Effective Dates: 03/03/2025 - Present Previous | Next

Last Update: 3/3/2025 (Transmittal I-3-201)

HA 01320.024 Handling Information Submitted or Associated in a Claim(s) File About a Person Other Than a Party to the Proceeding

Renumbered from HALLEX section I-3-2-24

A. General

All Appeals Council (AC) adjudicators and Office of Appellate Operations (OAO) staff are responsible for ensuring that the evidence of record properly relates to a party to the proceeding. For the definition of “party to the hearing,” see Hearings, Appeals and Litigation Law (HALLEX) manual HA 01210.045. This is necessary to ensure that the record on appeal contains only the evidence actually relied on to make the decision and to avoid inadvertent disclosure of another person's personally identifiable information (PII). For the definition of PII, see the Administrative Instructions Manual System, General Administration Manual, Chapter 15, Instruction No. 01 (AIMS GAM 15.01).

NOTE: 

This instruction does not address issues relating to form SSA-1695, “Identifying Information for Possible Direct Payment of Authorized Fees.” Form SSA-1695, which is now obsolete, has been incorporated into form SSA-1696, “Claimant's Appointment of a Representative.” If OAO receives a form SSA-1695, the instructions in HALLEX manual HA 01120.095 apply.

B. Information Inadvertently Associated With the Wrong Claim(s) File

When reviewing the evidence in a case, OAO staff must be alert to the possibility that medical records or other documents may have been inadvertently associated with the wrong claim(s) file, either at a prior level of adjudication (see generally HALLEX HA 01210.024) or in newly submitted information. OAO staff must be diligent in reviewing associated and incoming information to ensure all information is associated with the correct claim(s) file(s).

When OAO staff discovers information in the wrong claim(s) file, OAO staff must immediately remove the information from the claim(s) file. If an adjudicator first discovers the issue, the adjudicator will not sign the action document until the adjudicator has verified that staff has removed from the claim(s) file the information relating to the person who is not a party to the proceeding.

NOTE: 

If OAO staff observes a consistent pattern of a particular appointed representative repeatedly associating information with the wrong claim(s) file, staff will report the issue to the immediate supervisor. It may be appropriate in some instances for the supervisor or designee to contact the representative's office to inform the office of the issue and to remind the representative of the importance of not inappropriately disclosing PII or submitting information that is unrelated to the claimant. If OAO believes the circumstances involved demonstrate that the representative may have violated the rules and standards of responsibility for representatives, the supervisor will prepare a referral for possible misconduct using the procedures in HALLEX HA 01110.050.

After OAO staff removes information in the claim(s) file that relates to someone other than the named claimant, analysts and adjudicators must carefully evaluate whether the administrative law judge (ALJ) appeared to rely on the misplaced information in reaching the decision. If the ALJ cited or relied on the misplaced information and this information was material to the finding in the case, the AC will consider whether to grant review or take own motion review given the facts of the case, the consideration given to the information, and the nature of the information.

If the ALJ did not cite the misplaced information or, though cited, the misplaced information was not material to a finding in the case, the AC may find there is no basis for granting review. In these cases, the AC will include the following language in the denial notice:

We note that evidence formerly in the record at [describe location of PII prior to removal] does not belong to you. The Administrative Law Judge did not [reference/cite/rely on] this specific evidence in deciding your claim. We have now removed this erroneous evidence from the record in your case.

If the AC finds another reason(s) to grant review, the AC will include the following language in the action document:

We note that evidence formerly in the record at [describe location of PII prior to removal] does not belong to the claimant. The Administrative Law Judge did not [reference/cite/rely on] this specific evidence in deciding the claim. We have now removed this erroneous evidence from the record.

C. Information About a Person Who Is Not a Party Is Intentionally Submitted

In association with a request for review, a claimant or an appointed representative may intentionally submit documents related to a person who is not a party to the proceeding as support for consideration of a similar issue. For example, they may submit information from another claim(s) file to support:

  • •

    An argument for a grant review action based on a prior administrative action on the same issue (e.g., a prior remand order involving what appears to be the same substantive issue);

  • •

    An allegation that the ALJ has an unusually low allowance rate, supported by lists of actions taken in other cases;

  • •

    An allegation that the ALJ should have, but did not, recuse himself or herself from the case;

  • •

    An allegation of a pattern of unfairness, prejudice, partiality, bias, misconduct, or discrimination by an ALJ (hereinafter “bias allegation”); or

  • •

    An allegation that fraud or similar fault was involved in providing evidence related to their claim(s). When a claimant or representative intentionally submits supporting information that contains the PII of a non-party, the AC must associate any written arguments or objections specifically related to the case with the claim(s) file, redact any cited PII in those writings (if not already done so by the claimant or representative), and follow the applicable procedure below.

