Health & Benefits

The Appeals Council is responsible for reviewing decisions that Administrative Law Judges (ALJs) make in Social Security and SSI disability cases. It also reviews other Social Security and SSI cases, such as appeals about overpayments or Social Security survivor benefits. The Appeals Council assigns one of its appeal judges or officers to look at each case.

This article answers questions about disability appeals. It also answers some questions about appeals in other Social Security cases.

The Appeals Council is the highest appeal step within the Social Security Administration. In general, the appeal steps at Social Security are:

1. Initial decision (for example, a decision that you are not disabled or no longer disabled, that Social Security overpaid you, or that you are not eligible for retirement or survivor’s benefits),
2. Reconsideration,
3. Administrative Law Judge hearing, and
4. Appeals Council.

If you disagree with the decision that the Appeals Council makes, the next appeal is to federal court.

Your appeal to the Appeals Council is also called a “request for review.” There are two ways to file your appeal to the Appeals Council: 

• Online, or
• By completing a printed Social Security appeal form (Form HA-520). You can mail, fax, or drop off the form at the Social Security office. 

Here is more information about filing the request for review:

• You can go to your local Social Security office or call Social Security to ask for a copy of the form. The form number is HA-520. The number to call is (800) 772-1213 or TTY at (800) 325-0778. Note: With recent changes at the Social Security Administration, it may be hard to reach Social Security by phone.
• After you fill out the form, make a copy to keep for your records.
• You can mail the form to the Appeals Council at:  

Social Security Administration

Office of Appellate Operations

6401 Security Blvd.

Baltimore, MD 21235-6401

• You may want to send the appeal using certified mail, return receipt requested. This costs a little more than regular mail, but it will give you good proof of the date you mailed the appeal and let you know that your appeal reached the right office at Social Security.
• Another way to file the appeal is to fax it to (833) 509-0817. One reason faxing can be a good idea is that a fax machine usually prints out a receipt showing that the fax went through to the number.
• You can also drop off the form at your Social Security office. If you do this, be sure to bring a copy with you and ask the worker to sign and date your copy to show when Social Security received it.

Note: Social Security may ask the Appeals Council to review an Administrative Law Judge decision even if you have not requested review. If that happens, the Appeals Council will let you know.

Social Security’s rules say that the Appeals Council will review an Administrative Law Judge’s (ALJ’s) decision only for specific reasons. The most common reasons for the Appeals Council to review an ALJ decision are:

• The ALJ made an “error of law,” or a legal mistake,
• “The hearing decision [is] not supported by substantial evidence," meaning the evidence does not support the ALJ’s decision,
• There is “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 the additional evidence would change the outcome of the decision,” meaning you have strong new evidence that could change the decision, or
• There was “an abuse of discretion by the administrative law judge,” meaning the ALJ did something unfair in the hearing, such as not allowing you to testify.

The appeal form, Form HA-520, is a fill-in-the-blank form. Number 4 on the form is the spot to tell Social Security why you are appealing. Number 4 says “I request that the Appeals Council review the Judge’s action on the above claim because.” When you fill in number 4, it is very important to use the exact language of the regulation. See 20 C.F.R. § 416.1470 and 20 C.F.R. § 404.970. Even if you have a good reason for appealing the ALJ’s decision, the Appeals Council might refuse to look at your case if you do not use this key language.

You could use the words below for one or more of the reasons:

• The ALJ made an error of law,
• The hearing decision is not supported by substantial evidence,
• I have 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 the additional evidence would change the outcome of the decision, or
• There was an abuse of discretion by the ALJ.

You also have the right to tell the Appeals Council more details about the reasons that you think the ALJ’s decision in your case is wrong. You must put your reasons in writing. You can include that written argument with your appeal form. If you need to, you can ask for more time to send the written argument to the Appeals Council by checking the box under number 4 on the appeal form. The box says “Please grant me an extension of time to submit evidence or argument.”

You must file your appeal or request for review within 65 days of the date of the Administrative Law Judge’s (ALJ’s) decision. Social Security’s policy says that the appeal is considered filed as of the date you mail it to Social Security. If you mail the appeal near the 65-day deadline, it is particularly important for you to have proof of when you mailed the appeal, in case it arrives after the 65 days.

If you miss the 65-day deadline for filing your appeal, you can file the appeal anyway and ask the Appeals Council to accept your late appeal. Be sure to explain the reasons you are late. 

