TN 1 (01-12)
DI 12030.020 Claimant Files Request for ALJ Hearing in Substantial Gainful Activity (SGA) Cessation Case and No Longer Engaged in SGA
A. Policy when a claimant is no longer engaged in SGA
A previously entitled claimant has the option of filing a new claim or requesting expedited reinstatement (EXR) in the following situation:
the claimant files a request for an Administrative Law Judge (ALJ) hearing;
the field office (FO) determines that the reconsideration SGA determination was appropriate; and
the claimant is no longer engaging in SGA.
For an overview of EXR, see DI 13050.001.
B. Procedure when a claimant is no longer engaged in SGA
Assist the claimant in completing the HA 501-U5, “Request for Hearing by Administrative Law Judge” and document the file that the claimant is no longer engaging in SGA and the date that SGA terminated. For instructions on the use and completion of the HA 501-U5, see GN 03103.020.
Obtain a new application to protect the month of eligibility for benefit payments.
Request that the hearing office (HO) return the case to the FO if the HO affirms the reconsideration determination. In such case, process the new application or process as an EXR.
Most claimants who meet the eligibility requirements for EXR also meet the eligibility requirements to file an initial claim. The FO should conduct a thorough discussion with the claimant to inform him or her of the ramifications of requesting EXR versus filing a new initial application. The claimant must decide which avenue he or she wishes to pursue. For a detailed discussion of EXR versus an initial claim, see DI 13050.020.
The process of requesting and processing EXR and initial claim actions should be a sequential process. The claimant should file under the process that will be the most advantageous and then possibly pursue the other avenue if he or she is denied during the first approach. However, a claimant may wish to file for both approaches immediately.
If the claimant wishes to file a request for EXR and an initial claim, explain that we will process only one action to completion.
Route the folder, hearing request, and new application to the appropriate HO.
If the claimant decides to appeal the ALJ decision, follow DI 12020.001 to process a request for Appeals Council review. Follow DI 12045.027 to process a subsequent claim.