I-3-9-10.Claimant Requests Reopening (Express and Implied) with the Request for Review
Last Update: 7/27/15 (Transmittal I-3-121)
A claimant may expressly request that the Appeals Council (AC) reopen and revise a final determination or decision. Additionally, a claimant may submit additional evidence or information that implies a request for reopening. These requests can be submitted in conjunction with the request for review or in supporting contentions or statements from the claimant. For example, a claimant may allege an onset date of disability within a previously adjudicated period.
When a claimant does not specifically request AC review but submits a reopening request to the AC, the AC treats the reopening request as a request for review. If, after the AC has denied review, a claimant submits an express request for reopening or additional information that implies a request for reopening, the AC will treat the request as a request to reopen the administrative law judge (ALJ) decision. See processing instructions in Hearings, Appeals and Litigation Law (HALLEX) manual I-3-5-50 C.2.
Under 20 CFR 404.903(l) and 416.1403(a)(5), if the adjudicator at the initial, reconsideration, or hearing level concluded that the criteria for reopening were not met, the claimant has no right to request review of the reopening action. If the prior adjudicator did not address a reopening issue, the AC will evaluate whether a basis for granting review is present (see HALLEX I-3-3-1).
B. AC Action on Reopening Request
When a claimant expressly requests reopening, the AC will specifically address the request in its action document. If the claimant implied a request for reopening, the AC will use its best judgment in determining whether it will specifically address the issue in its action document.
1. AC Denies Request for Review
If the AC denies the request for review, the language the AC will use in its denial notice depends on the circumstances.
If the AC denies the request to reopen, the analyst will use the language in the Document Generation System (DGS) Stored Paragraph 9 (all templates).
If the AC refers the request for reopening to an ALJ for further consideration, the analyst will use the language in DGS Stored Paragraph 9A (all templates).
If the ALJ already considered the request for reopening and denied the request, the analyst will use the language in DGS Stored Paragraph 9B (all templates).
An Administrative Appeals Judge will review the denial recommendation and take appropriate action on the claim when the denial notice addresses reopening.
2. AC Grants Review
If the AC remands the case, the language the AC will use in the remand order depends on the circumstances:
If the AC reopens an ALJ decision, the analyst will use the language in DGS REM 47;
If the AC affirms an ALJ's finding that a claimant is disabled but is remanding a case for further proceedings (e.g., the AC is remanding a partially favorable decision), the analyst will use the language in DGS REM 48;
If the AC remands a case to an ALJ and is reopening a determination on a subsequent application, the analyst will use DGS REM 45x; or
If the AC remands a case to an ALJ but is affirming a determination on a subsequent application, the analyst will use DGS REM 46x.
If the AC issues a decision, the analyst will use the language in the appropriate DGS decisional templates (depending on whether the decision is fully favorable, partially favorable, or unfavorable).