I-2-5-10.Prehearing Case Review by Other Component
Last Update: 8/3/17 (Transmittal I-2-211)
After a claimant files a request for hearing but before an administrative law judge (ALJ) holds a hearing, an ALJ may, under the circumstances outlined in subsection B below, forward a claim for a prehearing case review to the Disability Determination Services or other component that issued the determination the claimant is appealing. On receipt of the claim(s), the receiving component will decide whether to revise the determination based on a preponderance of the evidence. See 20 CFR 404.941 and 416.1441. Under these procedures, the Social Security Administration may only issue a revised determination if it is fully or partially favorable to the claimant.
While a prehearing case review is pending, the ALJ retains jurisdiction of the claim and will not dismiss the request for hearing.
B. When an ALJ May Refer a Case for Prehearing Case Review
Additional evidence is submitted;
There is an indication that additional evidence is available;
There is a change in the law or regulation; or
There is an error in the file or some other indication that the prior determination may be revised.
In screening cases for the regulatory criteria, the ALJ will only refer cases for a prehearing case review in which application of the criteria may result in a fully or partially favorable decision.
C. When to Schedule a Hearing After a Case Is Sent for Prehearing Review
The hearing office will retain claims sent for a prehearing review in the Master Docket by date of receipt. When a claim sent for a prehearing review is ready to be scheduled for a hearing, the ALJ may not delay the scheduling of a hearing unless all parties to the hearing agree to continue the review and delay the hearing. See 20 CFR 404.941 and 416.1441. If all parties agree to a delay, the ALJ will ask the parties to indicate so in writing. The ALJ will then associate the writing(s) with the claim(s) file.
If a party to the hearing objects to a delay in scheduling the hearing, the ALJ will schedule the hearing. However, when administratively efficient to do so, the prehearing review may continue during the time between the date the hearing is scheduled and the date of the scheduled hearing. If the reviewing component cannot complete the prehearing case review before the scheduled date of the hearing, the component must return the case to the ALJ for a hearing unless the component is preparing a favorable revised determination and all parties to the hearing provide written consent for the ALJ to delay the hearing.
A prehearing case review is different than a prehearing conference, as described in HALLEX I-2-1-75. If it appears the ALJ may be able to issue a fully favorable decision, it may be more appropriate for the ALJ to hold a prehearing conference rather than send the case for a prehearing case review.
If the component revises the determination based on the prehearing case review, see HALLEX I-2-4-45. Generally, if the revised determination would be partially favorable, the request for hearing will proceed unless all parties agree to a dismissal of the request.
The regulations do not provide for revised determinations that would be unfavorable. If the revised determination would be unfavorable, the parties to the hearing will be notified that the agency will continue to process the RH.
D. Transmitting a Paper Claim(s) File
When sending a paper claim(s) file involved in a prehearing case review, the hearing office will use the Document Generation System (DGS) File Transmittal Sheet template to transmit the claim(s) file. Staff will indicate on the transmittal or in a separate letter the reason(s) for the prehearing case review, and identify any additional relevant evidence. The file transmittal template can be accessed through DGS by selecting “Correspondence,” “Other,” and “File Transmittal Sheet.”