DI 12010.001 Request for Administrative Law Judge (ALJ) Hearing

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 for requesting a hearing before an ALJ

A claimant, who is dissatisfied either with a reconsideration or revised reconsideration determination, or with an initial determination in a prototype state, may request a hearing before an ALJ. A claimant may submit a request for a hearing by walk-in, mail, fax, email, or internet.

If the field office (FO) interviews a claimant who submits a request for a hearing, it explains the hearing process and explains that if he or she appeals, the Social Security Administration (SSA) can review all issues, including those decided favorably. This means that the claimant’s disability status may change from “disabled” to “not disabled”. SSA may also find that the established onset date (EOD) may be the same, earlier, or later than the EOD established in the reconsideration determination or in the initial determination if a prototype state handled the claim. See DI 25501.260 Establishing the Established Onset Date (EOD) in Reconsideration and Appeal Claims.

The FO obtains form HA 501-U5 (Request for Hearing By Administrative Law Judge) or completes the request on the Modernized Claim System (MCS) or the Modernized Supplemental Security Income Claims System (MISSICS) unless a hearing was requested informally by letter or other correspondence, or the request was made using the iAppeals process.

B. Procedure when claimant requests a hearing before an ALJ

1. Conduct the interview, if necessary

Explain the hearing process and the claimant's rights and responsibilities. Refer to GN 03103.010C for FO instructions on interviewing the claimant.

2. Form HA 501-U5

Assist the claimant in completing the HA 501-U5. See GN 03103.020 HA-501-U5 (Request for Hearing by Administrative Law Judge) for instructions on the use and completion of the HA 501-U5. For electronic files, see DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases and DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS).

3. Copy of reconsideration notice

Take one of the following actions for verifying receipt or non-receipt of the notice.

a.

Check the file for a copy of the reconsideration notice. In electronic folders, check eView or the Online Retrieval System (ORS) for the notice.
b.
If a copy of the reconsideration notice is in file but the claimant alleges not receiving a notice:
- •
  
  Make a copy of the reconsideration notice for the claimant and accept the request for hearing.
- •
  
  Document the file that the claimant did not receive the original reconsideration notice.
c.
If a copy of the reconsideration notice is not in file, check the claim folder(s) for an indication that a reconsideration determination was made, e.g., item 34 (Remarks) on the SSA 831 (Disability Determination and Transmittal) shows “Recon Affirmation.”
- •
  
  If there is evidence that a reconsideration determination was made, i.e., disability determination services query (DDSQ), accept the request for a hearing and contact the disability determination services (DDS) by email or phone. Immediately send a duplicate reconsideration notice to the claimant, the FO, and a copy to his or her attorney or non-attorney representative, if applicable. If the SSA-831 is missing, ask the DDS to send a copy of SSA-831 as well.
- •
  
  If there is no indication that a reconsideration determination has been made, follow the instructions in GN 03103.120 Hearing Filed Before Receipt of Reconsideration Determination.
- •
  
  When the disability quality branch (DQB) selects a case for review, an undated copy of the DDS prepared notice is stored in the certified electronic folder (CEF). After the review is completed, DQB prints, dates, and mails the notice. The DQB does not add the date to the image of the notice in the CEF. Instead, the notice release date is recorded in the Office of Quality Performance (OQP) Routing Information in the Case Review link.

4. Medical information and release forms

Obtain new Form SSA-3441 (Disability Report – Appeal) and Form SSA-827 (Authorization to Disclose Information to the Social Security Administration). Obtain one SSA-827 for in-person interviews. If the file does not contain an SSA-3441 or SSA-827 with an appeal, do not delay transferring the appeal request. Transfer it without the SSA-3441 or SSA-827. Do not make any follow up attempts to obtain one. See DI 12010.005 Development of Administrative Law Judge (ALJ) Hearing Cases and DI 11005.055 Completing Form SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)). Follow regional instructions when they differ from national instructions.

5. Concurrent claims

If an application involves claiming Title II and Title XVI benefits, or claiming more than one Title II disability benefit, and the claimant appeals any medical issue for any of the benefits, the entire claim is under review, including any favorable determination regarding disability status. Therefore, transfer the case as a concurrent claim for a hearing before an ALJ.

The FO may still effectuate the favorable determination, but the claimant should be aware that our determination regarding the medical issue is not final.

If the other claim was a technical denial that is not under appeal, do not forward the technically denied claim for a hearing before an ALJ as the issues under appeal are not the same.

6. Folder request

If the case is paper and if the claim folder(s) is not in the servicing FO when the claimant files the request for hearing, follow GN 03103.080 Forwarding the Form HA-501-U5 (Request for Hearing by Administrative Law Judge) to obtain the claim folder(s).

7. Informal remand

Review the claim folder(s) to determine if an informal remand or reopening applies. Refer to DI 12010.015 Informal Remand of Medical/Vocational Determinations and DI 12010.020 Informal Remand Requested By The Review Component.

For the Electronic Process see:

DI 81010.085 Transferring Cases in Electronic Disability Collect System (EDCS).

DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS).

DI 81010.141 Processing Electronic Informal Remands

DI 81010.155 Processing Subsequent Claims or Appeals Filed While a Prior Claim or Appeal is Pending at the Appeals Council (AC)

DI 81020.119 Processing Electronic Informal Remands

Program Operations Manual System (POMS)