Good cause for a late appeal could be:

• You were seriously ill during the 65 days,
• A family member was seriously ill during the 65 days, and you were caring for them,
• There was a death in your family,
• Your home was destroyed by fire or flood during the 65 days,
• A worker at the Social Security office gave you incorrect information that caused you to be late,
• You did not understand the appeals process because of your disability, or
• Any other situation that was outside your control and interfered seriously with getting the appeal filed on time.

Include proof of your reason for filing the appeal late. Proof could be a medical record, documents from FEMA or an insurance agency, or other evidence, depending on the situation.

You have the right to represent yourself at any Social Security appeal stage. However, one of the most common reasons for the Appeals Council to review an Administrative Law Judge’s (ALJ’s) decision is for a legal mistake. The law can be complicated. A lawyer might be able to spot a legal mistake that you did not catch. A lawyer could help with a written explanation of the ALJ’s mistakes. Therefore, your chances of winning a case with the Appeals Council are better if you have a lawyer or a trained advocate, like a paralegal, representing you.

The Appeals Council does not hold hearings. There is no chance to testify before the Appeals Council. In very unusual situations, the Appeals Council might ask your lawyer to make the arguments in your case orally, not just in writing. However, in almost every case, the review by the Appeals Council is a “paper review.” The Appeals Council looks at all of the documents that the Administrative Law Judge (ALJ) had and listens to the recording of the testimony. The Appeals Council also looks at any written arguments for your case. Then the Appeals Council makes a decision based on that information. 

Yes, you can give new evidence – but only in certain situations. In general, the Appeals Council looks at the evidence that the Administrative Law Judge (ALJ) had in your case and decides whether the ALJ made a mistake. However, Social Security's rules allow you to give new evidence to the Appeals Council in a disability case if two things are both true:

• The evidence shows your condition on or before the date the ALJ made their decision, and
• You have a good reason for not having given the evidence to the ALJ at least five days before the hearing.

Any new evidence must be about your medical condition up until the time the ALJ decided your case. In other words, if you got sicker after the ALJ made their decision, the Appeals Council will not accept evidence showing that you got sicker. 

The Appeals Council will not accept new evidence in a disability or any other case if you could have gotten the evidence in time for the ALJ hearing. Good cause for not giving the evidence to the ALJ before the hearing can be the same reasons that are considered good cause for a late appeal. For example, you were very ill and were not able to gather the evidence. 

If you did everything you could to get the evidence for the ALJ, but you only got the evidence after the ALJ decision, that also could be good cause for not having given the evidence to the ALJ. For example, if you contacted your doctor’s office to get the evidence in plenty of time before the hearing, but the doctor’s office did not send the evidence until after the ALJ hearing. If so, you can ask the Appeals Council to accept the evidence.

When you send the new evidence to the Appeals Council, include an explanation of why you did not have the evidence for the ALJ. Include any proof you have. You can send the new evidence with your appeal form HA-520. If you need time to get the new evidence, you can check the box on your appeal form HA-520 that says “Please grant me an extension of time to submit evidence or argument.”

A case at the Appeals Council can take anywhere from a few months to a year or longer. According to USAFacts, the average time in 2023 was 264 days, or over eight months.

In most situations, you are not allowed to file a new application for Social Security or SSI disability benefits while your disability case is at the Appeals Council. If you start a new application while you have an appeal at the Appeals Council, Social Security will ask you to choose whether you want to go ahead with the appeal or with the new application. If you have an attorney or paralegal representing you at the Appeals Council, be sure to talk to that person to decide what makes sense for you. 

Note: If you have a new, severe, disabling condition that started after the Administrative Law Judge’s (ALJ’s) decision, you may be allowed to file a new application while your case is at the Appeals Council. For example, you may have a disability case at the Appeals Council based on back pain and depression. After the ALJ hearing, you start having new and different symptoms. Your doctor diagnoses you with a cancer that has spread. You may be allowed to file a new application based on your cancer.

If the Appeals Council denies your case, you can file a new application for disability benefits at that time.

The chances of winning a case at the Appeals Council are very small. Many people still decide to file an appeal to the Appeals Council.

