DI 43525.050 Request for Reconsideration - Disability Cessation--Disabled Individual Resides in a Foreign Country
Basically, the same criteria will be applied to the development and processing of foreign requests for a disability hearing that are used in domestic cases. See DI 29001.000 and DI 29005.000 for a complete description of the provisions and the guidelines for case development and evaluation.
No provisions have been made for disability hearings to be held outside the United States; therefore, the claimant would at his own expense have to come into the United States for a hearing or the DHO in OD will review the claim and issue a decision based on the evidence in file.
A. Interaction between INTPSC and the DHO
Upon receipt of a Request for Reconsideration-Disability Cessation, INTPSC is to forward a copy of the request to either:
The DHO in OD, DHQB if the claimant/representative does not request a hearing in the United States (waiver of appearance cases); or
A DHO in the appropriate regional office (RO) if the claimant/representative requests a hearing.
If the claimant or representative wishes to appear at the disability hearing, ascertain where, in the United States, the claimant wishes to have the hearing held. Forward the information and SSA-789-U4 to the appropriate regional DHU. The DHO in the RO will make arrangements to hold the hearing at a time and place convenient for all parties involved and will notify the claimant of any subsequent changes. If there will be no personal appearance, the folder will be reviewed by the DHO in OD, DHQB.
B. Case review warrants fully favorable determination
If, after developing and reviewing the evidence in the case, INTPSC finds a fully favorable determination is warranted, a reconsidered determination will be processed in accordance with case processing described in DI 29001.000. INTPSC will prepare and release the SSA-833-U5/ SSA-832-U5 (or SSA-831-U5), Notice of Favorable Determination and other appropriate forms for effectuation. See DI 31515.000 for notice language. A copy of the determination must be sent to the appropriate DHO (either in OD or the RO) upon completion of the action.
NOTE: In rare cases, INTPSC will receive additional evidence which indicates that its reversal was erroneous. If the time period for reopening (see DI 27505.001) has not expired, INTPSC will prepare a Summary of Evidence, realign the folder and forward the case to the DHU. The DHO will review the case and decide whether or not INTPSC's determination should be reopened. If the DHO decides that, based on the additional evidence, INTPSC's determination should be reopened, the DHO will afford the claimant due process offering a disability hearing. If, however, the DHO determines INTPSC's reversal determination to be correct, the DHO will annotate the additional evidence to show that he or she did not revise the reversal determination. The claims folder will then be sent to INTPSC for maintenance.
C. Case review does not warrant fully favorable determination
If, after developing and reviewing the evidence in the case, INTPSC does not find that a fully favorable determination is warranted, INTPSC will realign the case folder, prepare the Summary of Evidence and forward the claim under cover of an SSA-408 to the appropriate DHO in accordance with DI 29025.000.
D. Processing cases received from DHO
Upon completion of the disability hearing, the DHO will prepare and release the SSA-833-U5/SSA-832-U5 (or SSA-831-U5), the Notice of Disability Hearing Decision to the claimant and dispatch the folder to INTPSC under cover of an SSA-408 annotated with appropriate identifying remarks. If, however, the case is selected for QR sampling, the determination and notice will not be released pending completion of the review.
NOTE: DHO decisions are excluded from any pre-effectuation review or reversal by INTPSC; DHO's decision is subject only to a quality review by the DQB and a subsequent review by the DHQRB of OD.
However, if in processing the postadjudicative action, an error is detected, or if additional evidence is received that may affect the determination, prepare a memorandum citing the problem and forward the case to the DHQRB of OD for resolution. Refer to DI 27505.000. regarding the expiration of the specific time limits provided in the Act and/or regulations for reopening and revising a determination.
1. Cessation affirmed by DHO
These cases will be returned to INTPSC for processing and retention during the appeals period. (Cases selected for QR sample will be forwarded to the DQB for review.) INTPSC will prepare all of the necessary adjustment notices and input forms to correct history and adjust benefits, taking into consideration current payment status, representative payee, overpayments, auxiliaries' benefits and other postadjudicative actions.
2. Cessation reversed to a continuance by DHO
Upon receipt of the folder from a DHO (the DQB or OD if it is a QR case), INTPSC will take appropriate actions to reinstate, continue or adjust benefits as applicable and notify the beneficiary of any adjustment actions in accordance with existing procedures.