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.