Last Update: 9/28/05 (Transmittal I-2-65)
An Administrative Law Judge (ALJ), on his or her own initiative, has jurisdiction to consider the issue of reopening and revising any prior final determination or ALJ decision under any of the following circumstances:
The claimant did not file a request for review by the Appeals Council;
The Appeals Council did not review the prior ALJ decision and issue an Appeals Council decision either on its own motion or after granting the claimant's request for review;
The claimant filed a request for review and the Appeals Council dismissed the request for a reason other than death of the claimant; or
The claimant filed a request for review, the Appeals Council denied the request, and the 60-day period for filing a civil action has expired.
If additional evidence is received in connection with a request for reopening, and the Appeals Council has jurisdiction to consider the reopening issue, forward the evidence to:Office of Hearings and Appeals, SSA
If additional evidence is received in connection with a request for reopening, and neither the ALJ nor the Appeals Council have jurisdiction because a civil action is pending before a court, forward the evidence to:Office of Hearings and Appeals, SSA
(See I-4-2-1, Supplemental Review of Pending Court Cases — General.) The appropriate Branch (DPB, RSI or CCPRB) jurisdiction can be determined from the chart at I-4-3-103.
If the Appeals Council has denied a party's request for review of an ALJ decision (regardless of whether a Federal court has affirmed the ALJ decision), the ALJ cannot later reopen and revise the ALJ decision solely on the basis of the same evidence the Appeals Council considered when it denied the request for review. Such evidence would not be “new.” However, if new and material evidence (See I-2-9-40 C., New and Material Evidence.) is submitted with either a request for reopening or in connection with a new application and the other conditions for reopening exist, the ALJ must reopen the prior hearing decision.
The current case before the ALJ does not involve an application for benefits but involves some other issue, such as a post-entitlement or post-eligibility issue.
The Appeals Council or another SSA component refers a final ALJ decision to an ALJ for consideration of the issue of reopening and revision of an ALJ decision.
An ALJ does not have jurisdiction to reopen an Appeals Council decision. Therefore, if an ALJ believes that evidence submitted in connection with a current application establishes that the claimant was under a disability during a period previously adjudicated by an Appeals Council decision on a prior application, the ALJ must take the following actions:
If the time limit on reopening has expired and reopening is no longer possible:
Issue a decision finding the claimant disabled as of whatever date the evidence establishes, but find entitlement based only on the current application.
If the claimant explicitly requested reopening, explain in the decision why reopening is not possible. If the claimant did not explicitly request reopening, reopening by the Appeals Council is barred by the regulations and no useful purpose would be served by addressing the reopening issue in the decision on the current claim.
If the time limit on reopening has not expired:
Issue a decision finding the claimant disabled as of the day after the date of the Appeals Council decision, and find entitlement based on the current application only.
State in the decision that the Appeals Council decision on the prior application is final and binding.
On the transmittal to the effectuating component, state that the Appeals Council has jurisdiction to consider the issue of reopening its decision on the prior application, and ask the effectuating component to forward the claim file to the Appeals Council when they complete their action.
Send a memorandum to the Executive Director, OAO, Suite 1400, Skyline Tower, 5107 Leesburg Pike, Falls Church, VA 22041 requesting the Council to consider the issue of reopening its decision on the prior application. Attach copies of the ALJ decision and transmittal.