I-4-4-25.Additional Evidence Affects the Defensibility of the Pending Court Case
Last Update: 5/1/17 (Transmittal I-4-72)
A. Analysis of Good Cause
When an analyst performs a supplemental review and concludes that additional evidence or other materials may affect the defensibility of a pending court case, the analyst will determine whether good cause exists to include the evidence before seeking remand of the pending court case.
The 1980 Amendments to the Social Security Act (P.L. 96-265; 42 U.S.C. § 405(g)) provide that the court may remand a case to the Commissioner only when good cause exists. Good cause before the Commissioner has answered the plaintiff's complaint is not defined; however, after answer, good cause exists only upon a showing that there is new evidence that is material and good cause exists to explain why the evidence was not incorporated into the record in a prior proceeding.
To determine whether a good cause exception exists regarding the submission of the additional evidence or other material, the analyst will use the rules in 20 CFR 404.970 and 416.1470. These sections discuss acceptable reasons for missing the deadline to submit evidence as described in 20 CFR 404.935 and 416.1435. For example, a representative submits additional evidence after a civil action is filed, we note the evidence existed before the administrative law judge's (ALJ) decision, but the representative explains that these records were lost when the physician moved and were only recently located.
If the analyst determines, in his or her opinion, that good cause for seeking remand does not exist, and the administrative appeals judge (AAJ) responsible for the case concurs, the analyst will prepare a memorandum to the Office of the General Counsel (OGC). In the memorandum, the analyst will explain:
How the additional evidence may affect the pending court case; and
Why good cause for seeking remand does not exist.
For example, although the evidence may be new, it existed prior to the date of the hearing decision but was not submitted by the claimant's representative until after the civil action was commenced and a good reason was not provided to explain why it was not submitted at the appropriate time.
B. Recommendation to Seek Remand
If the analyst determines that good cause for seeking remand of the pending court case exists, he or she will prepare an analysis and recommendation for the AC. The analyst will submit the analysis and recommendation to the AAJ responsible for the case (see HALLEX I-3-0-6). In the analysis and recommendation, the analyst will explain the reasons for seeking remand of the pending court case and propose the action to take upon remand.
C. Appeals Council Agrees with the Analyst's Recommendation
If the AC agrees with the analyst's recommendation to seek voluntary remand of the pending court case, the analyst will prepare a memorandum to OGC setting forth the reasons, including good cause, for seeking remand of the case, and the action the AC proposes to take upon remand.