I-3-5-25.Preparation and Issuance of a Denial Notice
Last Update: 9/11/20 (Transmittal I-3-170)
The purpose of denial notices is to notify the claimant that the Appeals Council (AC) has not found a basis for granting review. The AC will not use a denial notice to make substantive findings, change the outcome of a hearing decision, make substitute findings, or in any other way revise an administrative law judge (ALJ) decision. If the AC needs to amend, modify, or change the substance in an ALJ decision, it must grant the request for review.
B. Drafting a Denial Notice
When recommending that the AC deny review, an analyst will prepare a denial notice for review by the AC. Based on the facts of the case, the analyst will select the appropriate denial template in the Document Generation System (DGS) and take any needed action in regard to additional documents, translations, or other needed language.
In general terms, the notice informs the claimant that the AC action document is enclosed and that the AC did not find a basis for review was present. When the AC denies review of an ALJ's decision, the notice also informs the claimant that he or she has the right to commence a civil action.
The analyst must be careful to select the appropriate DGS denial notice template. The claimant has no right to commence a civil action when the AC denies review of an ALJ's dismissal order, unless the claimant resides in the 7th Circuit (Illinois, Indiana, or Wisconsin), which is subject to Acquiescence Ruling (AR) 16-1(7), Boley v. Colvin. For information about AR 16-1(7), see Hearings, Appeals and Litigation Law (HALLEX) manual I-3-3-15 A.
1. Spanish Notices
When the criteria in HALLEX I-3-1-60 is met, the analyst will also prepare the Spanish informational cover notice, using the appropriate DGS template.
2. Claimant Resides in Foreign Country (Title II only)
Section 205(g) of the Social Security Act provides that a civil action may be brought “in the district court of the United States for the judicial district in which the plaintiff resides, or has his principal place of business, or, if he does not reside or have his principal place of business within any such judicial district, in the District Court of the United States for the District of Columbia.” When a claimant resides in a foreign country, the AC will notify the claimant that he or she has the right to commence a civil action in the U.S. District Court for the District of Columbia, or, if applicable, in the judicial district of the United States where the claimant has his or her principal place of business. (See Stored Paragraph 6 in the Denial Notice templates in DGS).
Addresses in American Samoa, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, and the Virgin Islands are not foreign addresses for commencing a civil action. Individuals residing in these places may file a civil action in the local U.S. district court.
3. Split Actions
Split actions occur when a case has more than one claim, and the AC takes different actions on those claims. If the AC issues split or different actions on a case with more than one claim (e.g., a title II disability claim and a title XVI supplemental security income claim, or a title II adult disability claim and a childhood disability claim), the AC will issue one action document covering the multiple claims. Office of Appellate Operations (OAO) staff will modify or combine language from the appropriate DGS templates to reflect dispositions for all claims within one action document. After the AC issues the split action, OAO staff will send copies of the action document to all necessary offices (e.g., hearing office, payment center, field office). OAO staff will ensure the correct disposition code is associated with each claim in the Appeals Review Processing System.
C. AC Approval
Only one AC member signature is required on a denial action. An administrative appeals judge (AAJ) or an appeals officer (AO) will review the analyst's proposed action and either agree or disagree with the recommendation.
If the AC member agrees with the proposed action, he or she will approve the recommendation and sign the denial notice. In some cases, the AC member may return the case to the analyst for further analysis or revision before deciding whether a denial action is appropriate.
If an AAJ is reviewing the case and disagrees with the analyst's recommendation, he or she will return the case to the analyst with appropriate instructions for revising the action. However, if an AO is reviewing the case and disagrees with the analyst's recommendation, the AO will first discuss the case with his or her supervising AAJ to determine the next appropriate course of action.