TN 1 (11-02)

DI 12045.015 Claims Under Different Titles – Common Issue at the ALJ Hearing Level

A. Policy

If a claim at the ALJ hearing level shares a common issue with a new claim under the other title or with a claim pending appeal, the claims are generally combined. Claims are not combined if either the claimant objects or the ALJ does not agree that the claims should be joined.

B. Procedure

1. Contact with ALJ

Contact the hearing office by telephone to determine if the ALJ will agree to join the claims.

2. Consolidated Processing

If the ALJ decides to join the claim, proceed as follows:

  1. Do not undertake any development for a new claim.

  2. Use an SSA-636-U3 to forward the claim(s) to the ALJ, unless informal remand is appropriate (DI 12010.015).

NOTE: For Title XVI escalated claims, send the entire claims file including the medical and nonmedical development.

3. Separate Processing

If the ALJ or claimant objects to joining the claims, process the claims separately. In this situation, the FO, DDS, or ODIO adjudicates the lower level claim as appropriate.

  • Place photocopies of pertinent evidence in each claim folder.

  • Request the ALJ to send medical evidence directly to the DDS if appropriate.

4. Medical Issue

  • Document the claim with a report of contact (SSA-5002) to indicate the independent processing.

  • Route the claim to the DDS for processing.

  • Advise the DDS to notify the hearing office if the determination is favorable.

5. SGA Issue

  • Process the initial claim or reconsideration request.

  • If a denial results, do not contact the ALJ.

  • If an allowance or reversal results, contact the ALJ to suggest return of the claim under the other title if it appears that an allowance or reversal may result on that claim as well.

  • If the ALJ returns the claim and a medical determination had not been made previously, route both claims to the DDS for a medical determination at the initial level.

  • If the ALJ does not return the claim pending in ODAR, and a medical determination had not been made on the current claim, route the current claim to the DDS for a medical determination at the initial level.

    NOTE: If any issues that were to be decided by an ALJ, remain unresolved on a claim returned by the ALJ, the case must be returned to the ALJ.

6. Late Filing Under One Title

a. Protective filing

  1. If a hearing request under one title is timely, but a request under the other title was late, secure a subsequent application for the late-filed request. This application will protect the filing date in the event the previous claim cannot be reopened.

  2. Secure a good cause statement and forward to ODAR for the good cause determination along with the hearing request and new application.

  3. Flag the case for the ALJ to return to the FO if good cause is not established and the hearing is dismissed so that the new claim can be processed.

b. Informal Remand

In medical issue cases in which the informal remand criteria are met (DI 12010.015), send both claims to the DDS. If the determination is favorable, the DDS will consider the prior claim.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412045015
DI 12045.015 - Claims Under Different Titles - Common Issue at the ALJ Hearing Level - 05/23/2006
Batch run: 01/27/2009
Rev:05/23/2006