TN 13 (06-11)

GN 03101.080 Appeals of Actions Which Are Not Initial Determinations

We may review administrative actions that are not initial determinations, but they are not subject to administrative or judicial review. These actions include, but are not limited to, actions about:

A. Non-payment of benefits

  • suspension of benefits pending investigation of entitlement, for correct address;

  • suspension of benefits pending an investigation and determination of any factual issue relating to a deduction due to work;

  • suspension of benefits pending an investigation to determine if a claimant's disability has ceased;

  • temporary withholding of benefits based on a claimant's estimate of earnings to avoid creating an overpayment. We make an initial determination regarding the claimant’s right to benefit payment after the close of the year. However, in some instances, we can make an initial determination to coverage, earnings, transfer of business, or a substantial service issue, while there is a temporary withholding of benefits. Determinations made for those issues are initial determinations, but the resulting suspension of benefits is not an initial determination. (For more information on appeals, see GN 03101.090.);

  • incorrect payment (not the same as overpayment). The most common incorrect payment is payment incorrectly paid for the current year based on current year work and estimated earnings;

  • the rate of withholding to recover an overpayment if less than the full amount of the monthly benefit;

  • failure to take a suspension action when an auxiliary or survivor claimant becomes entitled to another auxiliary or survivors benefit on another earnings record;

  • continuation of benefits to a beneficiary who fails to report a termination or suspension event does not constitute a determination. We may consider the correctness of such payments whenever we become aware of the event. The determination made to terminate or to make deductions is an initial determination, which is subject to administrative review and to reopening under the rules of administrative finality.

B. Appeals and reopening a prior determination

  • denial of request to extend the time period for requesting review of determination or decision;

  • denial of request to use the Expedited Appeals Process ;

  • denial of request to reopen a determination or decision;

  • denial on the basis of res judicata. (SSA will review cases denied on the basis of res judicata, but only to see if we correctly applied res judicata.);

  • denial of request to readjudicate claim and apply an Acquiescence Ruling (For information on Acquiescence Rulings see GN 03501.001);

  • denial of request to be included as a class member eligible for relief in a court case;

  • determining whether (and amount of) travel expenses are reimbursable in connection with proceedings before us.

C. Appeals for representative payee actions

  • determinations that a representative payee is required for a legally incompetent beneficiary (For information regarding representative payee and appeal rights, see GN 00503.110);

  • determinations that a minor needs a representative payee when the court finds the minor is still under parental control;

  • determinations not to appoint a payee applicant cannot be appealed by the applicant;

  • a determination regarding whether a representative payee misused benefits paid on behalf of a claimant (This includes a determination of “misuse” as well as “no misuse.”);

  • determinations to pay a large conserved or accrued benefit to a representative payee in installments;

  • suspension of benefits pending the appointment of a representative payee.

D. Attorneys and representatives

  • a finding determining the amount an attorney or other repre