The ultimate responsibility for resolving earnings issues or discrepancies is with the reconsideration reviewer in the Office of Central Records Operations (OCRO). However, the resolution of earnings discrepancies in cases being processed at the reconsideration level is the responsibility of the RECONR of the Reconsideration (Recon) Staff. Therefore, if an earnings issue is the subject of the request for reconsideration, whether or not insured status is affected, resolution of the issue is always the responsibility of the RECONR.

There are exceptions to this general rule, particularly where a favorable decision has been reached and payment of benefits must be expedited. Use the guides below to process cases where a favorable decision has been (will be) made by the Recon Staff which will result in the payment of benefits, and an earnings discrepancy exists. This includes discrepancies in lag and pre-lag periods, as well as cases containing a DO prepared SSA-7000-U5 or SSA-7010-U5 which has not been signed on the right.

If the file contains evidence to resolve the discrepancy, process the SSA-831-U5 and route the case to RECONR in the Recon Staff for resolution of the discrepancy.

If the file does not contain evidence to resolve the discrepancy and/or if doubt exists or it is not possible to determine if resolution of the discrepancy will result in the claimant meeting the earnings test, route the case to RECONR for resolution before processing the SSA-831-U5.

If there is an earnings discrepancy but it is not material to insured status; i.e., the earnings test is met at onset, process the SSA-831-U5 and route the case to the module Claims Specialist (CS), calling attention to the discrepancy.

If insured status is met, based partly on SSA-7011s or SSA-1002s which establish earnings which were lag when the earnings record was certified and no other discrepancy material to insured status exists, process the SSA-831-U5 and route the case to a CS.

The CS will usually resolve these discrepancies and process the claims to payment. When immediate resolution is not feasible, the CA will have the case returned after payment for post-adjudicatve resolution.

After a case folder has been sent by the Recon Staff to a DO, DDS, an ALJ or the AC, any correspondence, additional evidence, etc., that is received will be forwarded to the appropriate receipts point if the SSN is identified. Before referring this material, the module will have obtained an MBR printout to obtain exact location of the file.

Module personnel will examine the material to determine what requires referral to Reconsideration Staff and what will remain for processing or other transfer. Material received for processing by the module will be handled as described in the following sections.

OS 15010.000 exhibits the following forms applicable to reconsideration and appeal:

In addition to the above forms applicable to reconsideration and appeal, the following 3 exhibits refer to forms and notice letters used in the processing of reconsideration and appeal cases.

1. Exhibit 1, SSA-L844 Social Security Notice of Reconsideration

This form letter is used in conjunction with SSA-1227 (Reconsideration Determination) to inform the claimant that the original decision was correct and in accordance with the law and regulations.

Exhibit 1, SSA-L844 - Notice of Reconsideration

 

2. Exhibit 2 SSA-1227 Reconsideration Determination

This form is used in a non-disability issue case to notify a claimant who filed for reconsideration that the claim was disallowed because the person did not meet a non-medical requirement. It also notifies the claimant that because the non-medical requirement is not satisfied, a determination as to disability has not been rendered. A detailed statement as to claimant earnings, employer, period earned and social security credits may be included in the letter.

Exhibit 2 - SSA-1227 Reconsideration Determination (Use for Non-Medical Disability Cases)

There will be times when in processing a reconsideration request the prior determination will be affirmed and an onset established with a future month of entitlement. In this event, the claimant will receive both a notice and reconsideration determination which explains the affirmation and a conditional award which advises that he or her has been found disabled, gives the date when he or he may expect his or her first check and advises that he or she should let us know about any changes in his or her condition or work status. See instructions below for processing these cases.

There will also be situations in which a request for reconsideration will be received prior to the first month of entitlement in a case in which the prior determination was a future allowance. Onset with future month of entitlement established on reconsideration will be processed as described below.

1. 1. 

   If the prior determination is affirmed and at the same time an onset date is established which results in a future month of entitlement, enter in item 28 of the SSA-831-U5 the date the period of disability began. Also prepare a notice of reconsideration determination in the usual way. In that notice, just before the hearing paragraph, include the following: “However, the evidence shows that you have been disabled since (date). You will soon receive an award notice stating that you will become entitled to disability insurance benefits when your disability has existed for five full calendar months. If your condition improves or there is a change in your work status, you must notify us immediately.”

