If you have been denied at your Social Security hearing in front of an Administrative Law Judge (ALJ), you may end up having to file an appeal to the Social Security Appeals Council.  

In my experience handling Social Security disability cases in Colorado, it can take between 6 – 18 months to get a decision back from the Appeals Council.  

However, even if you “win” the appeal, that is not the end of your case. In the vast majority of cases, the Appeals Council does not approve benefits outright.  Normally, they simply send the case back for another hearing with instructions to the ALJ on what should be done next time.  

When your case gets sent back to the Office of Disability Adjudication and Review (ODAR), it may take another 6-18 months for the second hearing to be scheduled.  

Altogether, you may be looking at 12 to 36 months before you get another chance to present your case even if you “win” your case at the Appeals Council!

Note:  wait times at the Appeals Council, and particularly at the various ODAR offices around the country, vary quite a bit, so take this estimate with a grain of salt and get up to date information from a lawyer in your area.

If your Social Security case is denied after a hearing with an Administrative Law Judge (ALJ), you have a couple of options:

Appeal the ALJ’s decision to the Social Security Appeals Council

To do this, you need to file form HA-520-U5 “Request for Review of Hearing Decision/Order.”  

One benefit of appealing is that it preserves your entitlement to past benefits.  Whereas, if you start a new claim, you normally lose your entitlement to the back benefits from the just-denied claim.  

So, generally, if you can continue to appeal the current claim, you may get more back benefits that on a new claim.  

There are exceptions to this, including the possibility of reopening a prior claim during a new claim.  If the Judge decides to reopen the prior claim, you might not lose any back benefit.

However, there is no guarantee that you will be able to reopen a prior case.  You have to meet additional requirements to request a reopening, and, more importantly, the choice of whether to reopen a prior claim is discretionary.  If the Judge decides not to reopen the prior claim – that’s it!  In my experience in Colorado, judges generally do not like to disturb a prior judge’s decision.

So, you do not want to count too much on reopening a prior claim. I warn my clients not to expect that a prior claim will be reopened if they have to start a new application. 

Start a new claim from scratch by filing a new application  

You may be wondering:

Why would any one want to start a new claim when an appeal may get me more benefits?

The answer is that if you “win” at the Appeals Council, chances are that they will not approve your case outright. Instead, the Appeals Council typically will only vacate (throw out) the prior decision and send the case back for another hearing with specific instructions about what needs to be done differently at the second hearing. 

So, even if you win, you just get a “do-over.”

Here is the real kicker.  The hearing will most likely be with the same Judge.  I have seen quite a few cases where the Judge simply did not believe my claimant, or their doctors. Having another hearing with the same just is not much of a victory.

Sometimes, it is just better to start fresh with a new claim.  If the case has to go to hearing again, it will probably get a different Judge.  Of course, there is no guarantee you wont get the same judge, but, by filing a new claim, you have a significantly better chance of getting a new judge.

Which is faster?  A new claim or an Appeals Council appeal?

It is too close to call.  Both can take more than two years to get back in front of a judge.  The main exception is if there has been a significant change in the case which might cause Social Security to approve a new claim at the initial review level.  Since the initial review takes only 4-6 months, under these circumstances, a new claim might be faster.  

In some case, you cannot reapply

There are several situations where you cannot reapply for Social Security:

1. You are beyond your “Date Last Insured (DLI).” See my article about this here. DLI only applies in Disability Insurance cases, so if you are applying for SSI, this will not prevent you from applying.  
2. If you are applying for SSI, your spouse’s income or other household income may make financially ineligible for SSI.  Strictly speaking this does not keep you from applying, but you may quickly get a denial for financial ineligibility.

Deadlines for Appealing a Hearing Denial

Normally, you have 5 days to receive the denial and 60 days to submit the appeal. Check your paperwork for the specific dates.  Also, keep in mind that it is not 60 days to mail the appeal.  The appeal has to be received at the Appeal’s Council (the address is in the denial) by the 60th day.

If you are denied at your Social Security hearing by the Administrative Law Judge (ALJ), you have the right to appeal the judge’s decision to the Social Security Appeals Council.  

To do this, you need to file form HA-520-U5 “Request for Review of Hearing Decision/Order.”  You only have 60 + 5 days to get the appeal to the Appeals Council from the date stamped on the judge’s decision (5 days to receive the decision and 60 days to deliver the appeal).  

Note:  The appeal must be delivered by the 65th day!  Unlike filing your taxes, postmarking the letter on the 65th day is not enough.  The appeal must be in the Appeal Council’s hands no later than the last day. 

There is the possibility of filing late with the Appeal Council’s permission, but that is not something you want to count on.  

Here are a couple of things to keep in mind about the appeal.

1. The Appeals Council will not hold a hearing on the appeal.  The Appeals Council only does a “paper review” of the file.  
2. This means you must provide all your reasons for appealing and everything you disagree about the ALJ’s decision as early as possible; preferably along with the appeal.
3. Because the appeal form does not provide a lot of room to explain what you disagree with, attorneys often add a supplemental brief.
4. The Appeals Council mostly looks for legal arguments:  did the judge misapply the law?  While you can argue that the “facts” in the decision were incorrect (in legal terms:  that the judge’s findings were not supported by substantial evidence), the Appeals Council is mostly interested in whether the proper process was followed.  Because the Appeals Council is much more legalistic than the earlier appeals, you really should have an attorney helping you. 
5. The Appeals Council usually will not upset a judge’s factual determinations – even if they would have come to different determinations themselves – if there is a basis for the judge’s findings.  This is a critical point. The Appeals Council does not want to step into the judge’s shoes about findings of fact if they can help it. However, if there is a significant factual error which is not supported by substantial evidence, I will include it in my arguments. 
6. If you think the ALJ misquoted the testimony, or if you want to review the hearing tape for other reasons, you can request a copy of the hearing record. I previously wrote about this here.

Practice tip:  When I request the hearing tape, I file the appeal form with a cover letter requesting the hearing tape AND 30 days after the recording is sent to me to provide a supplemental argument based on the tape.  Note: the Appeals Council usually grants a shorter amount of time, but it is still useful to ask for 30 days.

If possible, do not wait until you are denied at hearing to hire an attorney. Many attorneys will not take a case if they hired after the hearing because there is very little time to review the hearing decision, become familiar with the evidence, and prepare a legal argument for the Appeals Council.  

It is much better to get an attorney before the hearing. If the case needs to be appealed to the Appeals Council, that attorney is already up to speed on the case.

You finally got the decision on your Social Security case and it says… “Partly Favorable.”

This does not mean that you are “partly disabled.” Usually, it means one of the following:

• The Judge found you disabled, but not as far back as you wanted; or
• The Judge is approved a “closed period” of disability: that you were disabled from one date through another date. For example: the Judge might find that you were disabled from May 1, 2005 through December 31, 2007.

If you are ok with the partly favorable decision, give yourself a pat on the back for winning your Social Security case.

If, however, the partly favorable decision just makes you angry and you are thinking of appealing, please keep the following in mind:

1. When you appeal a partly favorable decision, you appeal the entire decision, including the part that says that you are, or were, disabled.
2. The Social Security Appeals Council can take a look at the Judge’s decision and say that the Judge should not have found you disabled at all.
3. Then, your case will go back to (probably) the same Judge, with the implicit suggestions to give you less or nothing at all.

Please note: it is rare for the Appeals Council to completely overrule a partly favorable decision and recommend a denial, but I have seen it happen. So, keep this possibility in mind when considering your options.