded") to the hearing level for the ALJ to take further action or hold a new hearing. The ALJ may deny your case again, of course. So, the odds are terrible.

Here's what many claimants don't understand: The AC does not make any attempt to decide whether you are disabled. That was already determined by the ALJ who denied your claim. What the AC does is review the judge's decision to determine whether (a) you received a fair hearing under the Social Security regulations, and (B) Did the judge act properly with regard to Social Security rules and procedures. If there is no technical, legal issue, the AC will not review your case.

Even if the AC reviews your hearing and disagrees with the judge's decision, the AC will NOT change the decision. The denial remains a denial. If the AC determines that the hearing judge made a legal or procedural error (violated the rules), your claim is still not approved. It is sent back to the judge for further action to correct the error, which could be a new hearing. But this only happens in 9 percent of all AC appeals (fewer than 1 out of 10).

Here are some other points about an Appeals Council review:

• No one appears before the AC; there is no hearing. It is a paper review.

• You have only 60 days after a denial to file for an AC review.

• The AC will not consider new medical treatment occurring after the hearing. It will only review evidence that was available, or should have been available at the hearing.

• It usually takes about 1 year to get an AC decision.

• If the AC dismisses your appeal, your only other appeal is a lawsuit in federal district court.

The absolute best odds of winning your benefits happens at the hearing with the administrative law judge (ALJ). This is where you need to concentrate on winning. There is never as good chance to win after the hearing. Thus, your case should be prepared thoroughly when presented at the hearing. Once you lose at the hearing level, your best chance has gone! Most claimants get one and only one hearing, so take full advantage of it.

"Once you lose a hearing, your best chance to be approved has passed you by. Most folks only get 1 hearing.

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Charles W. Forsythe is founder of The Forsythe Firm in Huntsville, AL. He works tirelessly to help disabled individuals get their Social Security Disability benefits. (256) 799-0297.