I-2-9-1.Administrative Finality — Reopening and Revising Determinations and Decisions — General

Last Update: 9/28/05 (Transmittal I-2-65)

Citations:

“Claimant,” as used herein, refers to the party to the initial, reconsidered, or revised determination who has requested a hearing before an ALJ, and any other party to the determination, or person whose rights may be adversely affected by a hearing decision. (See I-2-1-45, Parties to the Hearing.)

A determination or decision made at any step of the administrative review process becomes final and binding if the claimant does not appeal timely and, in the case of an ALJ decision, the Appeals Council does not decide to review the decision on its own motion under section 404.969 or 416.1469. If a claimant timely appeals an ALJ decision (i.e., requests review by the Appeals Council), the ALJ decision will become final and binding if the Appeals Council denies the request for review and:

  • the claimant does not timely file a civil action, or

  • the claimant timely files a civil action and a court affirms the ALJ decision.

Generally, if the Appeals Council grants a claimant's request for review of an ALJ decision, or reviews an ALJ decision on its own motion, the Appeals Council will vacate the ALJ decision and either remand the case to an ALJ for further action, including a new hearing and decision, or issue an Appeals Council decision. The Appeals Council's decision will become final and binding if:

  • the claimant does not timely file a civil action, or

  • the claimant timely files a civil action and a court affirms the Appeals Council's decision.

A claimant may explicitly request an ALJ to reopen and revise a final determination or ALJ decision, or may submit additional evidence or information which implies that the claimant is requesting reopening and revision of such determination or decision. An ALJ may grant or deny a claimant's request to reopen and revise a final determination or ALJ decision. The ALJ may also decide on his or her own motion to reopen and revise a prior determination or decision.

If an ALJ has jurisdiction to reopen and revise a determination or decision (see I-2-9-10, Administrative Law Judge's Jurisdiction to Reopen and Revise a Determination or Decision) and the conditions for reopening are met, the ALJ must reopen the determination or decision.

NOTE:

In some circuits, circuit case law may limit reopening. Check the Acquiescence Rulings applicable to the circuit where the claimant resides.

If an ALJ receives a request to reopen a determination or decision, and the ALJ does not have jurisdiction to consider the request, the ALJ must refer the request to the component that has jurisdiction. For example, if an ALJ receives a request to reopen a reconsidered determination which was not appealed to the hearing level, and there is no subsequent claim pending before the ALJ, the ALJ must refer the request to the component that issued the reconsideration determination. (See I-2-9-40, Reopening for Good Cause, for certain exceptions to this rule.)

NOTE:

There may be circumstances in which it would be appropriate for the ALJ to treat a request to reopen a final reconsidered determination as a request for an extension of time to file a request for an ALJ hearing, e.g., the claimant alleges a reason(s) for not appealing the reconsidered determination that falls within the scope of section 404.911 or 416.1411 as opposed to referring the request to the component that has jurisdiction.

If an ALJ is issuing a decision on a current application, and the record shows that in connection with the current application the claimant specifically requested reopening and revision of an unfavorable determination or decision on a prior application, the ALJ must include in the decision a finding on the reopening and revision issue, and supporting rationale.

If an ALJ is issuing a decision on a current application, and the record shows that in connection with the current application the claimant did not specifically request reopening and revision of the prior determination or decision, but did allege an onset date of disability within the previously adjudicated period, the ALJ must consider the claimant's current application to be an implied request for reopening and revision of the determination or decision on the prior application. Under these circumstances, if the ALJs decision on the current application is unfavorable, the ALJ need not discuss or make any findings on the issues of reopening and revising the unfavorable determination on the prior application. However, if the ALJ's decision on the current application is favorable, the ALJ must include in the decision appropriate findings and rationale on the reopening and revision issues.

Even though a claimant has not specifically requested reopening and revision of a determination or decision on a prior claim in connection with his or her current application for benefits, the ALJ should address the reopening and revision issues in his or her decision on the current application, regardless of whether that decision is favorable or unfavorable to the claimant, if the ALJ has informed the claimant in the Notice of Hearing that reopening and revision of the prior determination or decision are issues to be decided by the ALJ.

If an ALJ is issuing a decision on a current application, the ALJ may also decide on his or her own initiative to reopen and revise a prior determination or decision. In such instance, the ALJ must include in the decision a finding on the reopening and revision issue, and supporting rationale for such action.