Identification Number:
DI 33020 TN 05
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Procedures Following the Hearing Decision
Type:POMS Transmittals
Program:Disability
Link To Reference:
 
PROGRAM OPERATIONS MANUAL SYSTEM
Part 04 - Disability Insurance
Chapter 330 - Disability Hearing Unit Procedures
Subchapter 20 - Procedures Following the Hearing Decision
Transmittal No. 05, 12/2017

Audience

PSC: DEC, RECONR
OCO-ODO: DE, RECONE
OCO-OEIO: CTE, FCR, FDE, RECONE
ODD-DDS: DHU

Originating Component

ODP

Effective Date

Upon Receipt

Background

This transmittal is part of the ongoing process by the Office of Disability Policy (ODP) to update the Program Operations Manuel System (POMS). This transmittal contains procedures following the hearing decision. We did not change policy.

Summary of Changes

We may use these POMS procedures for both the electronic and paper environments. We provide appropriate text for a specific environment. Where appropriate, we rewrote text to follow the guidelines for plain language and to clarify content.

DI 33020.005 Routing Cases After the Disability Hearing

Subsection A - Changed the title from “Procedure – recon cessation” to “Procedure for reconsideration cessation cases”

Subsection B - Changed the title from “Procedure – recon continuance” to “Procedure for reconsideration continuance cases”

DI 33020.015 Death After Cessation Decision by Disability Hearing Unit

We made minor changes based on plain language.


DI 33020.020 Procedure for Trailer Material Received Subsequent to the Release of the Disability Case Folder

We changed the title from “Material Received Subsequent to the Release of the Disability Claims Folder (Trailer Material) –Procedure” to “Procedure for Trailer Material Received Subsequent to the Release of the Disability Case Folder”

DI 33020.025 Reopenings by the Disability Hearing Officer (DHO)

We made minor changes in formatting based on plain language.



DI 33020.030 Informal Remand of Administrative Law Judge (ALJ) Hearing Case

We made some minor changes based on plain language.




DI 33020.005 Routing Cases After the Disability Hearing

A. Procedure for reconsideration cessation cases

1. Completing and routing non-sample cases

  1. Complete, sign, and date the SSA-832 and SSA-833. Refer to Disability Hearing Officer (DHO) signature requirements in DI 28084.050. Do not complete blocks 26–28, 30, 30A, and 32. Sign blocks 25 and 31.

    Complete an SSA-831 when applicable, e.g., reconsideration of adverse revision of initial decisions and escalated claims. For instructions to complete the form, see DI 27015.001 and DI 27530.000. However, do not complete blocks 30 through 32B. Sign the form in block 37, and leave the SSA code block blank.

  2. Check the “Recon DHU” (Disability Hearings Unit) block on the pertinent forms.

  3. Upload the SSA-831, SSA-832, and SSA-833 to the certified electronic folder (CEF).

    Image the SSA-832 and SSA-833 in Section A, Payment Documents/Decisions. Image the SSA-1207 Disability Hearing Decision in Section B, Jurisdiction Documents and Notices.

  4. For paper cases, place the case folder copy and field office (FO) copy of the SSA-831, SSA-832, or SSA-833 on the top of the left side of the folder.

    A paper folder for concurrent Title II/Title XVI cases may have both a paper modular disability folder (MDF) and a brown folder that contains the Title XVI non-medical material (see DI 70005.005A.2). Place the decision form(s) on top of Section A (front yellow) of the folder. File the original hearing decision and the case folder copy of the cover notice of decision in Section B (red). Also, place a copy of the decision form(s) on top of the left side of the brown folder and a copy of the hearing decision and case folder copy of the cover notice of decision on top of the right side of the brown folder.

  5. Retain the State Agency copy of the decision form, and send the Vocational Rehabilitation (VR) copy to the servicing VR agency, if applicable.

  6. For paper cases, file the original hearing decision and the case folder copy of the notice of decision under the envelope on the top of the right side of the case folder.

