TN 1 (01-12)
DI 12030.015 Request for Administrative Law Judge (ALJ) Hearing in Substantial Gainful Activity (SGA) Cessation Cases
A. Policy when a claimant requests an Administrative Law Judge (ALJ) hearing in a substantial gainful activity (SGA) cessation case
When a claimant (or proper applicant) files a request for an ALJ hearing of a reconsidered cessation based on SGA, the field office (FO) will assist the claimant with completing the HA-501-U5, Request for Hearing by Administrative Law Judge. If pertinent, the FO will assist the claimant with preparing a statement of good cause for late filing. The FO will review the request and any new evidence submitted to determine if the reconsideration determination is appropriate.
This review should verify that all documentation is in the official folder. Generally, the FO will use eWork to process the SGA determination. For detailed FO instructions on processing continuing disability work issue determinations in eWork and eWork exclusions, see DI 13010.020 through DI 13010.025 and DI 13010.145.
B. Procedure when the FO receives a hearing request on a reconsidered SGA cessation
1. Undertake a case review
Carefully review the claim to ensure that the SGA cessation is appropriate to prevent unnecessary Office of Disability Adjudication and Review (ODAR) hearings. It is very important that the FO review the official folder to ensure that all decisional and supporting documents related to the work continuing disability review (CDR) decision are in the folder. If the official folder is paper, print and place all documentation in the Modular Disability Folder (MDF); or if the official folder is the Certified Electronic Folder (CEF), make sure that all documentation is in eView, before forwarding it to the hearing office (HO).
2. You may reverse the SGA cessation
If you determine that it is possible to reverse the reconsidered SGA cessation (i.e., the determination is fully favorable), reopen the claim and process it the same way that you process a reversal of an initial SGA cessation. Follow the procedures outlined in DI 13010.145B.2.b. The FO may reopen an incorrect SGA cessation no matter which component (FO or Processing Center (PC)) made the incorrect decision. In such instances, notify the claimant that we are not forwarding the hearing request to ODAR because we made a fully favorable decision, but he or she can still request a hearing if he or she disagrees with our decision.
See GN 04001.090 Reopening – Appeal Rights – Operating Procedures
3. Affirm the reconsidered cessation
If you determine that the prior reconsidered cessation was appropriate, send the MDF or CEF (within five calendar days) to the HO for its action on the request for hearing. Be sure that the MDF or CEF contains all pertinent documents before sending it on. If the claimant is no longer engaged in SGA, see DI 12030.020.
NOTE: The ALJ does not have access to eWork, and relies on the FO to include all decisional material from eWork in the official folder.