BASIC (01-01)

VB 02504.010 Appeals Council (AC) Role in the SVB Administrative Review Process

A. Preview

The purpose of this subchapter is to give the field offices (FOs) the information they need to answer questions about AC review of SVB claims from individuals, their representatives, and any other parties to an appeal. It also provides instructions to the FO for processing AC review requests and requests by the AC for assistance and for effectuating AC decisions.

B. Background

An individual who is dissatisfied with a hearing decision or dismissal of his or her hearing request may ask the AC to review the action. The AC may deny, grant, or dismiss a request the review.

The AC may grant a request for review to:

  • Remand the case to an ALJ for further proceedings, including a new decision; or

  • Issue a decision; or

  • Dismiss the request for hearing for any reason the ALJ could have dismissed the request for hearing.

The AC will notify the parties at their last known address of the action it takes.

The AC may, on its own motion, review a hearing decision or dismissal within 60 days after the date of the decision or dismissal. If the AC decides to review a case on its own motion it may:

  • Dismiss the request for hearing for any reason the ALJ could have dismissed the request for hearing; or

  • Remand the case to an ALJ for further proceedings, including a new decision; or

  • Issue a decision.

The AC will notify the individual at his or her last known address of the action it plans to take.

C. Policy - AC Jurisdiction

1. When the AC Will Review a Case

The AC will review a case when:

  • There appears to be an abuse of discretion by the ALJ; or

  • There is an error of law; or

  • The actions, findings or conclusions of the ALJ are not supported by substantial evidence; or

  • There is a broad policy or procedural issue that may affect the general public.

2. Obtaining Evidence From the AC

The individual may request and receive copies of the documents or other written evidence on which the hearing decision or dismissal was based and/or a copy of the transcript of the oral hearing. The individual will be asked to pay the costs of providing the copies unless there is good reason he or she should not pay.

D. Policy - FO Responsibility

It is the FO's responsibility to:

  • Discuss with the individual the reasons that he or she disagrees with the ALJ's action;

  • Explain the basis for the hearing decision or dismissal, the right to request AC review of the ALJ's action, and the time limit to file an appeal;

  • Explain the consequences of filing a new application in lieu of filing for AC review; i.e., the ALJ's action becomes the final decision of the Commissioner and is not subject to further review, and the attendant possible of loss of benefits by filing a new claim instead of pursuing the appeal;

  • Help an individual to file a request for review of an ALJ decision or dismissal;

  • Forward Form HA-520 (Request for Review of Hearing Decision/Order), with appropriate attachments, to ODAR, 5107 Leesburg Pike, Falls Church, VA 22041 using the SVB (Title VIII) Hearings and Appeals Council Review case flag with the annotation: Attn: RSI Branch—SVB/Title VIII Claim;

  • If the claims folder is in the FO, forward it with the request for review to the AC;

  • Undertake development requested by the AC;

  • Effectuate AC decisions (when appropriate); and

  • Expedite processing in Terminal Illness (TERI) cases. (See GN 00203.010)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1402504010
VB 02504.010 - Appeals Council (AC) Role in the SVB Administrative Review Process - 08/13/2012
Batch run: 08/13/2012
Rev: