Identification Number:
DI 29001 TN 1
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:General
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 290 – Reconsideration of Continuing Disability Review (CDR) Cases, and Reopenings Applicable to Disability Hearings (Pre-DHU Processing)
Subchapter 01 – General
Transmittal No. 1, 09/23/2019

Audience

PSC: DE, DEC, RECONR, SCPS;
OCO-OEIO: CR, ERE, FDE, RECONE;
OCO-ODO: DE, DEC, DS, PETE, PETL, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure. Updated title for links in Reference subsections to be consistent with recent POMS revisions of DI 33010.001.

Summary of Changes

DI 29001.005 The Scope of the Disability Hearing

Updated title for reference in subsection B from Receipt and General Review of Claims Folder in the Disability Hearing Unit (DHU) to General Review of Claims Folder and Preparation of In-House Folder in the Disability Hearing Unit (DHU).

 

DI 29001.010 Overview of Component Responsibilities Related to Medical Continuing Disability (CDR) Disability Hearings

Updated title for reference in subsection B from Receipt and General Review of Claims Folder in the Disability Hearing Unit (DHU) to General Review of Claims Folder and Preparation of In-House Folder in the Disability Hearing Unit (DHU)

DI 29001.005 The Scope of the Disability Hearing

A. Policy on disability hearings

1. Issue addressed at the disability hearing

The disability hearing addresses only the issue of disability based on medical factors which is under appeal to the reconsideration level of review (or which is the subject of a proposed adverse reopening and revision).

2. When a disability hearing does not apply

The disability hearing does not apply:

  • in making an initial determination on a new application (including closed period cases) unless it is forwarded for association with a prior claim which is subject to the disability hearing process;

  • in a reconsideration of an initial determination on a new application (including partially favorable determinations, e.g., closed periods and later onsets); or

  • to non-medical issues (substantial gainful activity (SGA), overpayment of benefits, amount of income and resources (Title XVI)), or to reconsiderations of continuing disability review (CDR) cessations based on “whereabouts unknown”.

3. Who conducts the disability hearing

Disability hearings are conducted by a:

  • State or Federal disability hearing officer (DHO) if a State made the determination under appeal; or

  • Federal DHO if a Federal adjudicator made the determination under appeal.

B. References

  • DI 12026.020 Field Office (FO) Responsibilities When Claimant Wants to Request a Reconsideration - Disability Hearing

  • DI 29005.022 New Application and Request for Reconsideration - Disability Cessation

  • DI 33001.001 The Disability Hearing Process - Title II and Title XVI

  • DI 33010.001 General Review of Claims Folder and Preparation of In-House Folder in the Disability Hearing Unit (DHU)

DI 29001.010 Overview of Component Responsibilities Related to Medical Continuing Disability (CDR) Disability Hearings

A. Component responsibilities

The following chart describes the responsibilities of various components in the disability hearing process at the reconsideration level:

Component

Responsibilities

Field Office (FO)

 

  • Assists individuals with filing a Form SSA-789-U4 (Request for Reconsideration - Disability Cessation Right to Appear), and obtains all necessary supporting forms. For more information on these forms, see DI 12026.020B;

  • Sends these documents with the folder to the disability determination services (DDS), or the component responsible for developing non-State cases;

  • Serves as remote hearing site in order to provide accessible disability hearings to individuals who do not live within a reasonable distance of a DHU; and

  • Effectuates favorable reconsidered decisions.

Disability Determination Services (DDS)

  • Assigns the case to a pre-hearing examiner, who fully develops the case and reviews it for completeness with respect to each relevant issue;

  • Issues fully favorable reconsideration CDR determination if evidence warrants; and

  • Prepares folder for disability hearing and routes it to the DHU when unable to make a fully favorable determination.

Disability Hearing Unit (DHU)/ Disability Hearing Officer (DHO)

 

  • Schedules and holds hearing unless individual waived his or her right to appear. (If an individual waives the right to appear at a hearing or fails to appear, the DHO issues a decision based on the evidence in file, including any additional evidence submitted.)

    NOTE: If an individual fails to appear, the DHO must follow appropriate policy, which may require rescheduling the hearing (mental impairment involved, or good cause for not appearing).

  • Completes the appropriate disability determination and transmittal form SSA-831-U3, SSA-832, or SSA-833 ;

  • Issues a decision via a notice of reconsideration which provides administrative law judge (ALJ) appeal rights and, when appropriate, rights to statutory benefit continuation.

Review Components

 

  • Reviews the DDS' fully favorable reconsideration determinations. (Such determinations are subject to quality assurance review and, in Title II cases, to pre-effectuation review.); and

  • Returns case to the DDS for corrective action if the review indicates that the evidence does not warrant a fully favorable determination.

    NOTE: When the review component returns a case to the DDS, the DDS completes any necessary additional development and either prepares a revised (fully favorable) determination and returns the case to the review component, or prepares the folder for a disability hearing and forwards it to the DHU.

Great Lakes Program Service Center (GLPSC)

 

 

  • Processes career railroad and dependent annuitant cases;

  • Handles Request for Reconsideration-Disability Cessation in a manner similar to DDS procedure;

  • Forwards case to the DHO in the appropriate regional office (RO) if a hearing is necessary;

  • Effectuates determinations rendered by GLPSC or a DHO in coordination with the Railroad Retirement Board; and

  • Routes folder(s) to proper component for maintenance.

Office of Earnings and International Operations (OEIO)

 

  • Processes foreign claims in a manner similar to that described for the DDS;

  • The International Disability Unit (IDU) has its own DHO. Assist is sometimes requested from the Regional Office when the IDU DHO has had previous involvement in a particular claim (e.g., quality review); and

  • Effectuates reconsidered decisions issued in the OEIO.

B. References

  • DI 12026.020 Field Office (FO) Responsibilities When Claimant Wants to Request a Reconsideration–Disability Hearing

  • DI 12095.171 SSA-795 Election Statement - Exhibits

  • DI 29005.020 GLPSC - Career Railroad and Railroad Annuitant Cases

  • DI 33010.001 General Review of Claims Folder and Preparation of In-House Folder in the Disability Hearing Unit (DHU)

  • DI 43501.001 Processing Responsibilities for Foreign Claims


DI 29001 TN 1 - General - 9/23/2019