TN 53 (12-05)
SI 02305.065 RZs as Part of Effectuation of an Appellate Decision
An unscheduled RZ may be required after an appellate reversal (i.e., hearing level or higher). The purpose of the unscheduled RZ is to ensure that the file is complete and current with respect to all relevant elements of eligibility and payment for the period under review. This period begins with the effective month of the adverse action and ends with the month the appellate determination was made. However, if at least one RZ was completed during this time period a RZ is not required as part of the effectuation of the appellate decision.
If the case has never been redetermined, the beginning date for the period of review is the month of eligibility.
An unscheduled RZ is required after all appellate reversals EXCEPT when all of the following conditions are met.
The ALJ reverses an unfavorable CDR determination; and,
The individual is receiving Statutory Benefit Continuation (SBC) payments; and,
There has been a RZ during the time period beginning with the first month of SBC payment and ending with the month of the appellate determination.
NOTE: SBC payments are not made for appeals beyond the ALJ level.
If an unscheduled RZ is required to effectuate an appellate reversal, you must review the entire period covered by the appellate decision to ensure that the file is complete and current. This period begins with the effective month of the adverse action and ends with the month the appellate determination was made.
However, if the case has never been redetermined, or a RZ was not conducted during the period of SBC payment, the beginning date for the period of review is the month of eligibility or the month of the last RZ which ever is latest.
If you discover any new and material evidence related to the appellate determination, send this evidence to the ALJ for necessary action if that evidence relates to an issue decided by the ALJ or AC. (See SI 04030.050C.11.)