I-2-5-10.Prehearing Case Review by Other Component

Last Update: 9/28/05 (Transmittal I-2-68)

A. General

After a hearing is requested but before it is held, the ALJ may forward the case to the State agency or other component that issued the determination being appealed if certain conditions exist (See B. below), for a prehearing case review. That component will decide whether the determination can be revised to be wholly or partially favorable to the claimant. The ALJ will not dismiss the RH when forwarding a case for prehearing case review and will retain jurisdiction of the claim.

The ALJ may delay scheduling a hearing for a prehearing case review only if the claimant agrees to the delay. If the component cannot complete the prehearing case review before the scheduled date of the hearing, the component must return the case to the ALJ for hearing unless the component is preparing a revised determination and the claimant provides written consent for the ALJ to delay the hearing.

NOTE:

In lieu of prehearing case review, the ALJ should consider holding a prehearing conference to determine whether a fully favorable decision can be issued. (See I-2-1-75, Prehearing Conference.)

B. When a Prehearing Case Review May Be Conducted

An ALJ may consider a case for prehearing review by the State agency or other component that issued the determination being appealed when:

  • additional evidence is submitted or there is an indication that additional evidence is available, and the additional evidence could result in a revised favorable determination;

  • there is a change in the law or regulation that could result in a revised favorable determination; or

  • there is an error in the file or some other indication that the prior determination may be revised to a favorable determination.

C. Component's Notice of Revised Determination

If the component revises the determination based on their prehearing case review, it will mail written notice of the revised determination and the basis for it to the claimant at the claimant's last known address. The component will also send a copy of the revised determination to the ALJ.

1. Revised Determination Is Wholly Favorable

If the revised determination is wholly favorable to the claimant, the component will notify the claimant that the ALJ will dismiss the request for a hearing (RH) unless the claimant or another party to the hearing notifies the ALJ in writing, within 30 days after the date on which the component's notice was mailed, that he or she wants the ALJ to proceed with the hearing.

2. Revised Determination Is Partially Favorable or Unfavorable

If the revised determination is partially favorable or unfavorable to the claimant, the component will tell the claimant in the notice that the ALJ will proceed with the scheduled hearing unless all parties to the hearing agree to dismissal of the RH.

D. Transmitting the Claims Folder (CF)

When sending a case to a component for a prehearing case review, use DGS form File Transmittal Sheet for OHA to transmit the CF. Indicate on the transmittal or in a separate letter the reason(s) for the prehearing case review, and identify any additional evidence that is relevant to the review. Do not dismiss the RH. To access the OHA Transmittal Sheet, go to Document Generation System (DGS), click on the tab “Correspondence”, then click on “Other,” then click on “File Transmittal Sheet.”

E. ALJ Action Following a Component's Partially Favorable or Unfavorable Revised Determination

If a component issues a partially favorable or an unfavorable revised determination as a result of a prehearing case review, and the ALJ does not hear from the claimant or the representative within 30 days after the date on which the component mailed notice of the revised determination, the ALJ must send a letter to the claimant and the representative (if any) inquiring whether the claimant wishes to pursue the RH. The letter should inform the claimant and the representative (if any) that if the claimant is satisfied with the component's revised determination, he or she should submit a written request to withdraw the RH.

If the claimant or representative submits a written request to withdraw the RH, the ALJ should issue an order dismissing the RH. (See I-2-4-20, Dismissal at the Claimant's Request.) If the claimant or representative does not submit a written request to withdraw the RH or responds that the claimant wished to proceed with the RH, the ALJ should proceed with action on the RH in the usual manner.