What is the Appeals Council?

Social Security Disability Insurance (SSDI) Appeals in Massachusetts

The disability lawyers at Kantrovitz & Associates are devoted to helping disabled individuals in Massachusetts obtain compensation for their injuries. After more than 25 years in appellate practice, we have obtained reversals of denied benefits before the Appeals Council, formerly the Disability Review Board (DRB). Our knowledge of the higher levels of the review process has been instrumental to winning SSDI for injured workers in counties including Suffolk, Essex, and Middlesex, as well as other counties throughout the Commonwealth.

Appealing an ALJ’s Decision

The United States Code of Federal Regulations (C.F.R.) sets forth rules regulating review of administrative law judge (ALJ) decisions. As the governing body responsible for allocating federal funds, the Social Security Administration (SSA) hears appeals of decisions denying or discontinuing benefits based on disability. The last step in evaluating a disability claim is the Appeals Council. Throughout the claims process, the applicant must develop a record of evidence demonstrating a compensable disability. Thorough advocacy is required to raise appropriate objections to adverse claims by insurers, and to present persuasive arguments during hearings before the ALJ. If the ALJ issues an adverse decision denying SSDI benefits, the claimant may seek review before the Appeals Council.

Changes in Law

Final regulations in 76 C.F.R. 24802 eliminated the DRB on June 13, 2011 in favor of the Appeals Council, which now has authority to review disability applications filed on or after August 1, 2006 in Massachusetts. The SSA transferred any claims that were pending at the DRB on June 12 to the council for processing. The Appeals Council can take the following actions:

  • Review the ALJ decision and evidence in the record. 20 C.F.R. §416.1469
  • Review decision on council’s “own motion” within 60 days of decision date
    • Give claimant opportunity to file further documentation for council to review
    • Interim SSDI benefits available if no final decision within 110 days of decision
    • Authority to pursue review on own motion pursuant to 20 C.F.R. §404.969(d)
  • Uphold, reverse, or remand the case for further proceedings. 20 C.F.R. §404.969
  • Review not limited to issues challenged by claimant, but entire ALJ decision, including:
    • Denial of benefits or award with unfavorable disability onset date
  • In some cases, reopen case under 20 C.F.R. §404..987 and revise ALJ decision
    • May conflict with prior case law. McCuin v. Sec’y, 817 F.2d 161 (1st Cir. 1987)

20 C.F.R. §416.976(b) allows the council to consider new and material evidence relating to the period on or before the date of the ALJ decision only in limited circumstances:

  • Reasonable probability that evidence would change outcome of case
  • SSA mislead the claimant, resulting in incomplete evidentiary record
  • Claimant could not submit evidence earlier due to:
    • Mental, physical, linguistic, or educational limitation
    • Other “unusual, unexpected, unavoidable” circumstance

Other than the exceptions provided in 20 C.F.R. §405.401, the council will not consider new evidence or argument after the ALJ decision. Effective July 28, 2011, SSA also discontinued its policy allowing claimants to simultaneously reapply for benefits and seek review by the council for the same disability. The policy change is implemented by Social Security Ruling 11-1p.

Successfully Appealing Denied Benefits

If you are appealing denied benefits or an ALJ decision, contact the social security disability attorneys of Kantrovitz & Associates today. We have over 25 years of experience obtaining needed benefits before the SSA, ALJs, and the Appeals Council. From the initial filing of a claim to appealing adverse decisions in federal court, Kantrovitz & Associates fights for your rights at every level of appeal. Our persuasive presentation of compelling medical evidence allows us to recover substantial awards for disabled claimants in New Hampshire, Rhode Island, and Massachusetts. Call (800) 367-0871 today for a free consultation or contact us online.