SSAOBENE0001 - Appeal Level 1 - Procedures

Other Fields

Agency Scheme:

SSAOBENE0001

Level:

Appeal Level One

ADJUDICATION STRUCTURE

Appeals: Basic Structure

Appeal Office (local name):

Office of Appellate Operations

Appeal Office (global name):

Social Security Administration: Office of Appellate Operations

Sub-Agency/Bureau/Division::

Office of Adjudication and Review

Appeal Officer #1 (Title):

Administrative Appeals Judge (AAJ)

Appeal Officer #2 (Title):

Administrative Appeals Officer (AO)

Are administrative appeals permitted from final decisions issued by this appellate office?:

Comments/Notes on Adjudication Structure:

SSA administers (1) social insurance programs that provide monthly benefits to disabled workers, their spouses and children, and survivors of insured workers; (2) a need-based program for the aged, blind, and disabled; and (3) certain benefits under the Federal Coal Mine Health and Safety Act. Claimants appeal adverse initial determinations to the Office of the Chief Administrative Law Judge. Although ALJs hear the cases, the proceedings are informal and non-adversarial. Claimants may appeal adverse ALJ decisions to the Appeals Council. At the appellate level (the Appeals Council), AAJs retain authority to issue such final decisions.

PROCESS & PROCEDURE - General Information

Which party (or parties) is/are permitted to file appeals with this office?:

Private Party

Are private parties permitted to have representation at appeal hearings?:

Yes (All Types of Cases)

Who may serve as a private party representative?:

Either

Is the agency permitted to have representation at appeal hearings?:

N/A (e.g., Agency Not Party to Hearing)

Are ex parte contacts prohibited?:

Yes (All Types of Cases)

Regulations/rules of practice for appeal hearings (please include CFR citations):

20 CFR 404.929-404.961, 405.301-405.383, 408.1040-408.1045, 416.1429-416.1461

Other published guidance for appeal hearings (if any):

Hearings, Appeals, and Litigation Law (HALLEX) Manual, Program Operations Manual System (POMS)

PROCESS & PROCEDURE - Hearing Procedure

What types of hearings are permitted on appeals adjudicated by this office?:

Written (Document-Only) Hearing

In-Person

Video

Phone

Please provide the approximate percentage of each type of hearing relative to the total number of appeal hearings (FY2013)
Written (Document-Only) Hearing:
100%
In-Person:
0%
Video:
0%
Phone:
0%

How is the type of hearing selected for appeals heard by this office?:

By Agency

By Private Party

Depends on Nature of Case/Claim

If "Depends on Nature of Case/Claim", please describe:

A claimant may request an oral hearing. If the Appeals Council believes the case raises an important question of law or policy or that having an oral hearing will help reach a proper decision, it will grant such hearing. We note that the percentages above relate to request for review workloads for FY 2013 excluding our Retirement & Survivors Insurance workload as well as our representative sanction cases which typically include around one in person hearing a year.

How many appeal officers preside at each hearing?:

Varies by Case

If "Varies by Case," please describe:

Usually, cases are decided individually, by two-member panels, or by three-member panels. If the case is before a two-member panel and the members cannot agree on an outcome, the Chairman, Deputy Chairman, or his/her delegate will participate as a third member of a panel. At the discretion of the Chairman, the Appeals Council may meet en banc, or a representative body of the Appeals Council--which consists of not less than five members--shall meet to decide a case. See 20 CFR 422.205(c), 422.205(e)

Is factual development permitted at the appellate hearing as a means of supplementing the record from below?:

Yes (Some Types of Cases)

Can third-parties submit amicus briefs and/or evidence?:

Are appeal hearings recorded and/or transcribed?:

Yes

N/A (Document-Only Hearings)

Are appeal hearings open to the public?:

Varies by Case

If "Varies by Case," please describe:

Appeal hearings are closed during oral hearings. This question is inapplicable to document-only hearings.

PROCESS & PROCEDURE - Post-Hearing Procedure

Who typically drafts final decisions on appellate cases adjudicated by this office?:

Staff Attorney

Who has authority to issue final decisions on appellate cases adjudicated by this office?:

Adjudication Officer

Do agency regulations or guidance provide time limits for issuance of final decisions on appellate cases?:

About how long does it take on average—as of FY2013—to adjudicate appeals by this office?:

364 Days

Is judicial review available after issuance of a final decision on appellate cases adjudicated by this office?:

Yes (Some Types of Cases)

If "Yes (Some Types of Cases)," please describe types of decisions/cases that are judicially reviewable:

When the Appeals Council dismisses a case, there is no judicial review, but all other cases have judicial review.

