I-3-3-1.Bases for Appeals Council Grant Review Action

Last Update: 5/1/17 (Transmittal I-3-154)

Pursuant to 20 CFR 404.970(a) and 416.1470(a), the Appeals Council (AC) will grant review of a case if:

  • There appears to be an abuse of discretion by the administrative law judge (ALJ) (see Hearings, Appeals and Litigation Law (HALLEX) manual I-3-3-2);

  • There is an error of law (see HALLEX I-3-3-3);

  • The ALJ's action, findings, or conclusions are not supported by substantial evidence (see HALLEX I-3-3-4); or

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

Additionally, the AC will evaluate additional evidence if the claimant meets one of the good cause exceptions set forth in 20 CFR 404.970(b) and 416.1470(b). For instructions about how to determine whether there is good cause, see HALLEX I-3-3-6.

NOTE:

When the AC evaluates a decision that is not based on an application for benefits and involves title XVI of the Social Security Act (e.g. age 18 redeterminations, continuing disability reviews, terminations), the AC considers the evidence in the hearing record and any additional evidence it believes is material to an issue being considered.

The AC will grant review of the case if the additional evidence is new, material, related to the period on or before the date of the hearing decision, and if there is a reasonable probability that the additional evidence will change the outcome of the decision. The AC will evaluate the additional evidence with the entire record. See 20 CFR 404.970(a)(5) and 416.1470(a)(5).

When the AC grants review, the AC will take one of the following actions:

  • Issue a fully favorable, partially favorable, or unfavorable decision (HALLEX I-3-8);

  • Remand the case to an ALJ (HALLEX I-3-7); or

  • Dismiss the claimant's request for hearing for any reason for which the ALJ could have dismissed the request for hearing (HALLEX I-3-4-20).