  7. Forward the original notice and a copy of the DHO's decision to the individual, and a copy of the notice and decision to the individual’s representative, if any. For mailing instructions follow NL 00603.105B.2.

  8. Perform required systems inputs. (If using the NDDSS, for specific systems instructions see SM 06001.001. Otherwise, see SM 05901.000.)

  9. Route the case folder to the FO under cover of a properly completed SSA-2640 (DIB Hearing Case) unless the conditions noted in Section A apply. For an exhibit of Form SSA-2640, see DI 33095.135.

2. Quality Review (QR) sample cases

  1. Process the SSA-831, SSA-832, or SSA-833 as in Section A items a. through e. Leave all paper copies in the paper case folder.

    (The reviewing component, Disability Quality Branch (DQB), returns the DHU copy upon completion of the review.)

  2. For the paper folder, make copies of the SSA-831, SSA-832, or SSA- 833 for the DHU's records. Enter “Quality Review Sample Case” in the Remarks section.

  3. Place the individual’s (and representative's) copy of the hearing decision and decision notice, the envelope(s) for mailing the notice and decision to the individual (and representative), and a properly completed SSA-2640, in the paper case folder. Make sure the decision and notice are clean without evidence of mutilation (e.g., punched, stapled, or otherwise mutilated).

  4. Route the paper case folder to the reviewing component under cover of an SSA-408 (Route Slip). Annotate the form with “Medical Cessation - QR Action Required.” Indicate if the case is Title II, XVI, or concurrent. Staple Form SSA-3031 (Disability Hearing Quality Review Sample Case) under the SSA-408.

  5. If the official folder is a CEF, do not send paper copies of the hearing decision and decision notice to the reviewing component. The reviewing component will release notices if there are no deficiencies.

  6. In CEFs, the SSA-832 and SSA-833 are accessible in Section A. Do not send a paper copy to the reviewing component.

  7. If the official folder is a CEF, the system selects a sampling of DHO’s continuance or cessation decisions for part of the reviewing component’s download. We do not need paper flags or documents. The reviewing component corrects any deficiencies and then releases the decision.

  8. Update the case control system showing folder movement to the reviewing component.

3. Exceptions to reconsideration cessation routing

a. Special review cases

Special review cases include individuals with 301 involvement and Title II individuals who are age 54 or older with a revised cessation date.

NOTE: This procedure does not apply to foreign cases or to cases with railroad involvement.

  • Process the SSA-832 and SSA-833 hearing decision, and notice as in Section A. However, do not input decisions for 301 cases. For paper folders with 301 involvement, place the SSA-832 and SSA-833 in the case folder for processing by the program center (PC). For additional information on 301 cases, see DI 33025.025.

  • Route the Title II case folder via a properly completed SSA-2640 to the Office of Earnings and International Operations (OEIO) , or to the program center (PC) in these situations:

    1. if age 54 or older, and the cessation date has been revised, or

    2. if there is 301 VR involvement.

b. Foreign claims

Follow Section A, but route non-QR cases to the Social Security Administration, Office of Earnings and International Operations, P.O. Box 17769, Baltimore, MD 21203, Attn: Reconsideration Branch.

c. Concurrent disability insurance benefits and disabled widow (‘ers), including surviving divorced spouse benefits (DIB/DWB) cases

Follow Section A and route the case folders to the FO if the decision is the same on both cases. Route to the appropriate PC if the decisions are different, e.g., DIB continued, DWB ceased.

NOTE: Handle OQR cases as in Section A whether or not the decisions are the same on the two cases.

d. Drug Addiction and Alcoholism (DA/A) cases

Follow Section A, but remove any DA/A Routing Flag before releasing the case folder to the FO.

e. Railroad cases

Follow Section A, but route non-QR cases to the Great Lakes Program Service Center (GLPSC), Disability Review Section (DRS), P.O. Box 8470-A, Chicago, IL 60680.

