The Appeals Council Stage of a Disability Appeal, and What Follows

How long do you have to request Appeals Council review?

Sixty days from the date you receive notice of the hearing decision or dismissal. Under 20 CFR 404.968(a), you request review by filing a written request within that window, and you can file it at an SSA office.

The clock runs from receipt, not from the date printed on the decision. SSA's appeals page explains that it assumes you receive a notice five days after it is mailed unless you can show you received it later. Treat it the way you would treat a bill with a due date: the postmark is not the deadline, but counting from the postmark keeps you safe. The same page says you can fill in Form HA-520, Request for Review of Hearing Decision/Order, or start the request online.

Missing the deadline is not always the end. Under 404.968(b), you or any party may ask for more time. The request must be in writing, filed with the Appeals Council, and explain why the request for review was not filed on time. If you show good cause under the standards in 20 CFR 404.911, the time is extended.

We handle Appeals Council requests as part of our disability appeals work, and the earlier stages are covered in our guide to reconsideration.

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The five grounds the Appeals Council uses to review a disability decision

The Appeals Council reviews the hearing decision rather than starting the case over, and it measures that decision against five grounds set out in 20 CFR 404.970(a), and it will review a case if any one of them applies:

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 are not supported by substantial evidence.
4. There is a broad policy or procedural issue that may affect the general public interest.
5. The Council receives additional evidence that is new, material and relates to the period on or before the date of the hearing decision, and there is a reasonable probability that it would change the outcome.

That list shapes what a useful request says. A request that only repeats that you are disabled gives the Council nothing to measure against these grounds. A request that points to a specific error does: a medical opinion the decision did not evaluate for supportability and consistency, a symptom finding with no specific reasons, or a limit in the record left out of the residual functional capacity (RFC), meaning the most you can still do. Our guide to how judges decide disability claims covers what the written decision is required to explain.

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New evidence rules at the Appeals Council stage of an appeal

New evidence counts at the Appeals Council only if it clears every part of the fifth ground and you show good cause for not submitting it earlier. The Council does not take new records simply because they exist.

The evidence must be new, material and about the period on or before the date of the hearing decision, with a reasonable probability of changing the outcome. Under 404.970(b), you must also show good cause under 20 CFR 404.935. The reasons the rule accepts include that SSA's action misled you; that a physical, mental, educational or linguistic limitation kept you from submitting it earlier; or that some other unusual, unexpected or unavoidable circumstance beyond your control prevented it, such as a serious illness, a death or serious illness in your immediate family, or records destroyed by fire.

Evidence about a later period follows a different path. Under 404.970(c), if the evidence does not relate to the period on or before the hearing decision, or you do not show good cause, the Council sends a notice explaining why it did not accept it. The notice tells you about your right to file a new application. If you file one within six months of that notice, your request for review counts as a written statement of intent to claim benefits, and the date you asked for review becomes the filing date of the new application.

Under 20 CFR 404.976(b), the Council evaluates all the new evidence it receives, but only evidence that meets these requirements is marked as an exhibit and made part of the official record. If the case goes to federal court, the certified record must include all additional evidence the Council received.

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What the Appeals Council can do with your disability appeal

The Appeals Council can deny or dismiss the request for review, or grant it and then either issue its own decision or send the case back to an administrative law judge. Under 20 CFR 404.967, the Council notifies the parties of its action at their last known address.

• Deny review. Under 20 CFR 404.981, the judge's decision then becomes binding unless you file in federal district court or the decision is revised.
• Decide the case. Under 20 CFR 404.979, the Council may affirm, modify or reverse the hearing decision, and a copy of its decision is mailed to the parties.
• Remand. Under 20 CFR 404.977, the Council may send the case to a judge for a hearing and a decision or a recommended decision, and may also remand when more evidence is needed. On remand, the judge must take any action the Council orders and may take additional action that is not inconsistent with the remand order.

The Council may also limit the issues it considers, but only after notifying you and the other parties of the issues it will review, under 20 CFR 404.976(a). A remand is not the same as a decision in your favor. It sends the case back for more work, which can include another hearing and a new decision.

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Federal court as the next step after the Appeals Council

If the Appeals Council denies review or issues a decision you disagree with, the next step is a civil action in federal district court. Under 20 CFR 404.981, the Council's decision, or the judge's decision when review is denied, is binding unless you or another party file an action in federal district court or the decision is revised. You may file that action within 60 days after the date you receive notice of the Council's action.

SSA's appeals process page describes this as filing a civil suit in a federal district court. SSA staff prepare the claim record for the court, and a court filing fee applies.

We do not represent clients in federal court. When a case reaches that step, we refer it to affiliated counsel who handle federal court disability appeals. Because the 60-day clock keeps running during a referral, raise the question with us as soon as the Appeals Council's notice arrives, not near the end of the window.

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