TN 1 (06-01)
VB 02502.015 Case Review -- SVB Reconsideration
A. Definition -- Case Review
Case review is a method of reconsideration involving a thorough review of all evidence in the file, including evidence submitted by the claimant, his/her representative or otherwise secured by SSA. It is the only type of reconsideration that is available for individuals claiming SVB payments, unless the appeal is on an SSI nonmedical issue. (See VB 02502.001B.5. and VB 02502.010B.1.)
Claimants or beneficiaries requesting reconsideration and all other parties to a reconsideration action have the right to review the evidence in their files and then to present oral and written evidence. Following this, the official who will make the reconsideration determination will review all the evidence in the case and make the determination. (See VB 00901.015B.1 for instructions on routing reconsideration requests.)
1. Reviewing the File in the United States
Upon receipt of a reconsideration request, offer the claimant or beneficiary in the United States (and his/her representative, if any) the opportunity to review the file in the FO and to supply additional evidence as soon as possible. For this purpose, claimants or beneficiaries in Guam, Puerto Rico, American Samoa or the U.S. Virgin Islands are considered to be in the United States.
2. Reviewing the File Outside the United States
Do not routinely offer a file review to claimants or beneficiaries who are requesting reconsideration outside the United States. However, if a review is specifically requested, take the following action:
a. Claimant or Beneficiary in the Philippines
Mail photocopies of, or fax, material in the file to the Federal Benefits Unit (FBU) in Manila. Request that the FBU call the beneficiary in to review the material and any other pertinent material in the possession of theFBU. Once the review is completed, the FBU will notify the central processing site (CPS) and forward any additional evidence to the site for the reconsideration determination.
b. Claimant or Beneficiary in Other Countries
Contact the Office of International Programs (OIP) on (410) 965-3566 for assistance in arranging a file review when requested by claimants or beneficiaries who are abroad but not in the Philippines. Generally, OIP will request the assistance of a FBU to receive the file material when it is mailed or faxed to the post and conduct the requested review with the claimant or beneficiary. Once the review is completed, the FBU will notify the CPS and forward any additional evidence to the site for the reconsideration determination.
3. Additional Evidence or Information
Ask for all the evidence the claimant has or can obtain and fully develop any questions he/she raises. If additional evidence is promised, allow a reasonable amount of time for it to be submitted.
For claimants in the Philippines, request assistance from the FBU in Manila if additional evidence or information is necessary. For claimants in Canada, Guam, Puerto Rico, American Samoa or the U.S. Virgin Islands, contact the FO servicing the claimant's place of residence. For claimants in other countries, write directly to the claimant or contact the appropriate FBU.
Document the additional information or evidence (or lack thereof) for the file.
Assist the claimant in completing an SSA-795 if necessary information is offered verbally. Complete an SSA-5002 (Report of Contact) if the claimant does not wish to sign a statement of information.
Develop other factors of qualification or entitlement if it appears additional development may result in favorable action on the contested issue.
4. Reasonable Time
Although the amount of time to submit additional information depends on the nature of the information or evidence and the difficulty in obtaining it, assist the claimant in obtaining it if it will take an inordinate amount of time (i.e., more than 10 workdays). If you cannot obtain it within 30 days, send the claimant a closeout letter giving him/her an additional 15 days to submit it. After 15 days, conduct the case review and render a reconsideration determination.
5. When to Conduct Case Review
When possible, the official who will make the reconsideration determination will review the case within 5 workdays after all evidence and/or information is submitted.
Document as follows:
FOs should complete Form SSA-8450 (District Office Record of SSI Reconsideration) to document the SVB reconsideration determination (see SI 04020.060C.);
Amend the title of the SSA-8450 to show “RECORD of SVB RECONSIDERATION”;
If necessary, check the “OTHER” block when describing the SVB issue involved in the reconsideration action. (See VB 02502.025C.4.)
Make the necessary systems input (see VB 04001.001)
Prepare and release a manual notice. (See VB 02502.025B.)