If an individual who did not meet the MC or PC qualifications completed and signed the medical assessment(s) and the medical portion of the disability determination, and the determination has become administratively final, the DDS must determine whether the case is within:
the 1-year unrestricted reopening period,
the 2-year period for reopening a title XVI determination based on good cause (unless fraud or similar fault is involved), or
the 4-year period for reopening a title II determination based on good cause (unless fraud or similar fault is involved).
For cases within the 1-year unrestricted reopening period or the applicable period for reopening based on good cause, the DDS must ensure that a qualified MC or PC, as appropriate, completes a medical review following the below instructions in DI
For more information about the time limits for reopening, see DI 27505.001.
For additional reopening considerations, see the below instructions in DI
It is not necessary to obtain a medical review of, or otherwise take further action on, an initial determination signed by an unqualified individual if a different, qualified MC or PC signed the reconsideration determination and the claimant did not seek further administrative review. Further action is not necessary because a qualified MC or PC completed the medical portion of the case review and made the medical assessments for the final determination on the claim(s).