2. 2. 

   After releasing the notice of reconsideration determination, forward the file by SSA-559 for preparation of the award indicating thereon that the hearing paragraph (140) should be included on the SSA-L30 in place of the reconsideration paragraph. Subsequent processing is essentially the same as in initial cases.

ODO has jurisdiction over all requests for reconsideration of DIB-DWB claims under age 59. All DIB-DWB claims age 59 or older are the jurisdiction of DRS. If either of the claims (or both) require DDS action, the DO will send both to the DDS who will return them, after their action, to ODO or DRS. If the issue on either claim is non-disability, refer it for reconsideration of the non-disability issue and preparation of language for inclusion in the notice to be sent by the disability examiner. (If both claims are concerned only with non-disability issues, special attention will be necessary to process both cases including preparation of the notice.) The RECONE/ODO DEC/DRS should complete action on the case and take action as follows:

1. 1. 

   Denial of Both Claims - Send a combined denial notice and return both folders to files.

2. 2. 

   DIB allowed—DWB denied—Prepare DWB denial language on SSA-865 for inclusion with the hearing paragraph (140) on the SSA-L30 award notice. Refer the case to the CS for further processing.

3. 3. 

   DWB allowed—DIB denied—Prepare DIB denial language on SSA-865 for inclusion with SSA-30 award notice. Send the DWB folder by SSA-559 to the servicing PSC and request inclusion of the DIB denial language and the hearing paragraph. Return the DIB folder to files.

4. 4. 

   Both DIB-DWB Claims Allowed—Refer both folders to the CS and ask them to process the DIB claim to payment and to send the DWB claim folder to the servicing PSC after enclosing a photocopy of the SSA-101-U3 (Determination of Award) on the DIB claim in the DWB folder.

Occasionally a claimant who has not received notice of initial determination will file a request for reconsideration. This may occur if he or she feels strongly that an adverse initial determination will be made, and he or she wishes to appeal the determination immediately. Under the regulations, a claimant does not have a right to request reconsideration in advance of the initial determination. However, any request for reconsideration filed under these conditions will be accepted and forwarded to the appropriate office for processing. The adjudicators in the processing offices will dismiss such requests on the basis that an initial determination has not been made in accordance with GN 03102.200. Also, since the claimant still retains the right to reconsideration, notify him of this right when the dismissal notice is prepared. Include in this notice, language similar to the following.

“We have dismissed your request for reconsideration dated                because an initial determination has not been made in your case. The Social Security Regulations provide the right to reconsideration only after an initial determination has been made. Also, there is no authority in the Social Security Act or implementing regulations which permits us to combine the initial and reconsideration determinations.

“You still have the right to reconsideration once we process the initial determination. You will be advised of this right in the initial determination notice.”

“If you have any questions about your claim, get in touch with any Social Security office. Most questions can be handled by mail or telephone. However, if you visit the office, please take this notice with you.”

(See GN 03101.070 for Medicare and SI 04020.030 for SSI).

ODO or DRS will send the hearing file copy of the SSA-3583-U2 to OHO without the claims folder but with the certification below if (1) no reconsideration has been requested, or (2) a reconsideration is in process but a determination has not been made (see exception below), or (3) a reconsideration request was not timely filed and was dismissed.

If a reconsideration determination can be made within 3 days of the time the HA-501-U5 is received in the Reconsideration Branch and such determination will be unfavorable, process the determination but substitute the following for the regular hearing paragraph;

“Since you have requested a hearing, we are referring your request to the administrative law judge for his or her action on your request.”

The claims file will then be prepared as indicated in GN 03103.120 and forwarded to the DO for transmittal to the ALJ. If a favorable reconsideration determination will be made, or an unfavorable decision will not be made in 3 days, do not delay processing the SSA-3583-U2 but forward immediately without the claims file to the ALJ. This will permit the claimant to decide whether he or she again wishes to request a hearing after the ALJ’s dismissal of the premature hearing request, and the favorable reconsideration determination has been received.

In those cases in which the SSA-3583-U2 is forwarded without the claims file to the ALJ, enter the following certification under “Remarks.”

