TN 2 (11-11)
SI 04030.010 Administrative Law Judge Hearings for Supplemental Security Income Cases
A. The hearing process
A claimant may request a hearing conducted by an administrative law judge (ALJ). The claimant may appear in person, submit new evidence, examine the evidence used in making the determination or decision under review, and present and question witnesses. The ALJ may question the claimant and witnesses. If the claimant waives the right to appear at the hearing, the ALJ will make a decision based on the record and any evidence the claimant submitted.
1. Who may request a hearing
The claimant, his or her appointed representative or representative payee, or other third party on behalf of the claimant can file a hearing request. The FO employee must provide a copy of the hearing request to the claimant as notification that SSA received the appeal. In addition, any other person who can show in writing that his or her rights may be adversely affected may request a hearing.
NOTE: Effective March 16, 2012, appointed representatives have the affirmative duty to use the iAppeals (i561, i501, and i3441) application to file a request for reconsideration or a request for hearing on a medically denied claim if they request direct fee payment on the matter. For more information about appointed representatives’ affirmative duties, see GN 03970.010.
2. When an ALJ will hold a hearing
The ALJ will hold a hearing if any person mentioned in SI 04030.010A.1. in this section requests a hearing in writing and Social Security made any of the following determinations or decisions.
Revised initial determination
Reconsideration of a revised determination
Initial or reconsidered determination that involves a suspension, reduction or termination of current benefits
Revised reconsidered determination that does not involve a suspension, reduction, or termination of current benefits
Revised hearing decision based on evidence not included in the record on which the prior hearing decision was based
3. Who are parties to a hearing
Other parties to the initial, reconsidered, or revised determination
Anyone whose rights may be adversely affected by the decision, and who shows that in writing
Anyone whose rights we may adversely affect by the decision; and the ALJ notifies the person to appear at the hearing or to present evidence supporting his or her interest in the decision
4. Notice of the hearing
At least 20 days before the hearing, we mail or give by personal service a notice to all of the parties to the hearing, who have not waived the right in writing to receive notice, a notice that includes the following information.
The time and place of the hearing
A statement of the specific issues to be decided
A statement informing the claimant of the right to designate a person to represent him or her
An explanation of the procedures for requesting a change in time and place of the hearing
A reminder that the ALJ may dismiss the hearing request if the claimant fails to appear at the hearing without good cause
5. Acknowledgement of the notice by the claimant or the representative
If the claimant or the representative does not acknowledge receipt of the notice, Social Security will attempt to contact the claimant or his or her representative for an explanation. Send an amended notice by certified mail if the claimant states they did not receive the notice.
6. Where hearings are held
Social Security holds hearings within the 50 States, the District of Columbia and the Northern Marianna Islands, normally within 75 miles of the claimant's residence.
7. Who can Social Security reimburse for travel expenses to attend hearings
The claimant if the distance to the hearing is more than 75 miles
Witnesses who were not subpoenaed if the distance to the hearing is more than 75 miles
Witnesses who were subpoenaed. We reimburse subpoenaed witnesses under the rules for reimbursing witnesses who are compelled to appear in a United States District Court under the Federal Rules of Civil Procedure.
An appointed representative. Reimbursement may not exceed the maximum amount allowable for the representative’s travel originating within the geographic area having jurisdiction over the hearing.
B. Issues considered by the Administrative Law Judge (ALJ)
1. Which issues are considered
The issues before the ALJ are all the issues brought out in the initial, reconsidered, or revised determination that were not decided entirely in the claimant's favor.
If evidence presented before or during the hearing causes the ALJ to question a fully favorable finding, the ALJ will notify the claimant and will consider it an issue at the hearing.
2. New issues
The ALJ may consider a new issue at the hearing if the ALJ notifies the claimant and all the parties about the new issue any time after receiving the hearing request and before mailing notice of the hearing decision.
The ALJ or any party to the hearing may raise a new issue even if the issue arose after the request for hearing and even if we did not consider the issue in an initial or reconsidered determination. A new issue decided by an ALJ is not an initial determination because no lower appeal rights flow from the decision.
The ALJ or any party to the hearing may not raise a new issue if it involves a claim that is within the jurisdiction of a State agency.
If the new issue includes an issue of blindness or disability not previously adjudicated by a disability determination services agency (DDS), return the case to the DDS to make a determination on the new issue.
3. Notice of a new issue
The ALJ will notify the claimant and any other party if the ALJ will consider any new issue. We will give notice of the time and place of the hearing on any new issues to the parties to the hearing unless the parties indicated in writing that they do not want to receive the notice.
4. Disability issues
When we base the initial determination on nonmedical factors and the ALJ makes a favorable finding based on nonmedical factors, the ALJ can refer the case to the Social Security field office for referral to the Office of Disability and International Operations (ODIO) or the DDS for a determination of the disability or blindness issue.
5. Nonmedical issues
If we base the initial determination on medical factors, and the ALJ makes a favorable finding on the medical factors, the ALJ can:
make a decision of the non-disability issues after meeting the notice requirement in SI 04030.010B.2. in this section; or
make a decision of the disability issues and refer the case to the field office for resolution of the non-disability issues.
C. Effect of the ALJ’s decision
The ALJ's decision is binding on all parties to the hearing unless the:
claimant or another party to the hearing requests a review of the decision by the Appeals Council (AC) within the time period to request appeal, and the AC accepts the case for review;
claimant or another party to the hearing requests a review of the decision by the AC within the time period to request appeal, the AC denies the request for review, and the claimant seeks judicial review of the case by filing an action in a Federal District Court;
decision is revised by an ALJ or the AC;
expedited appeals process is used;
ALJ issues a recommended decision; or
AC assumes jurisdiction of the case on remand from a court.