1. Information Submitted in Support of a Grant Review Action Not Based on Bias

If the claimant or representative submits information about a non-party in support of a grant review action based on a non-bias related issue, the AC will not associate the non-party information with the claim(s) file but will note in writing that:

  • •

    The brief or argument was associated with the claim(s) file; and

  • •

    The supporting information attached to the brief was not associated with the file because it relates solely to the adjudication of another person whose claim is not properly before the AC.

Whether this writing is in an action document or other correspondence, the AC will associate a copy of its writing with the claim(s) file. If the evidence is unusual, an original document, or is otherwise appropriate to return, the AC will also return the evidence to the sender.

NOTE: 

If the information is already exhibited in the claim(s) file, the AC will also follow its procedures for removing information inadvertently associated with the wrong claim(s) file. See OAO Practices and Applications (PANDA) Section 4.14.

2. Information Submitted to Support a Bias Allegation

When considering bias allegations, the AC reviews any allegation of bias as it specifically relates to the facts of a particular claim using the abuse of discretion standard. See HALLEX HA 01320.025. For more information about the definition of an “abuse of discretion,” see HALLEX HA 01330.002.

Information about an action an ALJ took in a different claim(s), including information about an ALJ's allowance rates, does not meet the specificity requirement needed for the AC to evaluate an abuse of discretion in the case pending before it. Therefore, because it does not specifically relate to the claim the AC is adjudicating, the AC cannot accept information about an action the ALJ took in a different claim(s). The AC will not add the information to the claim(s) file and will remove the information if uploaded directly to the electronic claim(s) file.

In some situations, the representative may submit information that is not from another claim(s) file, but rather is information specifically about the ALJ, such as statistics about the ALJ's allowance rate or affidavits from representatives with observations about the ALJ. These same instructions apply when this information is received.

NOTE: 

If the information is already exhibited in the claim(s) file, the AC will follow its procedures for removing exhibited information inadvertently associated with the wrong claim(s) file. See PANDA Section 4.14.

While the AC will not consider the information under the abuse of discretion standard, the information related to another person that a claimant or representative submits for this reason may constitute or accompany an allegation of an ALJ's general bias or a pattern of bias or misconduct against a group or particular category of claimants. The AC will follow the instructions in HALLEX HA 01180.004 to process these allegations.

3. Information Submitted to Support a Fraud or Similar Fault Allegation

The claimant may allege that supporting information from a non-party's claim(s) file establishes a particular pattern of fraud or similar fault or misconduct. This supporting information may include, but is not limited to, statements from consultative examination (CE) providers who were not involved in the pending claim(s), or statements from a CE provider who was involved in the pending claim but that relate to a report provided in a different claim.

If such allegations are based entirely on evidence involving a non-party, the AC must inform the claimant and representative, in writing, that it cannot consider the allegations of fraud or similar fault because the information does not relate to the claimant or a party to the hearing. The information must be handled consistent with subsection C.1. above.

OAO staff will manually insert the following language into the action document(s) to satisfy the notification requirements. If the evidence is unusual, an original document, or is otherwise appropriate to return, the AC will also return the evidence to the sender using the following language:

The Appeals Council cannot consider your allegation of fraud or similar fault because the information supporting the allegation does not relate to you or a party before the proceeding. Under Hearings, Appeals, and Litigation Law (HALLEX) manual I-3-2-24, the Appeals Council may not associate information related to an individual who is not the claimant or a party to the proceedings before the Appeals Council. Therefore, [the Appeals Council did not add the documents to the claimant's claim(s) file] OR [the Appeals Council has removed the documents from the file].

If you would like to submit your allegations directly to the Office of the Inspector General, please visit http://oig.ssa.gov/report or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If issuing a corrective decision, the AC decision must specifically acknowledge allegations of fraud or similar fault, as required by HALLEX HA 01395.012. If the allegations are based entirely on evidence involving a non-party, the AC will address the allegation of fraud or similar fault in the AC decision with the following language:

The claimant has alleged that there is reason to believe that fraud or similar fault was involved in the provision of evidence in support of the claimant's application(s). The evidence submitted to support this allegation(s), however, does not relate to the claimant or a party to the appeal. The issue is outside the scope of issues the Appeals Council is adjudicating in this claim, and the Appeals Council has not considered this evidence.

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HA 01320.024 - Handling Information Submitted or Associated in a Claim(s) File About a Person Other Than a Party to the Proceeding (I-3-2-24) - 03/03/2025
Batch run: 04/20/2025
Rev:03/03/2025