In determining whether the conditions for reopening and revising a final determination or administrative law judge (ALJ) decision are met, the Appeals Council (AC) will compute the time between:

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  The date of the notice of the initial determination on the application the AC is considering reopening; and

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  The date of the claimant's request for reopening or the date the Social Security Administration takes action to reopen the determination or decision.

The date of the request for reopening will vary from case to case depending on the circumstances. To illustrate, in some cases:

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  The date of the request for reopening is the filing date of the new application because the claimant raises the issue of reopening (express or implied) in the application. For example, reopening is an issue implied in the application if the claimant alleges an onset of disability during a prior adjudicated time period.

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  The claimant may not have raised the issue of reopening before the AC level. In that circumstance, the AC computes reopening from the date of the request for reopening (or if on its own initiative, the date the AC first identified the issue).

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  The AC may receive a referral from another component about a processing issue that would require the AC to reopen the case to correct the issue. In that circumstance, if the time to exercise own motion review has passed, the AC would compute reopening from the date it received the referral.

Under limited circumstances, the AC may reopen multiple prior determinations or decisions. The AC will use the same criteria in subsection A above to compute the time period for reopening any earlier determination or decision.

For an illustrative example of reopening multiple applications, see Hearings, Appeals, and Litigation Law manual HA 01290.020 B.

In the Fourth Circuit, AR 90-4(4): Culbertson v. Secretary of Health and Human Services provides an expanded timeframe in which certain claimants may request reopening on a prior determination. In short, if an adjudicator determines that mental incompetence prevented the claimant from understanding the procedures for requesting administrative review of a prior determination, and the claimant had no individual who was legally responsible for prosecuting the claim, he or she will not apply res judicata or administrative finality even if more than four years have elapsed in a title II claim or two years in a title XVI claim. Rather, the AC will reopen the prior determination and issue a revised determination.

The Ninth Circuit also provides an expanded timeframe in which certain claimants may request reopening. AR 92-7(9): Gonzalez v. Sullivan applies only to claimants in the Ninth Circuit who received an adverse initial determination prior to July 1, 1991 and did not timely appeal that determination. For the purposes of this AR, the time limits for reopening and revising final agency determinations do not apply when the claimant meets the criteria outlined in the AR.

In addition to these ARs, see also Social Security Ruling (SSR) 91-5p, Mental Incapacity and Good Cause for Missing the Deadline to Request Review, when applicable (e.g., the claimant was unrepresented at the time of the prior administrative action), and SSR 95-1p, Policy Interpretation Ruling Title II and Title XVI: Finding Good Cause for Missing the Deadline to Request Administrative Review Due to Statements in the Notice of Initial or Reconsideration Determination Concerning the Right to Request Administrative Review and the Option to File a New Application, as applicable.