TN 15 (02-11)

GN 04440.244 Policy Requirements for Assuming Jurisdiction

Citations: Soc. Sec. Act § 205, 20 CFR § 404.915

A. Introduction to assuming jurisdiction

“Assuming jurisdiction” means the review component takes jurisdiction of a claim, takes the necessary corrective action, and prepares a new disability determination. Except for certain decision basis code technical corrective action (TCA) cases, assuming jurisdiction of a case is an optional decision left to the discretion of the review component management.

For an explanation of situations when the review component may consider assuming jurisdiction, see GN 04440.245.

B. Benefits of assuming jurisdiction

Assuming jurisdiction of deficient cases:

  • provides claimants and beneficiaries with timely action on their claims; and

  • expedites payment of any benefits due.

C. When jurisdiction cannot be assumed

Review components cannot assume jurisdiction in the following situations:

1. Group I deficiencies

Do not assume jurisdiction to correct group I deficiencies before returning the case to the adjudicating component for the first time.

2. Possible disability hearing cases

Do not assume jurisdiction for cases when the next level of appeal is a disability hearing at reconsideration. This includes the following determinations:

  • continuing disability review medical cessations;

  • adverse reopenings of favorable initial determinations based on medical factors;

  • adverse reopenings of reconsideration reversals based on medical factors; and

  • adverse reopenings of cessations that change only the basis for the cessation.

The review component's amended determination becomes a Federal determination. If the claimant appeals that determination, a Federal hearings officer will conduct a subsequent disability hearing rather than a state agency hearing officer.

For an explanation of disability hearing unit cases, see DI 29001.001.

D. Determining if jurisdiction should be assumed

1. Documentation requirements

Before making the decision to assume jurisdiction, examine the case for sufficient documentation as follows:

  • if there is insufficient documentation, return the case to the adjudicating component for development and adjudication; but

  • if there is sufficient documentation, the review component can assume jurisdiction.

2. Other factors

If there is sufficient documentation, consider the following factors to determine if you should assume jurisdiction.

  • Are you able to prepare new determinations, notices, forms, and rationales without affecting either timely adjudication of the claim or other workloads?

  • What is the frequency of assuming jurisdiction? Do not compromise the adjudicating component’s accuracy by the review component’s decision to assume jurisdiction frequently. If repetitive TCA’s occur, return the case to the adjudicating component.

For information on correcting other TCAs, see GN 04440.235B.2. and DI 30005.232B.

E. When jurisdiction is assumed

1. General requirements

When assuming jurisdiction, the quality reviewer is required to:

  • notify the adjudicating component of the deficiency and explain the corrective action;

  • ensure the same quality reviewer and regional medical reviewer (the adjudicative team) complete and sign all determinations, notices, forms, and rationales that are required to adjudicate the case (i.e., the determinations, forms, notices, and rationales that the adjudicating component disability examiner and medical consultant (MC) or psychological consultant (PC) completed).

NOTE: Keep the original determination form(s) in file as part of the audit trail. Annotate the original form, “Do Not Process,” per GN 04440.237F.

2. Signature requirements

The regional MC or PC is not required to sign the disability determination form if the MC's or PC's assessment completes the medical portion of the disability determination, and the MC or PC signed the appropriate medical evaluation document. For a complete explanation of the requirements and procedure of when the MC or PC does not sign the determination form, see DI 26510.090 and DI 24501.002C.2 For an explanation of MC and PC signature requirements on determination forms, refer to GN 04440.135B.3.

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GN 04440.244 - Policy Requirements for Assuming Jurisdiction - 09/03/2015
Batch run: 05/17/2016