TN 1 (09-19)

DI 27001.001 The Reconsideration Process

CITATIONS:

Social Security Act – Section 205(b)(2);

A. Introduction

Reconsideration is the first step in the appeals process for a claimant who is dissatisfied with the initial determination on his or her claim, or for individuals (e.g. auxiliary claimants) who show that their rights are adversely affected by the initial determination. A reconsideration involves a thorough, independent review of all evidence from the initial determination and any new evidence the claimant or another individual submits in connection with the request for reconsideration.

A reconsideration determination is made by:

  • An adjudicative team consisting of a disability examiner and a medical consultant or psychological consultant; or

  • A disability hearing officer.

NOTE: The examiner and consultant must be different from the reviewers who made the initial determination.

B. Process for requesting reconsideration

1. Time period for filing a reconsideration request

A request for reconsideration must be filed within 60 days after the date the claimant receives notice of the initial determination.

For the Disability Determination Services (DDS) responsibilities in cases with a late filed request for reconsideration, see (DI 27010.001)—Appeal Filing Issues.

2. Who may file the reconsideration request

The claimant or his or her representative may file a request for reconsideration. For additional instructions on who may file a request for reconsideration, see (GN 03102.100C.1.)—The Reconsideration Process.

3. What constitutes a reconsideration request

A request for reconsideration can be expressed or implied; however, it must be in writing. A writing, for these purposes, is any documentation, e.g., a letter, facsimile, or submission of additional evidence, which clearly implies disagreement with the initial determination.

4. How to request reconsideration

A claimant or the claimant’s representative may request reconsideration by:

  • Completing and submitting an SSA-561 (Request for Reconsideration); or

  • Completing and submitting an i561 (Request for Reconsideration) online; or

  • Submitting any documentation (e.g., letter, facsimile, or additional evidence) indicating disagreement with the initial determination.

A request for reconsideration may be filed at any Social Security Administration (SSA) office. For additional information on certain other offices where an appeal request may be filed, see (GN 03102.100C.7)—The Reconsideration Process.

5. What is not a reconsideration request

Contacting the 800 number or field office (FO) by telephone to inquire about the process, or to request forms, is not a reconsideration request.

C. Implied request for reconsideration

An implied request for reconsideration is any writing or timely submission of additional evidence by a claimant or his or her representative which indicates disagreement with the initial determination.

For further instructions see (DI 81020.025B) — Processing Electronic Reconsideration Cases.

D. Claimant’s rights during the reconsideration process

The reconsideration process provides the claimant:

  • An opportunity to present additional evidence;

  • A review of the evidence considered in making the initial determination and any other evidence presented;

  • An opportunity for a disability hearing in cases described in DI 29001.001—The Right to a Disability Hearing at the Medical Continuing Disability Review (CDR) Reconsideration Level;

  • A reconsidered determination based on all evidence of record;

E. DDS reconsideration processing actions

1. Affirmation of prior determination

An initial determination may be affirmed as written if all of the following conditions are met:

  • There is no allegation of a worsening of any previously documented impairment(s);

  • There is no allegation of any new impairment(s);

  • There has been no treatment for any impairment(s) since the prior determination; and

  • The prior determination was substantively and technically correct and the prior decision rationale correctly presented and resolved all pertinent issues to be adjudicated;and

  • There are no changes in the functional limitations.

For instructions, see (DI 27021.010) – Affirmation of a Prior Disability Determination.

NOTE: These bulleted conditions do not apply for DI 24510.066B. Adoption of Initial Level RFC Assessment or Adopting the initial level RFC or PRTF does not require affirming the initial determination as written.

2. Case development at reconsideration

Once a reconsideration case on an initial claim has been received from the FO, the disability examiner is responsible for reviewing the case to determine if additional development is warranted. If further case development is warranted, the disability examiner:

  • Determines whether the folder shows all necessary development, including appropriate follow-up, for the initial claim. If any required development action was overlooked, complete that development.

  • Obtains additional information needed to document new allegations or a worsening of the claimant’s condition including information that was required but not obtained before the initial determination (e.g., SSA-3373 Function Report, Medical Evidence of Record (MER), and work history).

  • Contacts all medical sources from which the claimant received examination or treatment since the initial determination for any new medical evidence.

  • Sends unsigned medical reports secured in connection with the initial determination which are material to the reconsidered determination to the medical source(s) for signature; and

  • Has a DDS medical or psychological consultant who was not involved in the initial determination review the medical evidence and provide a new medical assessment or, if supported by the evidence, an affirmation of the initial level medical assessment.

NOTE: Disability examiners must follow up with sources that were contacted, but did not submit MER, at the initial level.

For further instructions see:

  • DI 27021.010 – Affirmation of a Prior Disability Determination

  • DI 27015.001 -- Completing Form SSA-831–U3 for Reconsideration Cases

  • DI 24510.066B – Options to Simplify Case Processing

  • DI 81020.025—Processing Electronic Reconsideration Cases

3. Reconsideration of initial continuing disability review (CDR) determination or adverse reopening

For development and documentation instructions see:

  • DI 28005.001—Legal Standard for Determining If Disability Continues

  • DI 29005.001—Reconsideration Standards and Development Guidelines

  • DI 22505.035—Follow-up on Requests for Medical Evidence of Record (MER)

  • DI 29000.000 – Reconsideration of Continuing Disability Review (CDR) Cases, and Reopenings Applicable to Disability Hearings (Pre-DHU Processing) – Table of Contents


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427001001
DI 27001.001 - The Reconsideration Process - 02/16/2017
Batch run: 09/12/2019
Rev:02/16/2017