If an individual who did not meet the MC or PC qualifications completed and signed
the medical assessment(s) and the medical portion of the disability determination,
and the determination has become administratively final, the DDS must determine whether
the case is within:
the 1-year unrestricted reopening period,
the 2-year period for reopening a title XVI determination based on good cause (unless
fraud or similar fault is involved), or
the 4-year period for reopening a title II determination based on good cause (unless
fraud or similar fault is involved).
For cases within the 1-year unrestricted reopening period or the applicable period
for reopening based on good cause, the DDS must ensure that a qualified MC or PC,
as appropriate, completes a medical review following the below instructions in DI 24501.003F.
For more information about the time limits for reopening, see DI 27505.001.
For additional reopening considerations, see the below instructions in DI 24501.003G.
It is not necessary to obtain a medical review of, or otherwise take further action
on, an initial determination signed by an unqualified individual if a different, qualified
MC or PC signed the reconsideration determination and the claimant did not seek further
administrative review. Further action is not necessary because a qualified MC or PC
completed the medical portion of the case review and made the medical assessments
for the final determination on the claim(s).