I-2-10-14.Writing a Decision When Fraud or Similar Fault Is at Issue
Last Update: 6/25/14 (Transmittal I-2-112)
In addition to the standard issues addressed in an administrative law judge (ALJ) decision under Hearings, Appeals and Litigation Law (HALLEX) manual I-2-8-0, an ALJ must specifically address an issue of fraud or similar fault.
If the ALJ is asked to “redetermine” a claim under HALLEX I-1-3-25, the ALJ will be provided specific instructions regarding the nature of the fraudulent activity and any special decision writing requirements.
When the ALJ determines that the issue of fraud or similar fault is not material to the decision, the ALJ will not make a finding on the issue of fraud or similar fault, but will explain the reasons for not finding it material in the decision's rationale.
The ALJ will limit the decision to the issues set forth in the notice of hearing and not include any reference to suspected criminal violations.
B. Addressing Evidence
1. Findings of Fact if Fraud or Similar Fault Was Involved in Providing Evidence
If there is reason to believe that fraud or similar fault was involved in the providing of evidence in the claim, the ALJ's findings will clearly identify any document(s) or evidence that is disregarded because of a finding of fraud or similar fault and explain the basis for the finding in the decision rationale.
However, in addressing false testimony or evidence in the decision, an ALJ should be careful not to draw conclusions about possible violations of the law.
If evidence is not being disregarded, the decision rationale should include a statement that the ultimate decision regarding the benefit claim is based on evaluation of all the evidence, including the evidence that was questioned. Unsubstantiated suspicions about the evidence's authenticity or legitimacy should not impact consideration of the evidence.
2. The Authority
The ALJ will cite the authority for determining whether evidence is disregarded. The authority for these findings are sections 205(u) and 1631(e)(7) of the Social Security Act, and Social Security Ruling (SSR) 16-2p: Titles II and XVI: Evaluation of Claims Involving Similar Fault in the Providing of Evidence.
3. The Standard of Proof
The ALJ decision will state the standard of proof used when there is reason to believe that fraud or similar fault has occurred. As explained in SSR 16-2p and HALLEX I-1-3-15 C, the standard of proof for a finding of fraud or similar fault is a preponderance of the evidence.
In the decisional paragraph, the ALJ will address only the disposition of the claim.