PROCESS & PROCEDURE - Case Management

How are claims/cases processed at this appellate office?:

Differentiated Case Management

Please briefly describe your case management practice(s) at this office:

The Appeals Council uses the case processing order that is the most efficient, and this can include first-in/first out. We make case processing decisions in an effort to optimize the number of claimants we are serving.

Does the agency permit web-based electronic filing of briefs or other documents in cases adjudicated by this appellate office?:

Yes

Are final decisions issued by this appellate office published and/or posted on the agency website?:

Yes (Some Decisions)

If "Yes (Some Decisions)," how does the agency determine which final decisions to publish/post? Please briefly describe:

The Appeals Council only rarely publishes its decisions in the form of Appeals Council Interpretations.

Do agency regulations/rules of practice specify the contents of the administrative record on appeals heard by this office?:

If "Yes," please provide citation(s):

Subregulatory authority sets for the guidelines for contents of the record.

Do agency regulations/rules of practice provide for closure of the record on appeals heard by this office?:

Yes (Some Types of Cases)

If "Yes," please provide citation(s):

20 CFR 405.430 and 405.401(c) and 20 CFR 404.970(b) and 416.1470(b)

PROCESS & PROCEDURE

Comments/Notes on Appellate Process & Procedures (Optional):

SSA has divided the country into ten regions. Region I operates under slightly different regulations than the other nine regions (see 20 CFR Part 405). The biggest difference--as it relates to the appellate level--between Region I and the other nine regions is that claimants are required to submit all evidence 5 days prior to the ALJ decision with some exceptions. Any new evidence offered at the Appeals Council, while the case is on appeal, must meet a higher standard than other regions for consideration. The 404 and 416 regulations cited above set forth how the Appeals Council addresses additional evidence in other cases. SSA notes that 364 days as the answer to the question re: how long it takes on average to adjudicate appeals is for request for review processing time. We have other workloads that are not factored into this number.

ADJUDICATORS

Total # of Appeal Officers:

110

Information About Appeal Officer:

Adjudication Officer Title	Job Series	Pay Plan	Pay Range	Are persons in this position subject to performance evaluation?	Are persons in this position employed full-time as adjudication officers?	Are persons in this position subject to quality control measures or production goals?	If "Yes," briefly describe:
Administrative Appeals Judge (AAJ)	0930-Hearings and Appeals Series	AA	01-06	Yes	Yes	Yes	The very nature of most actions performed by AAJs ensures some degree of quality control. To remand a case to the hearing level, the case must have the signature of two AAJs which requires agreement on the action taken. In addition, AAJs are on performance standards and have the quality of their work evaluated by their management judge as part of the review process. We are also in the process of developing production goals for AAJs.
Administrative Appeals Officer (AO)	0905-Gen'l Attorney Series	GS	14	Yes	Yes	Yes	A small quality sample is conducted of the work of AOs. In addition, AOs are on performance standards and have the quality of their work evaluated by their management judge as part of the review process. We are also in the process of developing production goals for AOs.

Comments/Notes on Appellate Adjudicators (Optional):

The number of people in the Appeals Council--110--includes both Administrative Appeals Judges (with 2 rehired annuitants) and Administrative Appeals Officers as well as Senior Executives Service members who oversee the Appeals Council. Only Administrative Appeals Judges (AAJs) have the authority to grant review and issue decisions, dismissals, and remands as well as deny review on appellate cases. Appeals Officers with the Appeals Council only have the authority to deny a request for review. There are a few AOs who serve the Office of the Executive Director of the Office of Appellate Operations (which encompasses the Appeals Council), and do not work as full-time appeal officers.

ADR: General Information

Is ADR available at one or more points for appellate cases heard by this office?:

ADR – Summary Statistics

For Fiscal Year 2013, please provide the following annual ADR statistics:

CASELOAD STATISTICS - Summary Statistics

Total # Cases Filed/Opened (FY2013):

172,492

Total # Cases Decided/Closed (FY2013):

176,251

Total # Cases Pending (End of FY2013):

157,311

CASELOAD STATISTICS - Supplementary Statistics

Does your agency maintain annual caseload statistics for this hearing office by case type (e.g., discrimination complaint, licen:

Yes

Web address:

http://www.ssa.gov/appeals/DataSets/07_AC_Requests_For_Review.html

Supplementary Caseload Statistics by Case Type:

Verified by Agency:

Verified

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SSAOBENE0001 - Appeal Level 1 - Procedures