TN 2 (06-08)

DI 27505.010 Good Cause for Reopening

A. Good Cause - Definition

“Good Cause” for reopening a prior determination or prior decision exists when:

  • new and material evidence is furnished;

  • the evidence that was considered in making the determination or decision clearly shows on its face that an error was made; or

  • there was a clerical error in the computation or re-computation.

“Good Cause” for reopening does not exist because of a change of an administrative ruling or legal precedent (change of position).

See Also

  • Change of Ruling or Legal Precedent (Change of Position) (DI 27505.020)

  • Reopenings - Change in Ruling or Legal Interpretation - Change of Position (GN 04001.100)

  • Revising SSI Determinations – Policy – Change of Position (SI 04070.040C.)

B. New and Material Evidence

1. New and Material Evidence Furnished

New and material evidence is any evidence which:

  • Was not a part of the claims file when the final determination or decision was made; but

  • Relates back to the period adjudicated in the determination or decision; and

  • Shows facts that would have resulted in a conclusion different from the conclusion originally reached, had the new evidence been introduced or available at the time of the determination or decision.

NOTE: New evidence is “material” when it shows that the prior determination or decision was incorrect.

Additional evidence which by itself would not be sufficient to reopen a final determination or decision may cast doubt on the correctness of the prior determination or decision and may indicate the need for further development of the reopening issue.

2. The Disability Determination Services (DDS) Discovers New and Material Evidence Related to a Prior Decision

a. Administrative Law Judge (ALJ), Appeals Council (AC) or Court Decision

If reopening for good cause is still possible, direct Office of Disability Operations’ (ODO) or the appropriate Processing Center’s (PC) (Disability Processing Branch) attention to any new and material evidence that DDS discovers, if the evidence may have a bearing on the correctness of the prior decision. See DDS Reopening Prohibited (DI 27510.005C.2.).

b. Disability Hearing Officer (DHO) Decision

Refer the case to the Disability Hearing Unit (DHU).

NOTE: Also refer the case to the DHU if a DDS reconsideration determination needs to be reopened and revised to an adverse medical or medical/vocational determination.

See Also

  • Reopenings - New and Material Evidence (GN 04010.030)

  • The Right to a Disability Hearing at Reconsideration Level (DI 29001.001B.)

  • Title XVI Administrative Finality – General Reopening Policies – New and Material Evidence (SI 04070.010F.5.a.)

C. Error on the Face of the Evidence

An error on the face of the evidence exists where the evidence that was considered in making the determination or decision clearly shows on its face that an error was made. That is, based on all of the evidence in the file and any evidence of record located in any SSA or DDS office at the time that the determination or decision was made, it is clear that the determination or decision was incorrect.

See Also

  • Reopenings - Error on the Face of the Evidence (GN 04010.020A.) for additional information on reopening on this basis under title II.

  • Title XVI Administrative Finality – General Reopening Policies – Error on the Face of the Evidence (SI 04070.010F.5.c.) for additional information on reopening on this basis under title XVI.

EXAMPLE: Error on the face of the evidence could exist where a medical report in file materially affecting the end result of the prior determination was overlooked; or there was an obvious and material misinterpretation of laboratory tests, x-rays or other medical reports; or a report which was considered in deciding the claimant's case belonged to another person; or policy was clearly misapplied, such as