TN 7 (07-23)

GN 04040.001 Relationship Between Appeals Process and Administrative Finality

A. Introduction

There is no direct operational relationship between the appeals process and administrative finality.

An appeal request is not also a reopening request, and a reopening request is not also an appeal request.

Administrative finality is not a “procedure” which should generally be explained to the claimant because they fail to file an appeal request timely. However, if the interview shows that the claimant could obtain additional evidence which may be new and material, the FO should explain that if this evidence is obtained, SSA may still consider the effect of the evidence on the prior determination or decision, even if good cause for late filing is not established.

The fact that the claimant did not file timely for appeal does not mean that the requirements for reopening automatically exist.

B. Operating procedures

1. Field Office (FO) responsibility

  1. a. 

    GN 03101.001 and GN 03101.120 provide guidance to the FO on how to proceed when a claimant comes into the FO and is questioning (protesting) the decision made on their claim.

  2. b. 

    The FO can now reopen DOFA cases where the case was finally decided at the initial level and no appeal was filed. (The FO can also reopen cases processed by the PSC at the initial level which could now be processed by the FO under DOFA.)

  3. c. 

    Appeal Filed after Time Limit

    • The FO, in a situation where an appeal is requested after the time limit has expired, should never decide (nor does the POMS give it the authority to decide) in favor of reopening as opposed to taking the appropriate appeal request.

    • If a claimant protests after the time limit for filing an appeal, GN 03101.020 provides that the FO is to obtain an explanation as to why the protest was filed late. This statement is used to determine whether good cause exists for extending the time for filing.

    • Except in disability insured status cases and DDS jurisdiction cases, the FO does not have the authority to make determinations of good cause for late filing of a reconsideration (which is a step which must be completed in reconsideration cases before reopening is considered). Therefore, reconsideration cases which require determinations on good cause for late filing should be sent directly to the PSC for the good cause determination. (ALJ's and the AC's make good cause determinations for cases at their level.)

2. Program Service Center (PSC) responsibility

  1. a. 

    GN 03101.020 provides that the PSC will consider reopening in a case where a reconsideration was filed late if good cause for late filing cannot be found. Thus, the POMS currently gives the responsibility for deciding whether reopening is involved in a reconsideration case to the PSC (including ODO).

  2. b. 

    If good cause is found, SSA must process the reconsideration and give further appeal rights. In processing the reconsideration, SSA may also reopen prior determinations (e.g., allow payment based on an earlier application) provided the requirements for reopening and revising are met. However, reopening is at SSA's discretion and a decision not to reopen has no appeal rights. (Although reopening is at SSA's discretion, if the conditions for reopening are met, SSA as a matter of operating policy will reopen and revise the determination in question.)

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GN 04040.001 - Relationship Between Appeals Process and Administrative Finality - 07/05/2023
Batch run: 07/05/2023