The Appeals Council has these options when it reviews a case:

• It can say the Administrative Law Judge (ALJ) made a mistake and decide you are disabled,
• It can agree with the ALJ decision and decide that the ALJ’s decision stands,
• It can decide not to review the case, which also means the ALJ’s decision stands,
• It can dismiss the appeal, for example, because the appeal was not filed on time, or
• It can say the ALJ made a mistake in how the ALJ decided the case, and send the case back to the ALJ to make a new decision. This is called “remand.” When the ALJ looks at the case again, the ALJ usually holds a new hearing.

The first option, when the Appeals Council says the ALJ made a mistake and rules for you, only happens about 1% of the time. In 2024, the Appeals Council remanded about 18% of cases. This means the Appeals Council sent the cases back to the ALJ for a new decision. This gives you a new chance to prove and argue your case. It is important to remember that when a case goes back to the ALJ, the ALJ makes a new decision. But, that decision might still be against you.

In the other 80% or more of cases, the person appealing does not win at the Appeals Council. The ALJ decision against the person becomes Social Security’s final decision. 

Is it a good idea to take your case to the Appeals Council if you lose your case with the Administrative Law Judge (ALJ)? Would it be better to wait a while and start over with a new application? The answer depends on many things. 

If you give up and start again later with a new application, you lose the chance of getting benefits from the time of your first application. Appealing to the Appeals Council keeps the earliest possible date for getting benefits. Even though the Appeals Council turns down many cases, you cannot get your case to the next appeal stage, federal court, if you do not file an appeal with the Appeals Council.

In some cases, you may not be able to get any benefits at all if you file a new application. This is the situation if you have a “last insured date” earlier than the date of the ALJ decision. On the other hand, if your physical or mental health got much worse after the ALJ made their decision, you might be better off not appealing and filing a new application instead.

In cases that are not disability cases, you may only have one shot at the appeal. There is no chance to reapply or start over. Your only option if you want to fight the decision against you is to follow through on the appeal.

These are just some of the considerations that you need to think about when you decide whether to file an appeal to the Appeals Council. If you had a lawyer for the ALJ hearing, you should talk to that attorney to help you decide if an appeal is a good idea.

Here are a few examples of the kinds of cases that the Appeals Council might send back to the Administrative Law Judge (ALJ):

• You had an opinion from your treating doctor, but the ALJ ignored that opinion,
• The ALJ held the hearing without you while you were in the hospital, even though you asked the ALJ to postpone the hearing,
• It is clear that the ALJ misunderstood the medical evidence or reached conclusions that only a doctor can make,
• You suffer from mental impairments such as depression, but the ALJ based their decision only on your physical impairments, or
• The ALJ made findings that do not make sense. For example, if the ALJ said that you can work full time since you are able to babysit your grandchild a few hours a week. The Appeals Council might say that the ALJ’s conclusion does not make sense.

Sometimes, there are close cases where the ALJ considered all of the evidence but decided you are not disabled. The Appeals Council is not likely to send this case back to the ALJ. Even if the Appeals Council might have decided the other way if they were the ALJ, if the ALJ considered all the evidence and did not make an error, the Appeals Council will let the ALJ decision stand.

If the Appeals Council denies your case or says it will not review your case, you have the right to file an appeal in federal court. You have 65 days from the date of the Appeals Council decision to file the case in federal court. You have the right to represent yourself in federal court, but your chances of winning will probably be better if you have an attorney. Federal courts send many cases back to Social Security because of the kinds of mistakes described above, such as when the Administrative Law Judge (ALJ) and Appeals Council ignore or misread important evidence.

If you miss the deadline for filing in federal court, you can ask the Appeals Council to extend the deadline. The federal court does not have the authority or power to extend the deadline itself. 

If you miss the deadline to file your appeal from the ALJ to the Appeals Council, the Appeals Council may decide you did not have good cause for appealing late and dismiss your appeal. You cannot appeal that dismissal to federal court. The Appeals Council’s decision on whether you had good cause for the late appeal is final.

You can find more information about the Appeals Council on the Social Security Administration's website. 

Many legal aid programs can advise or represent clients with Social Security or SSI issues. To learn more about legal help in your area, try ILAO’s Get Legal Help tool. 

You can also contact the Illinois State Bar Association’s Lawyer Referral Service at (800) 922-8757 or the National Organization of Social Security Claimants’ Representatives (NOSSCR) at (845) 682-1881. These organizations may have names of attorneys in your area who have experience with Social Security cases.