TN 7 (01-13)

GN 03102.200 Claimant Requests Reconsideration

A. Responsibilities for handling title II reconsideration requests

A claimant who is dissatisfied with an initial determination may request an appeal by either an online iAppeal submission or calling, visiting, or writing a field office (FO) or calling the national 800 number network (N8NN). N8NN agents handle the request per the instructions in TC 03001.020 Handling Appeal Requests. A wet signature is not required on an SSA-561-U2 (Request for Reconsideration) or any other written request for reconsideration. An oral request to appeal a determination or decision does not establish the required writing for an appeal.

1. Claimant walks into FO

  • If a claimant walks into the FO to request a reconsideration, per the instructions on interviewing a dissatisfied claimant in GN 03101.120, conduct the FO interview with the claimant. Include in the interview why the claimant is dissatisfied, explain the basis for the initial determination, the right to appeal, and the time limit for filing the appeal.

  • Assist the claimant with completing an SSA-561-U2 per the instructions in GN 03102.500 (Modernized Claim System---MCS) or GN 03102.225. For reconsiderations on medical denials, see DI 81010.150. For electronic continuing disability review (eCDR) medical cessations, see DI 81010.255.

  • Give the claimant the Document Processing System (DPS) reconsideration acknowledgment notice or a date stamped copy of the appeal request. This establishes the writing since a signature is not required on the reconsideration form.

  • Transfer a reconsideration that is not within the FO’s jurisdiction to the servicing processing center (PC) for processing or to the appropriate DDS.

2. Claimant telephones the FO

  • If the claimant telephones the FO to request reconsideration, send the claimant an SSA-561-U2 to complete and return to the FO.

  • When the claimant returns the SSA-561-U2, if possible, establish the appeal request in MCS.

  • Send the claimant the DPS reconsideration acknowledgement notice or date stamped copy of the appeal request.

  • For reconsiderations on medical denials, see DI 81010.150. For eCDR medical cessations, see DI 81010.255.

  • Transfer a reconsideration that is not within the FO’s jurisdiction to the servicing PC for processing or to the appropriate DDS.

3. Claimant writes the FO

If the claimant submits his or her written appeal request via an iAppeal submission, mail, fax message, or email message, the FO takes the following actions:

  • Contacts the claimant for an interview to secure all needed information,

  • Establishes the appeal in MCS or establishes paper SSA-561-U2 for MCS exclusions and attaches a copy of the written request to any paper SSA-561-U2. For reconsiderations on medical denials, see DI 81010.150. For medical cessations, see DI 81010.255.

  • Sends the claimant the DPS reconsideration acknowledgment notice or a date stamped copy of the appeal request. This establishes the writing since a signature is not required on the reconsideration form.

  • Transfers a reconsideration that is not within the FO’s jurisdiction to the servicing PC for processing or to the appropriate DDS.

  • For information on an iAppeal submission, see GN 03101.125 and GN 03101.127.

B. Miscellaneous reconsideration situations

1. Request for reconsideration involves both title II and Medicare issues

SSA is responsible for reconsideration requests on Medicare Parts A and B (Health Insurance/Supplemental Medical Insurance (HI/SMI)) entitlement. The Centers for Medicare and Medicaid Services (CMS) are responsible for reconsideration requests on Medicare benefit issues. If a claimant appeals a Medicare benefit issue at the time he or she appeals a title II or HI/SMI entitlement issue, the FO assists him or her in completing a separate SSA-561-U2 for title II and HI/SMI entitlement issue (s) and a CMS-2649 (Request for Reconsideration of part A Health Insurance Benefits) for Medicare benefit issues.

2. Reconsideration request from a claimant who speaks Spanish

If claimant visits the FO, ask him or her (his or her interpreter) to complete the Spanish version of Form SSA-561-U2 (see OS 15010.180). Translate into English on a regular Form SSA-561-U2, staple both forms together, and if appropriate send the forms to the PC with jurisdiction.

3. Grounds for dismissal of a request for reconsideration

SSA can dismiss a request for reconsideration for a number of reasons. Grounds for dismissing a request for reconsideration include, but are not limited to the following reasons:

  • request not based on an initial determination,

  • request filed by improper requestor,

  • request filed prematurely,

  • request filed late and good cause for late filing cannot be found, or

  • request filed on a SSA-561-U2 when it is clear that the individual only intended to request information, reduction of the overpayment recovery amount, or waiver of the overpayment.

4. Claimant asks to withdraw request for reconsideration

Advise the claimant that a reconsideration is a prerequisite for an administrative law judge (ALJ) hearing, and that if he or she withdraws the request, he or she will lose all future appeal rights on the claim or issue and that the initial determination becomes final. If the claimant decides to withdraw his or her request for reconsideration, advise him or her that the withdrawal request must be in writing and include the following information:

  • number holder’s name and social security number,

  • the claimant's name,

  • a statement of why the claimant wishes to withdraw the reconsideration, and

  • a statement that the claimant fully understands the effect of the withdrawal.

If appropriate, send the withdrawal request to the PC with jurisdiction of the request for reconsideration. For more information on component responsibility in the reconsideration process, see GN 03102.175.

NOTE: Never suggest to a claimant that he or she withdraw his or her request for reconsideration. Do not accept a withdrawal of a reconsideration request if doubt exists about the correctness of a benefit payment made.

5. Claimant dies while the request for reconsideration is pending

Determine if there is a person who may be entitled or adversely affected by the determination under appeal.

  • If you identify another party to the appeal, ask the person if he or she wishes to proceed with the request for reconsideration. If the person does not wish to pursue the appeal, obtain a signed statement from the person indicating he or she fully understands the effect, if any, of not pursuing the reconsideration.

  • For reconsiderations under the jurisdiction of a PC, contact the PC to report the claimant's death, and advise whether a substitute person wishes to pursue the request for reconsideration. Contact the Disability Determination Services (DDS) for reconsiderations under their jurisdiction.

C. References

  • DI 12005.000 Reconsideration - Initial Claims

  • GN 03102.225 Preparation of Form SSA-561-U2 (Request for Reconsideration)

  • GN 03102.500 MCS (Modernized Claims System) Claims - Reconsiderations

  • SI 04020.030 Developing and Processing SSI Reconsideration Requests

  • TC 03001.020 Handling Appeal Requests

  • MSOM MCS 004.002 MCS Exclusions



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http://policy.ssa.gov/poms.nsf/lnx/0203102200
GN 03102.200 - Claimant Requests Reconsideration - 02/07/2017
Batch run: 02/07/2017
Rev:02/07/2017