B. Procedure for reconsideration continuance cases

1. Completing and routing non-sample cases

  1. Complete, sign, and date the SSA-831, SSA-832, and SSA-833. See Section A for instructions to separate and distribute the copies.

  2. For electronic cases, upload the SSA-831, SSA-832, and SSA-833 to the CEF.

  3. Follow Section A for filing and releasing the DHO's decision and notice of decision.

  4. Perform required systems inputs; see references in Section A.1.h. for instructions.

  5. For CEFs, route all final decisions, both favorable and unfavorable, to the FO. If necessary, the FO will forward the CEF to the program center (PC). For more information on DDS Responsibilities for eCDR Reconsideration Appeals, see DI 81020.255B.

  6. For a paper folder, route the Title II case folder and the Title II portion of a concurrent Title II/Title XVI to the appropriate PC. Send the Title II folder under cover of a properly completed SSA-2640. For an exhibit of this form, see DI 33095.135. Annotate the Remarks section of the SSA-2640 to show any action required, e.g., to update the Master Beneficiary Record (MBR) with diary information, to reinstate benefits, or to return the folder to files.

  7. Route Title XVI only paper cases to the servicing FO. Annotate the SSA-2640 to show any FO required action.

  8. If the DHU has a separate Title XVI paper folder, route the Title XVI case in concurrent Title II/XVI cases (if DHU has it) to the servicing FO. Send under cover of a properly completed SSA-2640. If the Title XVI folder is not in the DHU, route only the SSA-832 to the FO. Add to the SSA-2640 “FO Action Necessary.” Also, include a copy of the SSA-833 and annotate the SSA-2640 to show that we forwarded the SSA-833 for informational purposes.

2. Quality Review sample cases

  1. Process the SSA-831, SSA-833, or SSA-832 as in SectionA.1, items a through e. Leave all paper copies in the case folder. The reviewing component will return the DHU copy upon completion of the review.

  2. For paper cases, make a copy of the SSA-831, SSA-832, and SSA- 833 for DHU records and enter “Quality Review Sample Case” in the Remarks section of the form. For paper cases, place the individual’s (and representative’s) copy of the hearing decision, decision notice, the envelope(s) for mailing the notice and decision to the individual (and representative), and a properly completed SSA-2640 in the case folder. Make sure the decision and notice have not been punched, stapled, or otherwise mutilated.

  3. Route the paper case folder to the reviewing component via an SSA-408 annotated, “Recon Medical Continuance - QR Action Required”. On the SSA-408 show if the case is Title II, Title XVI, or concurrent. Be sure to staple an SSA-3031 (Disability Hearing Quality Review Sample Case) under the SSA-408.

  4. If the official folder is a CEF, the system automatically selects a sampling of DHO’s continuances or cessations for part of the review of the component’s download. The reviewing component does not need paper copies of the decision and notice. If there are deficiencies, the reviewing component will make corrections and then release the notices after review.

  5. In CEFs, the SSA-832 and SSA-833 will be accessible in Section A. The reviewing component does not need a paper copy.

  6. Update the case control system showing folder movement only to the reviewing component.

3. Exceptions to reconsideration continuance routing

a. Concurrent DIB/DWB claims

  • Prepare the forms and notices as in Section A.1.

  • Route cases to the program center (PC) with jurisdiction.

b. Medicare for Qualified Government Employment (MQGE) cases

Follow Section A.2. Include “MQGE Recon Case” in the Remarks section of the SSA-833.

c. Railroad cases

Follow Section A and forward the case folder to Great Lakes Process Service Center – Disability Review Section (GLPSC-DRS), P.O. Box 87755, Chicago, IL 60680-8115.

d. DA/A cases

  • Show in the Remarks section of the SSA-832 “DA/A Case” if DA/A is material to the hearing decision. Otherwise, except as noted in this section, process the case as in Section A.

  • During the reconsideration process, copy any received material that would be helpful to a treatment referral agency. Fasten the copies to the inside back cover of the paper case folder.

