Effective Dates: 06/14/2024 - Present Previous | Next

TN 70 (06-24)

DI 13010.145 Reconsideration or Reopening of Continuing Disability Work Issue Cases - Title II

A. Policy - continuing disability work issue determinations

All continuing disability work issue determinations are considered initial determinations which provide appeal rights and are protected by administrative finality. This includes trial work period service month determinations.

B. Procedure - reconsideration

When a beneficiary makes a timely request for reconsideration (or good cause applies for a late request) of a work issue determination:

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    Obtain a request for reconsideration using form SSA-561-U2 (Request for Reconsideration) or equivalent;

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    Establish the basis for the beneficiary's request for reconsideration;

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    Document the beneficiary’s allegations; and

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    Establish the reconsideration in eWork.

NOTE: 

If the initial determination was done outside of eWork, the reconsideration is an eWork exclusion. See DI 13010.026. for instructions on eWork exclusion cases.

1. Development

If the beneficiary alleges no changes in earnings, work activity or work incentives in their reconsideration request:

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    Verify that the original information regarding work is complete and accurate.

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    If necessary, obtain a supplemental SSA-821-BK (Work Activity Report - Employee) or SSA-820-F4 (Work Activity Report - Self- Employed Person) to document and update the file.

If there are allegations about changes in earnings, work activity or work incentives:

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    Obtain a supplemental SSA-821 and/or 820 to explain the changes; e.g., a reduction or discontinuance of work activity, incorrect or incomplete information about earnings or work incentives.

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    Verify any changes with the employer or others as necessary.

2. Determinations

When all development is complete, perform a thorough review of all evidence from the initial determination as well as any additional evidence received. A different individual than the one who prepared the original determination must perform the review and prepare the reconsideration determination. Process the case to completion using eWork unless an eWork exclusion applies. All necessary forms and notices will be generated through eWork.

a. Affirmations

If the review results in an affirmation of the previous determination:

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    Prepare a rationale with a brief summary of any new evidence submitted.

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    Prepare a reconsideration determination--either SSA-833-U3 (Cessation or Continuance of Disability or Blindness Determinations) or SSA-899-U2 (Continuing Disability Review).

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    Release a notice of affirmation to the beneficiary including appeals language advising the beneficiary of the right to an Administrative Law Judge hearing.

b. Reversals

If the review results in a reversal of the previous determination:

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    Prepare a rationale with a summary of the evidence and an explanation of the revised determination

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    Prepare a revised determination--either SSA-833-U3 or SSA-899-U2.

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    Afford due process if appropriate--see DI 13010.185 for due process requirements on adverse determinations

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    Release a notice of the revised determination to the beneficiary including appeals language advising the beneficiary of the right to an Administrative Law Judge hearing.

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    Effectuate the revised determination and input revised earnings and work determination information to the DCF. Reconsideration reversals are POS direct input exclusions--see DI 13010.025B for processing instructions on direct input exclusions.

NOTE: 

For possible medical issues, see DI 12025.001.

3. Routing

After completion of the work review, fax the documentation into eView or NDRed, per GN 00301.322. Material should be electronically retained and attached to the claims folder, and should include copies of any determinations and notices, the paper SSA-820/821, and any other evidence submitted which may be useful in an appeal, such as SSA-725s and pay stubs.

For determinations made on fully electronic cases, prepare a bar code and fax all documentation into the electronic folder (EF). If the determination is prepared in the FO and further PC action is needed, the FO must do a multi-fax; i.e., fax to both the EF and paperless. (See DI 80830.040 and DI 80830.060)

C. Procedure - Component Responsibilities

1. FO

If the request for reconsideration is received in the field office, follow the steps in DI 13010.145B. and process the request to completion.

If the folder is needed to complete the review, and the current folder location is the CAVE or a Megasite location, request the folder. If the current folder location is a PC processing component, or you are unable to complete processing for any other reason:

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    transfer the reconsideration request in eWork to OCO or the PSC/DPB of jurisdiction.

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    fax the SSA-561 and any other evidence received into the appropriate paperless fax number listed in DOORS. Document the SSA-561 that the reconsideration request has been established in eWork and is also being transferred.

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    If the case is fully electronic, fax the SSA-561 and any other evidence received into both paperless and the EF.

NOTE: 

Situations in which the folder is necessary should be relatively rare as most cases are processed without the folder and all necessary information is recorded within eWork. Referral of reconsideration requests to the PC from the FO should only be made if the paper folder is needed to make the determination and it is physically located in a PC processing component. See DI 13015.100 for information regarding PCACS location codes.

2. PC

If the request for reconsideration is received in the PC, follow the steps in DI 13010.145B. and process the request to completion, unless direct contact is needed and one of the exceptions to direct contact as listed in DI 13010.023 applies. If an exception to direct contact applies:

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    transfer the reconsideration request in eWork to the servicing FO.

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    fax the SSA-561 and any other evidence received to the FO using the fax number listed in DOORS. Document on the SSA-561 that the reconsideration request has been established in eWork and has also been transferred.

D. Policy - Reopenings

If the beneficiary does not request reconsideration during the appeal period, or does not have good cause for late filing of an appeal, and additional information received in the FO or the PC shows that the previous determination may have been incorrect, establish an affirmative action in writing and follow the policies and procedures in GN 04001.000 and DI 27505.000 to determine if a reopening is permitted under the rules of administrative finality.

E. Procedure - Reopenings

The component that receives the information indicating that the previous determination was incorrect has jurisdiction for processing and effectuating the revised determination, subject to the rules in DI 27501.005B.3.

To process a reopening of a previous work issue determination:

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    Establish the reopening in eWork by establishing a work review and making any necessary changes to earnings or work incentive information in the prior review period. When the changes are input, you will be prompted to establish a reopening.

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    Secure the folder, if necessary.

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    Prepare a revised determination--either SSA-833-U3 or SSA-899-U2 or SSA-831. GN 04001.080.

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    Afford due process if appropriate--see DI 13010.185 for due process requirements on adverse determinations, and;

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    Release a notice of the revised determination to the beneficiary including appeals language advising the beneficiary of the right to an Administrative Law Judge hearing.

If additional information is received regarding work activity within one year of onset, follow the guidelines in DI 13010.105 to determine if a reopening of the initial award is necessary.

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0413010145
DI 13010.145 - Reconsideration or Reopening of Continuing Disability Work Issue Cases - Title II - 06/14/2024
Batch run: 06/14/2024
Rev:06/14/2024