DI 12020: Appeals Council Review
TN 1 (09-11)
NOTE: If a claimant files a new disability application and has a prior disability claim for the same title and benefit type pending at any level of administrative review, see DI 51501.001, Procedural Change for Subsequent Disability Applications, Effective July 28, 2011.
A. Policy when a claimant requests AC review or the AC initiates own motion review
A claimant who is dissatisfied with a hearing decision or dismissal may request, in writing, review by the AC within 60 days of receipt of the decision or dismissal.
If the AC grants a request for review or reviews a case on its own motion, the AC prepares a decision action notice to affirm, modify, or reverse the hearing decision or dismissal or to remand the case to an ALJ for further action.
If the AC decides to review the decision or dismissal on its own motion, the AC notifies the claimant of its action within 60 days after the date of the decision. For additional information, see the NOTE in DI 12020.001C in this section.
B. Field Office (FO) procedure when a claimant requests AC review
When a claimant requests AC review:
Explain to the claimant the AC review process and the claimant's rights and responsibilities.
Obtain a written request for review (assisting the claimant or the claimant’s authorized representative in completing the HA-520-U5, “Request for Review of Hearing Decision/Order”). The claimant or his or her authorized representative may submit a letter or other written document, as described in GN 03104.100. If the written request is other than the HA-520-U5, attach that “writing” to the claims folder copy of the form. For instructions on preparing and distributing Form HA- 520-U5, see GN 03104.200B.
Input the request for AC review into the Electronic Disability Collect System (EDCS) if the claimant’s file is a Certified Electronic Folder (CEF). For electronic cases, you must fax the white copy of the HA-520-U5 into the CEF. If you cannot establish an AC case in EDCS, you must fax or mail the white copy of the HA-520-U5 to the Appeals Council at the address on the HA-520-U5 form. For detailed instructions on how to process in EDCS, see DI 81010.150A.3.
Follow the instructions in GN 03104.200C.4, if the request for AC review is not timely filed.
C. AC initiates review of hearing decisions or dismissals
The AC’s Division of Quality conducts a pre-effectuation review of certain hearing decisions or dismissals.
1. Notice to claimant
If the AC decides to review the decision or dismissal, the AC notifies the claimant of its action within 60 days after the date of the decision or dismissal.
NOTE: The AC is not required to notify the claimant of its action if it intends to issue a fully favorable decision.
2. AC Action after the decision or dismissal
The AC may affirm, modify, or reverse the decision or dismissal or remand the case to an ALJ for further proceedings.
D. Effectuating AC decisions
DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)
GN 03104.100 Requesting Appeals Council (AC) Review
GN 03104.200 Preparation of Form HA 520-U5 (Request for Review of Hearing Decision/Order)
GN 03104.300 Appeals Council (AC) Requests Development