  • Route the case folder to the FO via a properly completed SSA-2640. Check “DA/A no longer involved in disability”. Remove DA/A indicator” block of the SSA-2640 if we determine that the individual is disabled independent of DA/A. This action is necessary because if an individual is disabled independent of DA/A, he or she is no longer subject to the representative payee and treatment requirements. Also, he or she is not subject to an automatic 12-month diary.

  • See detailed information regarding DA/A in DI 90070.000.

e. Foreign cases

  • Route non-QR cases to the Office of Earnings and International Operations (OEIO) after completing the actions in B.1.

  • Forward the case folder via a properly completed SSA-2640 to the address shown in Section A.3.b.

NOTE: For CEFs, route all final decisions, both favorable and unfavorable, to the FO. If necessary, the FO will forward the CEF to the program center (PC). For more information see DI 81020.255B.

DI 33020.015 Death After Cessation Decision by Disability Hearing Unit

A. Policy for death after cessation

1. General procedures for re-review

When an individual dies within one year of cessation of disability, the disability hearing unit (DHU) will review its decision provided survivors would benefit by a favorable reopening of the prior cessation decision.

Any possible reopening is subject to the rules of reopening (see DI 33020.025).

2. Responsibility for review

The disability hearing officer (DHO) assumes jurisdiction over any possible reopening and future disability decision. However, if an administrative law judge (ALJ) made a subsequent medical cessation decision on the case, the Office of Hearing Operations (OHO) decides whether to reopen its decision.

B. Procedure for consideration to reopen

Review any evidence received at the time of the notification of the individual’s death.

If the DHU does not have a copy of the death certificate, have the FO secure a copy of it, prior to requesting DDS development.

For additional information and consideration of DDS actions when DDS receives notice of death, follow DI 23510.010.

DI 33020.020 Procedure for Trailer Material Received Subsequent to the Release of the Disability Case Folder

Follow the instructions

  • DI 22520.001 Disposition of Trailer Mail

  • DI 28030.04 Disposition of Trailer Mail

Read “DDS” to mean “DHU” and “examiner” to mean “DHO”.

DI 33020.025 Reopenings by the Disability Hearing Officer (DHO)

A. Reference for reopening

For rules for reopening for initial and reconsideration cases see chapter DI 27500.000. For instructions related to CDR reopenings, see 28500.000.

B. General Procedures for reopening

1. Basis change

When a disability hearing officer (DHO) proposes to reopen an unfavorable reconsidered decision only to change the basis for the cessation, offer the individual a disability hearing before we issue the final decision.

2. Conflicting decisions

For information on conflicting decisions see DI 33020.025C.2. in this subsection and DI 27520.030.

3. Due process

For information on due process for adverse reopening, see DI 27525.001.

In a fully favorable revision, we do not require advance due process since we are not depriving the individual of any property interest.

In a partially favorable revision that is more favorable than the prior DHO decision, we do not require advance due process since the present decision is more favorable to the individual’s interest see DI 28501.005A.

a. Requirements

  • Send a pre-decision notice to the individual explaining the evidence and the reasoning for the proposed adverse reopening.

  • The notice must include the right to submit additional evidence or arguments. Also, it must include the right to request a disability hearing before we make a formal adverse decision.

b. Pre-decision notice content

Send a notice containing the following elements to the individual and his or her representative prior to taking an adverse action:

  1. Indicate that we are planning to reopen our previous decision. Also, indicate the reason for doing so (e.g., we received new evidence; we made an error).

  2. The date of the proposed cessation.

  3. A list and dates of all medical reports we used to make the preliminary judgment to revise. If we undertook development but did not receive all reports, we will provide a disclaimer statement that:

    We attempted to obtain the reports but were unable to do so, and

    We must make the decision based on the available evidence.

  4. An explanation of why the evidence indicates that the individual is not disabled or blind. This information is similar to the information in a personalized decision notice (PDN).

