The Law Offices of Sheryl Gandel Mazur
North New Jersey: 973-200-6629
South New Jersey: 609-207-7905

When will the Appeals Council review after a denied claim?

When a New Jersey resident applies for Social Security disability benefits for injury, illness or a condition and the application is denied, there are four levels of appeal that can be attempted. After reconsideration and a hearing before an administrative law judge (ALJ), there is the Appeals Council followed by a lawsuit in federal court. The Appeals Council is different in that it is not obligated by law to examine a case and consider whether the decision should be changed or not. The Appeals Council will consider every case, but will deny the review if it finds that the previous decisions were just. Knowing which cases the Appeals Court will review is important.

A case will be reviewed by the Appeals Court if: the ALJ has abused his or her discretion; an error of law was made; the substantial evidence does not support the action, findings or conclusions the ALJ made; there is a policy or procedural factor that can impact the public interest; or if there is new evidence that relates to the time at which or prior to when the decision was made and the outcome would likely have been changed with the evidence.

The Appeals Council will assess the evidence from the ALJ hearing and other evidence the applicant presents if it is material. There must be good cause shown for not providing the evidence at one of the other levels of appeal or during the initial application process. The following are examples as to why the Appeals Council will allow new evidence to be presented: the applicant was ill and could not contact the Social Security Administration; an immediate family member suffered serious injury or death; there was a fire or other disaster that destroyed records; the person did try to gather the evidence and could not or got it fewer than five days before the hearing; or if there was a decision made on the record and the Appeals Council reviewed it.

When a person seeks SSD benefits and faces a denied claim, they might take some solace in the four levels of appeal that, on the surface, seem to give multiple opportunities to get a more favorable decision in the future. It is important to know when the Appeals Council will hear a case as it does not accept all cases. A law firm that has represented many people in the Social Security disability appeals process can help to explain the requirements and ensure the applicant has a good chance of the Appeals Council agreeing to hear the case.

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