I-3-2-24.Handling Information Submitted or Associated in a Claim(s) File About a Person Other Than a Party to the Proceeding
Last Update: 6/7/21 (Transmittal I-3-180)
All Appeals Council (AC) adjudicators and Office of Appellate Operations (OAO) staff are responsible for ensuring that the evidence of record properly relates to a party to the proceeding. This is necessary to ensure that the record on appeal contains only the evidence actually relied on to make the decision and to avoid inadvertent disclosure of another person's personally identifiable information (PII). For the definition of PII, see the Administrative Instructions Manual System, General Administration Manual, Chapter 15, Instruction No. 01 (AIMS. GAM 15.01).
This instruction does not address issues relating to a form SSA-1695, “Identifying Information for Possible Direct Payment of Authorized Fees.” Form SSA-1695, which is now obsolete, has been incorporated into form SSA-1696. If the Office of Hearings Operations (OHO) or OAO receives a form SSA-1695, the instructions in Hearings, Appeals and Litigation Law (HALLEX) manual I-1-2-95 apply. OHO staff will follow the instructions in Standard Hearings Operations Procedure section 188.8.131.52.
B. Information Inadvertently Associated With the Wrong Claim(s) File
When reviewing the evidence in a case, OAO staff must be alert to the possibility that medical records or other documents may have been inadvertently associated with the wrong claim(s) file, either at a prior level of adjudication (see generally HALLEX I-2-1-24) or in newly submitted information. Additionally, many appointed representatives are now submitting information electronically using fax machines, barcodes, the Electronic Records Express system, or by uploading evidence directly to the claim(s) file online through Appointed Representative Services. When doing so, an appointed representative may inadvertently submit or associate information with the wrong claim(s) file. OAO staff must be diligent in reviewing associated and incoming information to ensure all information is associated with the correct claim(s) file.
When OAO staff discovers information in the wrong claim(s) file, OAO staff must immediately remove the information from the claim(s) file. If an adjudicator first discovers the issue, the adjudicator will not sign the action document until he or she has verified that staff has removed from the claim(s) file the information relating to the person who is not a party to the proceeding.
If OAO staff observes a consistent pattern of a particular appointed representative repeatedly associating information with the wrong claim(s) file, staff will report the issue to his or her immediate supervisor. It may be appropriate in some instances for the supervisor or designee to contact the representative's office to inform the office of the issue and to remind the representative of the importance of not inappropriately disclosing PII or not submitting information that is unrelated to the claimant. If OAO believes the circumstances involved demonstrate that the representative may have violated our rules, the supervisor will prepare a referral for possible misconduct using the procedures in HALLEX I-1-1-50.
After OAO staff removes information in the claim(s) file that relates to someone other than the named claimant, analysts and adjudicators must carefully evaluate whether the administrative law judge (ALJ) appeared to rely on the misplaced information in reaching his or her decision. For example, the ALJ relied on the evidence if he or she cited it in the decision. The AC will consider whether to grant review or take own motion review given the facts of the case, the consideration given to the information, and the nature of the information. For example, if the ALJ cited the information in the decision, but the information was not material to a finding in the case, the AC may find there is no basis for granting review.
C. Information About a Person Who Is Not a Party Is Intentionally Submitted
In association with a request for review, a claimant or an appointed representative may intentionally submit documents related to a person who is not a party to the proceeding as support for consideration of a similar issue. For example, an appointed representative might submit information from another claim(s) file to support:
An argument for a grant review action based on a prior administrative action on the same issue (e.g., a prior remand order involving what appears to be the same substantive issue);
An allegation that the ALJ should have, but did not, recuse himself or herself from the case; and/or
An allegation of a pattern of unfairness, prejudice, partiality, bias, misconduct, or discrimination by an ALJ (hereinafter “bias allegation”).
In all cases, the AC will associate any written brief, contention, objection, or argument with the claim(s) file, redacting any cited PII in the writing. However, when a claimant or representative intentionally submits supporting information that contains the PII of a non-party, the AC will use one of the following procedures, as applicable.
It is irrelevant whether the claimant or representative redacted the PII of a non-party from “supporting information” before submitting it to the AC.
1. Information Submitted in Support of a Grant Review Action Not Based on Bias
If the claimant or representative submits information about a non-party in support of a grant review action based on a non-bias related issue, the AC will not associate the information with the claim(s) file but will note in writing that:
The brief was associated with the record; and
The supporting information attached to the brief was not associated with the file because it relates solely to the adjudication of another person whose claim is not properly before the AC.
Whether the writing is in an action document or other correspondence, the AC will associate a copy of its writing with the claim(s) file. If the evidence is unusual, an original document, or is otherwise appropriate to return, the AC will also return the evidence to the sender.
If the information is mistakenly exhibited in the claim(s) file and the exhibit designation cannot be removed, the AC will also follow its usual procedures for removing information inadvertently associated with the wrong claim(s) file.
2. Information Submitted to Support a Bias Allegation
When considering bias allegations, the AC reviews any allegation of bias as it specifically relates to the facts of a particular claim using the abuse of discretion standard. See HALLEX I-3-2-25. For more information about the definition of an “abuse of discretion,” see HALLEX I-3-3-2. Information about an action an ALJ took in a different claim(s), including information about an ALJ's allowance rates, does not meet the specificity requirement needed for the AC to evaluate an abuse of discretion in the case pending before it. Therefore, because it does not specifically relate to the claim the AC is adjudicating, the AC cannot accept information about an action the ALJ took in a different claim(s). The AC will not add the information to the claim(s) file and will remove the information if uploaded directly to the electronic claim(s) file.
If the information is mistakenly exhibited in the claim(s) file and the exhibit designation cannot be removed, the AC will also follow its usual procedures for removing exhibited information inadvertently associated with the wrong claim(s) file.
While the AC will not consider the information under the abuse of discretion standard, the information related to another person that a claimant or representative submits for this reason may constitute or accompany an allegation of an ALJ's general bias or a pattern of bias or misconduct against a group or particular category of claimants. Pursuant to Social Security Ruling (SSR) 13-1p: Titles II and XVI: Agency Processes for Addressing Allegations of Unfairness, Prejudice, Partiality, Bias, Misconduct, or Discrimination by Administrative Law Judges (ALJs), the Division of Quality Service (DQS) is the component responsible for reviewing general bias allegations. Therefore, the AC will not respond to general bias allegations but will instead send the information to DQS to consider under SSR 13-1p. See HALLEX I-1-8-4. When the AC sends the information to DQS, the AC will document the action in a remark in the Appeals Review Processing System.