TN 16 (11-23)

DI 42010.025 An Administrative Law Judge Reopens a Prior Administratively Final Determination or Decision

A. Guidelines for reopening

The administrative law judge (ALJ) may reopen and revise a prior initial determination, reconsidered determination, revised determination, or hearing decision under the rules of administrative finality. When processing a favorable ALJ decision, we generally only issue payments based on the current application unless the ALJ specifically reopens and revises a prior determination or decision or directs the issuance of payments from a prior application, properly following the rules of administrative finality.

NOTE: 

An ALJ may not reopen a decision made by the Appeals Council (AC). See DI 27501.005 for the rules governing reopening and revision of determinations and decisions. For our policy on administrative finality, see GN 04000.000.

B. Preparing the determination

1. ALJ reopens a prior administratively final determination or decision without providing the basis for reopening

If fewer than 4 years have elapsed since the date of the initial notice for the prior determination or decision in a title II claim, process the prior application to payment according to the instructions in DI 42010.020. Use the date of the prior application in Block 3 of the determination Form SSA-831. Do not refer the case to the Office of Appellate Operations (OAO) as a protest case solely because the ALJ did not provide a basis for reopening.

If more than 4 years have elapsed since the initial notice of the prior determination or decision in a title II claim, and the ALJ reopens and revises a prior determination or decision to a favorable decision without explaining why the rules for unrestricted reopening apply, expedite payment on the current application before the ALJ. Prepare an SSA-567 referring the file to the proper reviewing technician to prepare a protest memorandum to the OAO based on the reopening issue. For protest memorandum guidelines and procedure see DI 42010.080.

2. ALJ does not reopen prior unfavorable determination or decision

The ALJ may establish onset in the period covered by a prior unfavorable determination or decision without reopening, but the ALJ must address the reopening issue in the decision (see HALLEX I-2-9-85 and DI 25501.250A5.). If the ALJ addresses the reopening issue in the decision and declines to reopen the prior determination or decision, process the claim using the current application date and earlier disability onset date. If the ALJ does not address reopening, and the prior determination or decision could potentially be reopened under the provisions of 20 CFR 404.987- 404.989, see DI 42010.065 for an explanation on how to submit a protest to OAO.

3. ALJ erroneously reopens a prior administratively final determination or decision at the AC level or above

If the rules of administrative finality prohibit reopening and the ALJ incorrectly reopened a prior determination or decision, or if the ALJ erroneously reopened a prior court or AC decision, process the current application to payment, if possible. Follow the instructions in DI 42010.020 for preparing the determination form, and enter in item 3 (Filing Date) the date of the later application which was before the ALJ for a hearing. Prepare an SSA-567 referring the case after payment to the appropriate reviewer for preparation of a protest memorandum to OAO based on the reopening issue. For protest memorandum guidelines and procedure, see DI 42010.065 and DI 42010.080.

4. ALJ sets a subsequent disability onset during a prior period of entitlement

If the ALJ decision establishes a claimant’s disability onset during a prior period of disability entitlement, the processing center (PC) will be unable to correctly effectuate the case for payment. Do not treat the case as a continuance. Not allowing a claimant a new period of disability can be disadvantageous. When a hearing level decision is impossible to effectuate or contains an error of fact or law, the technician refers the matter to OAO. For protest memorandum guidelines and procedure, see DI 42010.065 and DI 42010.080 for protest memorandum guidelines and procedure.


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DI 42010.025 - An Administrative Law Judge Reopens a Prior Administratively Final Determination or Decision - 11/28/2023
Batch run: 04/01/2024
Rev:11/28/2023