“The undersigned, an employee of the Social Security Administration, Department of Health and Human Services, certifies that on   (date)   , notice was mailed to   (name of appellant)   that it was determined   (issue)   and he or she was advised of his or her right to request a reconsideration if he or she disagreed with the findings. On   (date)  , (Ms.) (Mr.)   (name of appellant)   requested a hearing with respect to the above determination. The undersigned further certifies that the appellant (has a request for reconsideration pending on which no determination has been made) (has not requested reconsideration of the initial determination) (did not timely request a reconsideration of the determination).”

The SSA-3583-U2 will be completed in all other respects as indicated in GN 03103.110. The control copy of the completed form should be forwarded to the DO so that they may cancel any controls they have established for securing the claims folder.

If the request for hearing is not accompanied by the required RC explaining why the claimant insisted upon filing for a hearing before having a reconsideration, the RECONR, RECONE (ODO) or DEC (DRS) will, when it forwards the certification to the ALJ, request the DO to contact the claimant to explain the necessity for reconsideration and a reconsidered determination before a right to hearing arises. The DO will assist the claimant in requesting a reconsideration if he or she so desires and he or she has not previously done so. The DO will submit the RC called for above to document the file. (See GN 03103.1205 for development where a letter requesting a hearing or an HA-501-U5 is received in the PC.)

If the ALJ dismisses the hearing request, he or she will advise the claimant that he or she has no jurisdiction to hold a hearing since the initial determination has not been reconsidered by SSA.

The PC would not take any final related action pending the ALJ action on the hearing request. Upon receipt of notice of the ALJ action, the PC may proceed to complete any pending action and/or consider any additional evidence or information submitted. In a dual determination situation, where SSA makes a revised initial determination and an initial determination on the same case, the ALJ will not dismiss the case merely because the initial determination has not been reconsidered; i.e., he or she will not dismiss the case since a hearing is proper with respect to the revised initial determination. See GN 04040.001. Therefore, if the PC cannot reconsider the initial determination within the time limit specified above, the entire claims file should be forwarded to the ALJ. An example of this situation usually occurs when an initial determination of entitlement is revised and thereby creates an overpayment. The claimant receives a notice telling him or her that his initial entitlement determination is now revised and he or she is at the same time given an initial determination as to the overpayment.

Where good cause for late filing is not established, the RECONE(ODO) or DEC (DRS) should still examine the case to verify the correctness of the prior action. Bear in mind that although the period for requesting reconsideration has expired, we may be able to revise the initial determination under the rules of administrative finality. See GN 04040.001 for notice of revision. If there is no basis for reopening and revising the initial determination, the PC should notify the claimant of his or her request for reconsideration, giving the reason for the dismissal and an explanation of the initial determination. Do not include a hearing paragraph.

Where reconsideration was not specifically requested, the letter should merely explain the basis for the initial determination. Where additional repetitious or cumulative evidence had been submitted, acknowledge the receipt of the evidence, indicate that it was considered and include an explanation. In all instances, the letter should avoid any inference that the claim was re-examined or reconsidered.

For SSI procedures, see SI 04020.030.

Occasionally after reconsideration, a claimant, instead of requesting a hearing, will file a new application, will submit additional evidence, or will write to the DO or PC, taking exception to the determination.

In some instances, the claimant may write to a member of Congress, union official, etc., who in turn may write to the SSA. The RECONE (ODO) or DEC (DRS) should review the case in the light of the new application, new evidence, and/or the information contained in the correspondence. The required action is as follows:

Requests for Reconsideration will be handled by the ODO Reconsideration Staff.

The Reconsideration Staff or module may affirm a cessation of disability, while finding that the claimant became disabled again subsequent to the cessation date. If the claimant will lose benefits because his or her new application (or protective writing) is not retroactive to the first month of potential entitlement under the new period of disability, see DI 42010.040.

If ODO or a PSC receives a request or implied request for reconsideration on a case meeting the criteria for the disability hearing process, it will associate the request with the claims folder and forward it to the servicing DO for its necessary action. The primary ODO/PSC-DRS responsibilities for cases in the disability hearing process are at the end of the process. (See DI 43525.050 for INTPSC instructions.)

A fee petition filed for services rendered in connection with a Request for Reconsideration-Disability Cessation will be processed by the PC servicing the claim. (See GN 03930.010.)

¹ This section reflects duplicated material.