PROGRAM OPERATIONS MANUAL SYSTEMPart VB – Special Veterans BenefitsChapter 025 – Appeals ProcessSubchapter 01 – OverviewTransmittal No. 1, 01/17/2019
This is a QAT and does- no change to or introduction of new policy or procedure.
Summary of Changes
VB 02501.010 Good Cause for Extending Time Limit
Updated policy with new language by changing acronyms to full names. Added new paragraphs to section 4.
Claimants may contact the Field Office (FO), the Teleservice Center (TSC), or the Federal Benefits Unit (FBU) to question or disagree with a determination after the 60-day time limit (or the 10-day limit for benefit continuation) has expired. These offices should assist the claimants if they want to appeal and should develop good cause for extending the time limits for appeal and benefit continuation. The request for an extension of time must be in writing and must give the reasons why the request was not filed timely. (Assist the claimant, if needed, in preparing this written request.) The FO, TSC, or the FBU should forward the appeal and good cause development to the servicing FO or Central Processing Site (see VB 00901.015). An individual from the component that has the authority to adjudicate the appeal being filed determines whether "good cause" exists.
The FO or FBU must accept the appeal request and develop for good cause. Good cause may extend well beyond the 60-day limit.
In determining whether the claimant had good cause for failure to file a timely appeal request, SSA considers:
whether circumstances (including foreign mail time) impeded the claimant's efforts to pursue his/her claim;
whether SSA actions were confusing or misleading;
whether the claimant understood the requirements of the Social Security Act (the Act), resulting from amendments to the Act, other legislation, or court decisions; and
whether the claimant's physical, mental, educational, or linguistic limitations (including any lack of facility with the English language) prevented him/her from filing a timely request or from understanding or knowing about the need to file a timely request for appeal.
Good cause for late filing may apply to any person standing in the place of the claimant.
Examples of circumstances where good cause may exist include, but are not limited to, the following situations:
the claimant was seriously ill and was prevented from contacting SSA in person, in writing, or through a friend, relative, or other person;
there was a death or serious illness in the claimant's immediate family;
pertinent records were destroyed or damaged by fire or other accidental cause;
the claimant was actively seeking evidence to support his/her claim, and his/her search, though diligent, was not completed before the time period expired;
the claimant requested additional information concerning SSA's determination within the time limit. (After receiving the information, the claimant has 60 days to request a reconsideration or hearing. He/she has 30 days after receipt of such information to request AC review or file a civil action);
the claimant was furnished confusing, incorrect, or incomplete information or was otherwise misled by a representative of SSA about his/her right to request continued benefits, reconsideration, a hearing, AC review, or to begin a civil action (see GN 00204.008);
the claimant did not understand the requirement to file timely or was not able (mentally or physically) to file timely because the claimant did not receive the requested enrollment or disenrollment forms or other documents in the requested accessible format (e.g. Braille, data CD or audio CD during his or her enrollment period)
a notice of the determination or decision was never received, or was received in an untimely manner (e.g., SSA used an incorrect address or the claimant moved or there were delays in mail delivery abroad);
the claimant transmitted the appeal request to another government agency in good faith within the time limit and the request did not reach SSA until after the time period had expired;
the claimant thought his/her representative had filed the appeal (good cause applies to the claimant despite whether the claimant is still represented or represented by a different person);
unusual or unavoidable circumstances exist, which demonstrate that the claimant could not reasonably be expected to have been aware of the need to file timely, or such circumstances prevented him/her from filing timely. (For example, claimant did not receive requested enrollment or disenrollment forms in accessible format, such as Braille, data CD or audio CD during his or her Initial Enrollment Period (IEP) or General Enrollment Period (GEP).
Develop for good cause as follows:
obtain a signed statement from the claimant explaining the reason for the delay;
develop documentation concerning the delay from FO or FBU records;
explain to the claimant that SSA will decide whether he/she has shown good cause for filing late and SSA may either extend the time or dismiss the appeal;
evaluate evidence on a report of contact; and
make a good cause determination or refer the case to the component responsible for making the good cause determination (see VB 00901.015; VB 02503.000 ff.).