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The Appeals Council is overturning favorable decisions

Most social security disability claimants are not aware of the existence of the Appeals Council. But lately, more and more are taking notice, as the Appeals Council increasingly seems to be exercising its right to review hearing decisions, including favorable decisions, and make its own decision.

Currently, the Appeals Council is made up of approximately 70 Administrative Appeals Judges, 56 Appeals Officers, and several hundred support personnel. The Appeals Council is physically located in Falls Church, Virginia with additional offices in Crystal City, Virginia, and in Baltimore, Maryland.

As the last administrative decisional level, the Appeals Council renders the Social Security Administration’s (SSA’s) final decision, usually because a claimant or his attorney has requested that it review an unfavorable decision.

But under Social Security rules, the Appeals Council has the right to look at cases that no one has appealed. That means the Appeals Council can decide to review a favorable decision and overturn it, which is bad news for claimants and their attorneys. The rules mandate that the Appeals Council must send a claimant and his representative written notification of its intent to review a case on its own motion by certified mail no later than the 60th day after the date of the hearing office’s action.

Here in Oregon, a number of us are seeing this happen. When it does, it causes dismay and hardship for claimants who waited years for their “day in court” – only to have a favorable decision overturned by a group of folks they will never see or speak with.

13 Responses

  1. Adam says:

    This has happen to my Wife. Fully favorable Overturned By them. Its amazing how much they put you thru. And then get your hopes up only to Tear you down again. Its getting to the point my Wife will be committed For extended period of time due to this added Stress and Depression! She gotten more Panic attacks and He other conditions become worse every time we talk to SSA or our attorneys!

  2. Tammy says:

    May I ask how they “decided to choose” her file?

    I applied July of 2011 got denied my hearing was November of 2012 and the Administrative Law Judge decision was found favorable in jan of 2013; however, I was RANDOMLY SELECTED to be reviewed by the Appeals Counsel.

    I’m so sorry about your wife. What happens now? I will pray for her!

  3. Tiquila says:

    Im sorry for your family.. Im 31 and ive been havin seizures since the age 11. I was receiving benefits until 2000, I have been tryin for 13yrs to get my benefits back. I have been hospitalized bout 25 times in the passed 5 yrs alone. I broke my foot having a seizure, third degree burns on my right arm I had my hair shaved at the top I hit my head on the tv… I feel yo pain, how much information do u need?

  4. Steve says:

    After fighting for years we finally won in court!!! Only to find out 3 weeks later that the Appeals Council decided to review my case. I just found out about an hour ago, I didn’t know that it was a possibility for them to overturn the judges decision??? Now I’m totally stressed out all over again and I’m getting ready to have my 11th surgery in 4 days and after I heal from that one in 3 months they are going to operate on me again 8~( My family and I are totally freaked out about all of this and the possibility of them overturning my favorable decision…. I will keep you posted as it progresses.

  5. George Waite says:

    I have an appeal that needs to be addressed. The alj in Detroit michigan mr. Gregory holiday is not listening to me. There is a shortage of help at the ssa office. I am not being helped as I should be at all. Lot of the evidence I have wasn’t submitted on my claim for feb 2014.the judges do not ask all questions on a illness. The attorney that represents me I have not heard from. They get fees set by ssa. The alj judge is not looking at my written evidence from the physicians.it is not fair to me that I am not getting the help I need.currently I have severe anxiety which is affecting my health. Again they are not listening to me.thankyou

  6. Judy says:

    Fully favorable decision but my cd states more than I can do as for lifting and walking sitting. And an expiration date of 2017. Like funds expire. Is it possible? I am 45. Been pd by ltd so I will owe back pay to them plus over payment. Then they review you and if ss doesn’t last blow can I wk with my pain. So many bone surgeries and internal health issues.

  7. Gary says:

    I received a favorable ruling in April only to find out today that the Appeals Council has pulled my case for revive. After two major spinal surgeries in two years and being 65 years old and several years going through the process I still have no answers…where is the justice in this country!

  8. mona says:

    This is new to me I didn’t know they could just randomly pick cases…and then over turn a favorable decision.
    I thought they only help with denied cases that should or could be approve…

    • cheryl says:

      Yes, the Appeals Council has this authority and is exercising it. It is very frustrating for claimants, who wait two years for a hearing and win, only to find out that there will be more delay as yet another administrative body reviews the Judge’s decision.

  9. Tammi says:

    My husband, 54 this July, has waited 31 months, applied Feb. 2012, denied May 2012, appealed for reconsideration same month, denied, December 2012, appealed for ALJ hearing, waited 16 months for April 9, 2014 hearing and April 24, 2014 received written notice of fully favorable decision, he called once and the operator stated it was in random selection review at appeals council. When he asked why, she said he is not entitled to that information and not to call again. This was the 1-800# Tomorrow is day 60. We have had no written notice of review, nothing since written decision issued.
    Does anyone know if after it passes 60 day mark, is ALJ decision binding?
    Cannot get a clear answer from SSA.

    • cheryl says:

      You are correct that the Appeals Council is supposed to make a decision within 60 days. If you have not heard anything, I would be cautiously optimistic but a decision after the 60-days passes is not unheard of and it is unclear whether there are any legal implications of the AC failing to take action within the 60 days.

      If you have an attorney representing you, I would ask him or her to look online at the status report on the case.

    • rachel says:

      Tammi, the same thing happened to my my case reviewed, what was the outcome of your husbands case???

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