Review component reopening situations may arise:
At the time of quality review; or
After a Request for Program Consultation (RPC) resolution does not affirm the review
component’s Group 2 deficiency.
When the eView reopening and reactivation requirements are met, as outlined in GN 04440.111B, those with the appropriate security profile in the review component will utilize
the eView “Reopen Prior Claim,” or “Reactivate,” functionality, as appropriate.
For more information on reopenings, see DI 27501.005 (Reopening and Revising a Determination or Decision); and DI 27505.001 (Conditions for Reopening a Final Determination or Decision).
When the review component user selects “Reopen Prior Claim,” eView will display the
prior filings that are available for reopening. eView will not display intervening
CEFs, which have been made by the FO, an administrative law judge, the Appeals Council,
or a Federal Court, or any CEF determinations prior to these intervening CEFs, as
they are not available for eView reopening. Return to the adjudicating component when
electronic reopening is not possible. See in DI 27510.005A, and DI 27510.005C2b regarding limited reopening authority.
The review component does not electronically reopen and revise prior CEF determinations
or cancel an erroneous adjudicating component’s reopening when also citing:
A group II deficiency with another necessary adjudicating component corrective action.
In these instances the review component will return these CEF cases to the adjudicating
component for the corrective action.
2. Inadvertently Effectuated CEF
The review component will not reopen and revise an inadvertently effectuated CEF determination
that has a group I deficiency. Return to the adjudicating component for their appropriate
action. For reviewing cases that are inadvertently effectuated, see GN 04440.250.
The FO inadvertently effectuates an adjudicating component’s denial determination;
however, the review component reviews the sample case post-effectuation and decides
there is a group I decisional deficiency because the case should be allowed. The review
component prepares an SSA-1774-U5 (Request for Corrective Action) and returns the
case to the adjudicating component to reopen and revise it to an allowance.
The FO inadvertently effectuates an adjudicating component’s allowance determination;
however, the review component reviews the sample claim post-effectuation and decides
that the determination should be a denial. The review component prepares an SSA-1774-U5
and returns the case to the adjudicating component for the appropriate action, including
application of the medical improvement review standard.
Return to the adjudicating component regardless of whether the adjudicating component’s
case processing system has the functionality to keep the folder electronic. The adjudicating
component is responsible for converting a current pending CEF to paper, if applicable.