TN 3 (10-09)

DI 12005.001 Documenting a Request for Reconsideration of an Initial Disability Claim

Citations:

Social Security Act, Section 205(b)(2)

20 CFR 404.907 - 404.922

20 CFR 416.1407 - 416.1422

  

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. Field office (FO) explanation of the determination and reconsideration process

A claimant who is dissatisfied with the initial determination on his or her claim may call, write, or visit an FO in person for an explanation of the determination. Describe, as objectively as possible, how the claimant's case was handled, the basis for the determination, and his or her appeal rights.

If the claimant decides to request reconsideration after receiving the explanation, follow the instructions in this subchapter to develop and process the request.

EXCEPTION: Reconsideration is not the first level of appeal for a medical determination on an initial claim in Prototype states, unless expedited reinstatement is involved (for additional information, see DI 12005.001C in this section).

When a claimant requests reconsideration of an initial disability determination, the FO explains the reconsideration process and obtains the appropriate appeal forms (e.g., the SSA-561 Request for Reconsideration). The claimant’s case then receives an independent and thorough reexamination of all evidence on record including any new evidence received after the initial determination

NOTE: To process a request for reconsideration of a medical cessation or an adverse reopening of a favorable initial determination due to medical/vocational reasons, follow the instructions in Reconsideration – Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination DI 12026.001.

B. Reconsideration procedure

1. Review the initial claim

Review the certified electronic folder (CEF) or paper modular disability folder (MDF) to ensure that an initial determination has been made. Also review the Online Retrieval System (ORS) and any pertinent queries for additional information before scheduling an interview with the dissatisfied claimant. If the claim folder(s) is not available in the FO, use judgment in deciding whether to conduct an interview or to undertake development without the claim folder(s).

2. Conduct the interview, if necessary

In most cases, the claimant submits his or her request for reconsideration via iAppeal or by submitting a written request, without having an interview with an FO employee. When reconsideration is requested in writing or via iAppeal, an interview with an FO employee is usually not necessary. Review these submissions for completeness, and load the reconsideration request information into the Modernized Claim System (MCS) and the Modernized Supplemental Security Income Claims System (MSSICS), as appropriate.

Conduct the interview as discussed in Appeals – FO Interview with Dissatisfied Claimant GN 03101.120.

Also, explain that the claimant:

  • has the right to present additional evidence to support his or her claim and may request FO assistance in determining what evidence is needed and how to get the evidence;

  • has the right to representation (see Appointment and Revocation of Appointment of Representative GN 03910.040); and

  • may be required to attend a consultative medical examination (CE). Stress the importance of attending the CE and of cooperating in securing and submitting medical evidence that the DDS may request.

3. Document the appeal request in MCS and or MSSICS

Import the appeal request via the Dallas Appeals Title II/Title XVI PComm (a.k.a., “banana”) program, or enter information into the appeal screens manually in MCS and MSSICS, as appropriate.

EXCEPTION: If the claimant submits an appeal of an FO determination (e.g., failure to cooperate or substantial gainful activity (SGA)) and the initial denial is reversed, see Processing Reconsideration Requests of Field Office (FO) Determinations DI 81010.145.

  • If the deciding issue inconcurrent Title II/Title XVI cases is the same (e.g., medical/vocational denial), complete the appeal screens for each Title. For exception cases (e.g., MCS or Electronic Disability Collect System (EDCS) exclusions), obtain one Form SSA-561 (Request for Reconsideration) and specify in the “CLAIM FOR” text that it applies to both claims.

  • If the reconsideration request is limited to one Title only, document the claim folder(s) to reflect the reason(s) the claimant is not requesting reconsideration for both claims.

  • If the claimant has limited the appeal in multiple claim situations (DIB/DWB or DIB/CDB), document this on the appeal request in the space provided for the reason for the appeal. If the claimant limits his or her appeal to Title XVI-only in concurrent cases, see Overview of the Filing for Other Program Benefits Requirement SI 00510.001.

  • If the issues differ in concurrent claims (e.g., technical denial on the Title XVI claim and medical denial by the DDS on the Title II claim), and the claimant disagrees with both decisions, complete the appropriate MCS and MSSICS appeal screens. If the appeal screens cannot be completed in MCS or MSSICS, obtain an SSA-561, and process in accordance with the procedures applicable under the respective program.

  • If the case is an MCS/MSSICS exclusion, and the claimant has not already submitted a written request as described in GN 03102.100C.2., obtain an SSA-561.

  • If the claimant submits non-medical evidence, follow Storing Non-Medical Evidence in the Electronic Folder (EF) DI 81010.135.

NOTE: A manually loaded appeal request must be printed and stored on the PRST screen to ensure that a copy is stored in the Online Retrieval System (ORS). For appeals brought into MCS/MSSICS via the Dallas Appeals Program, the program automatically completes the PRST screen for the user, saving the appeal request to ORS.

C. References

  • OS 15010.175 – Form SSA-561

  • OS 15010.180 – Form SSA-561–SP

  • GN 03102.100 – The Reconsideration Process

  • DI 13050.085 – Appeals Process Under Expedited Reinstatement

  • GN 03101.125 – iAppeals Title II

  • GN 03102.225 – Preparation of Form SSA 561-U2

  • SI 04005.035 – iAppeals - Title XVI

  • SI 04020.020 – Requests for SSI Reconsideration

  • MSOM MCS 010.002 – Appeal Establishment (NAPP) Screen-MCS

  • MSOM MSSICS 020.001 – Appeals Screens-MSSICS


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412005001
DI 12005.001 - Documenting a Request for Reconsideration of an Initial Disability Claim - 05/14/2012
Batch run: 05/14/2012
Rev:05/14/2012