Reopening is at the discretion of SSA and is not a right afforded to the claimant upon request, even if the claimant makes the request within one year of the notice of the initial determination. However, in all cases it is SSA’s policy to honor the request to review the case to see if reopening applies. After the proper review, we inform the claimant of the decision to reopen or not and the reason for the decision.

When we make a determination or decision with respect to entitlement, the claimant and SSA rely on its accuracy. The regulations prescribe that determinations and decisions made by SSA can be reopened and revised only for following specific reasons or within a certain time period:

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  Within one year of the date of the notice of the initial determination for any reason; or

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  Within four years of the date of the notice of the initial determination for good cause (GN 04010.001); or

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  At any time for cases meeting conditions listed in GN 04020.010 – GN 04020.110

Based on this principle, SSA can reopen a final determination if the review demonstrates erroneous information or questionable information procedure.

If after the proper claim’s review, you determine that the award is clearly erroneous (e.g., entitlement requirements not met previously, the claimant performed substantial gainful activity (SGA) during the waiting period of disability entitlement, etc.) and it is possible to reopen under the rules of administrative finality then:

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  Prepare an informal determination per GN 01010.365 and GN 04001.080 (see SI 04070.015 thru SI 04070.030 for title XVI)

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  Fax the determination to the Non-Disability Repository for Evidentiary Document (NDRed) and to the Processing Center (PC) paperless unit of jurisdiction;

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  Include all the appropriate information along with the informal determination for the PC termination action.

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  If after the proper claim’s review, you determine that the award contains contradictory information or evidence, which brings up doubt as to the validity of an award but the issue requires further development, continue payment until the issue is resolved.

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  If the Field Office (FO) discovers the questionable award, the adjudicator is responsible for reviewing and resolving the questionable information. If development indicates the award was erroneous, follow GN 01010.480B.

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  If the PC discovers the questionable award, the technician is responsible for reviewing and resolving the questionable information when possible. When needed, the PC can contact the FO via Processing Center Action Control System (PCACS) to request further development. If development indicates the award was erroneous, initiate the termination action.

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  GN 04001.010 When and Why SSA Reopens Policy Principle

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  GN 04001.020 Who can Reopen

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  GN 04001.080 Documenting the Rationale for Reopening

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  GN 04001.090 Reopening- Appeal Rights