I-4-6-20.Determining Whether the Case Requires Appeals Council Review

If the Office of Appellate Operations or Court Case Preparation and Review Branch analyst determines that appeal or reargument is not warranted, the next consideration is whether Appeals Council (AC) review is required. AC review is necessary in the following situations:

• The administrative law judge (ALJ) issued a partially favorable decision that was appealed to court.

• A subsequent application is present.

• The case is Title II only where the date last insured is before the hearing decision and the court did not specifically order the Commissioner to provide the opportunity for a hearing.

• A court remand is issued pursuant to sentence six of section 205(g) of the Social Security Act.

• The court imposed a time limit on the Social Security Administration to conduct further administrative proceedings.

• The AC issued the final decision.

• A circuit court remanded the case.

• The court remanded the case as a result of the request for voluntary remand process, based on the Commissioner's motion or a joint motion or stipulation between the Commissioner and the claimant.

• The case is one of “first impression,” and the court's holding is adverse to the Commissioner (i.e., a case in which the court enunciates for the first time an interpretation of the Social Security Act, a regulation(s), or a ruling that is contrary to the Commissioner's interpretation and that is not being appealed; see Hearings, Appeals and Litigation Law manual I-4-6-15).

• The court order is unclear.

• The court's order instructs the Social Security Administration to pay benefits or remands for the AC to take an action other than a remand to the ALJ.

• The analyst determines that the AC could issue a decision (either favorable or unfavorable) without remanding the case to an ALJ.

• The analyst determines that the AC could dismiss the proceedings (see 20 CFR 404.983(d) and 416.1483(d)).

• The analyst determines that the AC should remand the case to an ALJ, and that the AC's remand order should contain specialized language because of circumstances unique to that case.