TN 1 (11-02)

DI 12045.025 Conflicting Determinations in Claims Under Different Titles - All Levels

A. Introduction

The field office (FO) may discover that a favorable determination had been issued under one title and an unfavorable determination under the other title. An agreement must be coordinated between the components involved.

NOTE: Any adverse reopening resulting from this procedure is subject to administrative finality considerations as well as due process procedures.

B. Procedure

1. Medical Issue In Conflict

a. Initial or Reconsideration Level

Forward the claims for resolution to the disability determination services (DDS) that made the last determination if both determinations were made at the initial or reconsideration level.

b. Administrative Law Judge (ALJ) or Higher Level

  • Forward the claims to the regional office if either or both decisions were made at the hearing level, appeals council (AC) or Court level.

  • Identify the conflict on the route slip.

  • The Regional Office Programs Coordinator will work with the Office of Disability Adjudication and Review (ODAR) to coordinate the processing of the claim(s).

2. Substantial Gainful Activity (SGA) Issue in Conflict

The FO is responsible for resolving conflicts of substantial gainful activity (SGA) determinations at the initial or reconsideration levels. The FO should:

  • Be aware of the priority of decisions over initial and reconsideration determinations.

    NOTE: Priority of decisions refers to the fact that the DDS cannot disturb the period adjudicated by ODAR decisions. The DDS makes determinations and ODAR makes decisions.

  • Send the folder to the hearing office (HO) for additional review if there is material evidence that was not available prior to the ALJ decision.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412045025
DI 12045.025 - Conflicting Determinations in Claims Under Different Titles - All Levels - 05/23/2006
Batch run: 01/27/2009
Rev:05/23/2006