BASIC (09-09)

DI 27010.005 New Application with Reconsideration

NOTE: If a claimant files a new disability application and has a prior disability claim for the same title and benefit type pending at any level of administrative review, see DI 51501.001- Procedural Change for Subsequent Disability Applications Effective July 28, 2011.

A. Escalation of same type or related claim to reconsideration level

When an initial claim or subsequent application involves a common issue with a claim on which reconsideration is pending, it is escalated to the reconsideration level. The claims may be the same type or related claims.

1. Same type claims

Claims for the same type of benefits, e.g., Title II disability insurance benefits (DIB).

2. Related claims

Claims that share a common medical or substantial gainful activity issue. A common issue may exist if the claims share a common period for evaluating disability or blindness, although the dates of onset may differ. The following are examples:

a. Same title

  • DIB and childhood disability benefits (CDB).

  • DIB and disabled widow(er) benefits (DWB).

  • DWB and CDB.

b. Different titles

  • Title II DIB claim and Title XVI disability/blindness claim, Title II disability insured status is met in or after the month of filing for Title XVI eligibility or payments, and both claims involve a medical issue of disability.

  • Title II DWB claim and Title XVI disability/blindness claim, Title II prescribed period requirement is last met in or after the month of filing for Title XVI payments, and both claims involve a medical issue of disability.

  • Title II CDB claim and Title XVI disability/blindness claim, Title XVI application was filed by the claimant prior to age 22 and both claims involve a medical issue of disability.

B. Procedures for same type claims

When a new application is filed while a reconsideration of an initial determination is pending, and both applications represent the same issue:

  • Combine them;

  • Prepare a combined notice to the claimant and refer to the new application;

  • Refer to the new application with a “close out” paragraph if the reconsidered determination affirms the initial denial.

C. Procedures for related Claims

If a related claim is filed while a reconsideration is pending:

  • Escalate it to the reconsideration level.

  • Prepare a combined initial/reconsidered determination SSA-831-U5 (Disability Determination and Transmittal) on the related claim. Add “Recon Escalation — Combined Initial and Reconsideration Determination” in item 34 of the SSA-831-U5.

NOTE: Combined determinations prepared under this section will be treated as reconsidered determinations.

  • Complete the reconsidered determination on the pending reconsideration claim (an SSA-831-U5 for an initial denial).

  • Prepare appropriate notices.

NOTE: A personalized disability explanation SSA-4268-U4 (Explanation of Determination) is required for each claim if the determination is totally or partially unfavorable.

  • Release notices simultaneously.

D. Reconsideration request filed timely under one title but untimely under the other

If good cause for the untimely filing cannot be established, the claimant may file a new application. In such cases:

  • Escalate the new application to the reconsideration level; and

  • Consider reopening the initial determination if the determination is favorable.

References:

  • DI 27505.000 – Rules for Reopening

  • DI 25501.250 – Establishing an Established Onset Date by Reopening Prior Disability Filings and Previously Adjudicated Periods

  • DI 12005.015 – Late Filing of a Request for Reconsideration

NOTE: To find out if a determination can be adopted without completely developing the new claim, see DI 27515.000 — Collateral Estoppel.


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