PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 270 – Reconsideration Case ProcessingSubchapter 10 – Special Reconsideration IssuesTransmittal No. 2, 04/19/2021
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.
Summary of Changes
DI 27010.001 Appeal Filing Issues
Subsection D - We corrected the referenced descriptions.
A claimant who requests a reconsideration after the 60-day time period has expired may ask for an extension of the time period to request reconsideration. The claimant must:
Request an extension of the time period in writing; and
Provide the reasons why the reconsideration request was not filed timely.
The time period may be extended if the claimant shows us that he or she had good cause for missing the deadline to request reconsideration. The field office (FO) is responsible for developing, making, and documenting the file with a “good cause” determination.
The Disability Determination Services (DDS) will:
Review the file to ensure that the FO has documented that good cause has or has not been established;
Return the case to the FO for action shown in DI 12005.015, if documentation regarding a good cause determination is missing;
Process as a timely reconsideration request if good cause was established.
GN 03101.020—Good Cause for Extending Time Limit
The FO will secure a new application when appropriate, e.g., when insured status continued past the date of the last determination, and enter the remarks, “Late –Filed Reconsideration – Good Cause Not Met – New Application for Processing and Reopening Consideration” on the EDCS 3367 or the paper SSA-3367.
If good cause is not established and a new application is filed, the DDS will:
Review the evidence of record to determine if a reopening and revision of the initial determination is warranted under the rules of administrative finality;
Process per the instructions in DI 27501.001—Reopening and Revising a Determination or Decision, if a reopening is warranted;
Process new application(s) per initial claims procedures in DI 22000.000—Sequential Evaluation, if a reopening is not warranted.
The DDS reviews the claim(s) for possible reopening of the initial determination. For further instructions see, DI 27505.001—Conditions for Reopening a Final Determination or Decision.
The FO processes the claim according to the procedures in DI 81010.150E —Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS) Electronic Reconsideration Cases. DDS should attempt to obtain the SSA-3441 following DI 23007.005 Contacting the Claimant, Applicant, Appointed Representative, or Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence and DI 22505.014 Requesting Evidence or Action from the Claimant or Third Party.