TN 16 (11-23)

DI 42010.022 Processing Appeals Council Actions

A. General

When a party to an administrative law judge’s (ALJ)’s decision files a request for review, the Appeals Council (AC) within the Office of Appellate Operations (OAO) may grant the request for review by issuing its own decision, remanding the case to the ALJ for further proceedings, or dismissing the request for review. If the AC denies or dismisses the claimant’s request for review, the ALJ’s decision becomes the final decision of the Commissioner in the claimant’s case.

After the AC denies the claimant’s request for review, the claimant may further appeal their claim by filing a complaint with the U.S. District Court and, if an unfavorable decision is issued, appealing to the U.S. Courts of Appeals and then the U.S. Supreme Court.

The AC may also review an unappealed hearing decision or dismissal order on its own motion within 60 days after the date of the decision or dismissal. Both favorable and unfavorable decisions are subject to own motion review, and cases may involve any type of benefits. The AC considers cases for potential own motion review based on referral, and cases may be identified for referral based on random or selective sampling techniques, or when an effectuating component believes that the decision cannot be effectuated because it contains a clerical error affecting the outcome of the claim; the decision is clearly inconsistent with the Social Security Act, the regulations, or a published ruling; or the decision is unclear regarding a matter that affects the claim’s outcome. (See 20 CFR 404.969 and 416.1469).

For information on how an effectuating component can refer a case to OAO via the protest process, see DI 42010.065 and DI 42010.080.

B. Effectuation of AC actions

To effectuate an AC decision for an initial award, prepare an SSA-831-U5 according to the instructions in DI 42010.020, changing the appeal level indicators to indicate an AC decision where appropriate.

To effectuate an AC reversal of a termination to a continuance, prepare an SSA-833 following instructions in DI 42010.021.

When the AC remands a case to the ALJ, the ALJ will either affirm, modify, or reverse the prior decision. Process ALJ remand decisions according to the instructions in DI 42010.020 and DI 42010.021, as appropriate.

If an AC decision contains an error of fact or law that prevents effectuation, prepare and send a protest memorandum to OAO following the guidelines in DI 42010.080.

C. Statutory benefit continuation

If the claimant elected statutory benefit continuation (SBC), and a request for AC review is pending, do not issue an overpayment notice. Also ensure SBC payments have ceased. SBC is not available beyond the ALJ level.

If the AC issues a dismissal or unfavorable decision, allow 65 days to elapse from the date of the dismissal or decision, and check all relevant systems to ensure no further appeal has been filed, before issuing the overpayment letter.

For more information on processing AC actions when SBC is involved, see DI 12027.060.

D. SSI folders/material sent to processing center (PC) in error

If the AC routes SSI material to the processing center (PC) in error, the PC will immediately send the SSI folder or material to the servicing field office.

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DI 42010.022 - Processing Appeals Council Actions - 11/28/2023
Batch run: 11/28/2023