  5. An explanation that the individual may request a disability hearing and present any evidence or arguments in support of his or her belief that he or she is disabled. The individual must request this action within 10 days from receipt of the notice. The individual must complete the Form SSA-765 (Response to Notice of Revised Decision), and return it to the Disability Hearing Unit (DHU). Attach an SSA-765 to the notice so the individual can respond. We will make a formal decision if the individual fails to respond within 10 days.

  6. An explanation of the effect of a formal adverse decision (i.e., benefits continue for two months after the cessation date).

  7. An explanation of the right to have a disability hearing, including the right to representation, to bring witnesses and evidence. We will send notification of the date, place, and time of the hearing by mail.

For additional instructions related to the due process notice, see DI 33020.025C in this section.

c. Auxiliary notice

Send all auxiliaries an advance notice of a proposed adverse action.

For model notice language, see DI 27525.005

C. Procedures for various issues

1. Reconsideration decision cannot be reopened and revised

Follow instructions, Reopening and revising a determination or decision in DI 27501.005.

2. Conflicting decisions

a. General instructions to correct conflicting decisions

Offer due process as shown in this subsection before revising a favorable decision to correct conflicting decisions.

b. DHO issued an unfavorable decision; administrative law judge (ALJ) or the Appeals Council (AC) issued a favorable decision

  • Reopen and revise the prior DHO decision to conform to the ALJ's or AC's decision, or

  • Forward the case to the Office of Disability Operations (ODO) in central office to determine if there is a basis for reopening an ALJ's or AC's decision, e.g., material evidence is in the current case folder that was not available to the ALJ or AC, or error on the face of the evidence exists.

  • Prepare a revised decision if the Office of Hearings Operations (OHO) responds by stating that we will not reopen the ALJ's or AC's decision.

c. DHO issued a favorable decision ALJ or AC issued an unfavorable decision

Forward the case to OHO’s central office to resolve the conflict. This action is necessary considering that DHO cannot reopen an ALJ's or AC's decision and that we must give the individual an opportunity for a hearing before revising a favorable decision to an unfavorable one.

3. After due process notice released

  1. Diary the case for 15 days (10 days plus 5 days mail time).

  2. Add the case to the hearing schedule upon receipt of the individual’s response to the notice or upon expiration of the diary, whichever is earlier.

  3. Review all responses received from the individual to make sure that we have the information we need to provide notification of a hearing.

4. Due process notice returned

(i.e., whereabouts unknown)

  1. Attempt to contact the individual, including all auxiliary individuals, at their last known telephone number.

  2. Issue a due process notice if we obtain an address. Otherwise, request the FO to try to locate the individual's whereabouts. Advise the FO of any leads in the case folder which may aid in locating the individual.

  3. Add the case to the hearing schedule if we cannot locate the individual. When we schedule a hearing for the case, process it as a “waiver of appearance” case.

5. Allegations of improper or no due process notice

Follow instructions, Reinstating benefits when a beneficiary alleges improper or no due process in DI 27525.020.

6. Allegation of no final cessation or termination notice

  1. Review the case folder to ensure that the advance due process notice complies with existing instructions.

  2. Take corrective action if any deficiency exists concerning the due process notice see DI 27525.020.

  3. Determine if we sent a proper cessation notice. If we did not send a proper cessation notice, reinstate benefits as in DI 27525.020, and take appropriate corrective action.

  4. Send a letter to the individual and or representative explaining the situation, giving the date of the notice, etc. Send this letter regardless of whether we sent a cessation notice.

DI 33020.030 Informal Remand of Administrative Law Judge (ALJ) Hearing Case

A. Policy for informal remands

See instructions, Disability Determination Services (DDS) action upon receipt of informal remand (IR) cases in DI 27520.005.

B. Procedure for referring a case to the disability hearing unit (DHU)

1. When the disability hearing unit (DHU) receives a case

When the disability-hearing unit (DHU) receives an informal remand case from an ALJ, refer it to a disability-hearing officer (DHO) who had no prior involveme