TN 3 (02-95)

GN 01703.620 How to Process Appeal Requests

A. Introduction

Reconsideration of issues involving claims filed or benefits paid under an agreement is conducted in the same manner as the reconsideration of other Title II issues except as modified below.

B. Policy - timeliness of requests

The following statements concern the timeliness of reconsideration requests.

Under SSA regulations, a request for reconsideration must be filed within 60 days of the receipt of the notice of initial decision. This requirement is deemed to be met if a request appealing SSA's decision is received by the appropriate foreign agency within 60 days.

Extensions for good cause may be granted on requests filed with the foreign country as if they had been filed directly with SSA.

No attempt is made to judge the timeliness of appeals of foreign decisions filed with SSA. The foreign agency will make that determination.

C. Policy - forms for requesting reconsideration

There are no special forms for requesting reconsideration under agreements.

Each country takes requests under its own rules, using its own forms.

Each country accepts requests filed with the other country even though the request may not meet its own rules as to format or content.

D. Policy - scope of reconsideration review

The reconsideration reviewer conducts the review of a Title II reconsideration request in accordance with existing instructions. The reviewer may review SSA decisions as they relate to regular or totalization benefits, SSA's interpretation of the agreement, the accuracy of SSA's use of information provided by the foreign country, such as coverage, and the accuracy of information certified to the foreign country by SSA.

In cases where SSA's interpretation of the agreement is not clearly reflected in regulations or manualized procedure, or where there seems to be disparity between the regulations or procedures and the provisions of the agreement, the issue is submitted to IOTS for resolution.

The decisions of the foreign country, its interpretation of the agreement, or its use of information as provided by SSA is not to be addressed.

The reconsideration reviewer instructs the LC to refer any appeal of the foreign agency's decision to the appropriate foreign agency if not already done.

The reconsideration reviewer advises the appellant of the referral and gives them the address of the foreign office.

E. procedure - claims authorizer (CA)

Claims Authorizer -After a review of the request for reconsideration, take one of the following steps.

1. Foreign agency decision only

If the appeal is of a foreign agency decision only, request the LC to send the appeal to that agency under cover of a liaison form and notify the appellant of the referral. If the appellant is not an RSDI beneficiary and appears potentially entitled to U.S. benefits, treat the appeal as a U.S. claims lead.

2. U.S. decision only

If the appeal is of a U.S. decision only, send the case to the Reconsideration Branch.

3. Both decisions

If the appeal is of both decisions, send a copy of the appeal to the foreign agency, notify the appellant of the referral, and send the case to the Reconsideration Branch.

NOTE: If the reconsideration determination changes any information previously provided to the foreign agency, send the foreign agency the new information as well.

4. Premature

If the apeal is premature, (received after the initial “026” disallowance notice is sent, but before totalization decision is made), send a letter explaining that a decision on the totalization claim has not been made yet, but will be forthcoming when the necessary information from the foreign country is received.

5. Number of QCs

If the appeal concerns the number of QCs credited to NH's U.S. coverage record, develop for proof of additional U.S. coverage.

F. Procedure - reconsideration reviewer

1. Reconsideration procedures

Reconsideration Reviewers - Follow the procedure below when processing requests for reconsideration.

  1. Develop appeals filed under the agreement through normal channels. Do not initiate development through the foreign agency unless the evidence or information desired can only be obtained through or from them. Route these requests through IOTS prior to release.

  2. Do not send the foreign agency a copy of the reconsideration decision.

  3. If the claimant alleges additional foreign coverage, take action depending upon wheth