Legal Definitions - appeals council

The Appeals Council is a specialized body within the Social Security Administration (SSA) responsible for reviewing decisions made by Administrative Law Judges (ALJs) regarding Social Security benefits.

When an individual applies for Social Security benefits (such as disability, retirement, or survivor benefits) and is denied, they can appeal that decision. If their appeal is heard by an Administrative Law Judge and they still disagree with the ALJ's ruling, the next step in the appeals process is often to request a review by the Appeals Council. The Council examines the ALJ's decision to determine if it was legally sound and supported by the evidence presented.

Here are some examples of when the Appeals Council might be involved:

• Example 1: Disability Benefits Denial

  Maria applied for Social Security Disability benefits due to a severe back injury. After her initial application and a reconsideration were denied, she had a hearing before an Administrative Law Judge (ALJ). The ALJ, after reviewing the medical evidence and testimony, issued a decision denying her claim, stating she could still perform light-duty work. Believing the ALJ misunderstood her medical limitations, Maria then requested that the Appeals Council review the ALJ's decision. The Council would then examine the entire case record to see if the ALJ's denial was correct based on the law and evidence.

• Example 2: Overpayment Dispute

  Mr. Henderson, a recipient of Social Security retirement benefits, received a notice stating he had been overpaid by several thousand dollars and needed to repay the amount. He disputed this, arguing the overpayment was not his fault and he couldn't afford to repay it. An Administrative Law Judge (ALJ) heard his appeal and upheld the SSA's decision regarding the overpayment. Dissatisfied with the ALJ's ruling, Mr. Henderson submitted a request for review to the Appeals Council, hoping they would reverse the ALJ's decision or waive the repayment.

• Example 3: Survivor Benefits Eligibility

  Following the death of her spouse, Sarah applied for Social Security survivor benefits. The SSA initially denied her claim, citing a technical eligibility requirement. She appealed, and an Administrative Law Judge (ALJ) reviewed her case but ultimately agreed with the initial denial. Convinced that the ALJ misinterpreted the regulations concerning her specific situation, Sarah then sought a review from the Appeals Council. The Council would then determine if the ALJ's application of the law to her case was correct.