SSR 78-14: Reconsideration Step in the Administrative Appeal Process for Title II, XVIII and Black Lung Part B Benefits—Change in the Time Frame in Which a Claimant Can Request Reconsideration of an Initial Determination
To set out a new policy with respect to title II, title XVIII, and black lung part B reconsideration processes and to provide information related to the period of time within which a claimant and, where appropriate, providers and suppliers of services (under title XVIII) can request reconsideration of a title II, title XVIII, or black lung part B benefit initial determination.
Program Simplification Proposal dated May 19, 1975. Public Law (P.L. 94-202, Sections 4 and 5. House and Senate Committee Reports regarding H.R. 10727 (P.L. 94-202). Commissioner's testimony on September 19, 1975, before the Subcommittee on Social Security of the Committee on Ways and Means. Action memorandum dated November 21, 1975 (IDI-1), approved by the Commissioner on December 1, 1975. Regulations No. 4, section 404.911; Regulations No. 5, section 405.711; and Regulations No. 10, section 410.624.
The prescribed period of time currently allowed for requesting a title II, title XVIII, and black lung benefits reconsideration is 6 months from the date of mailing of notice of an initial determination. The administrative precedent of conforming the reconsideration time frame to the hearing time frame was established as a title II administrative procedure in 1940 when the reconsideration process was provided as an option to a hearing without forfeiting the claimant's right to a hearing if the claimant wished to pursue an unfavorable reconsideration determination. The time frames for the reconsideration and hearing levels were more closely linked in 1959 when the reconsideration step was made mandatory by regulations before the title II hearing would be authorized. Since the law provided at least 6 months for a hearing to be requested, it was necessary to protect the rights of a claimant who was required to go through the intervening reconsideration step before a hearing would be held. If a claimant had been limited to less than 6 months (e.g., 3 months) within which to request a reconsideration, and failing to file timely had been precluded from going on to the hearing level (because of the mandatory reconsideration step) the claimant would, in effect, have been deprived of his/her right to a hearing under the law even though 6 months have not elapsed since notification of the determination. Therefore, the time frame of 6 months as provided for title II hearings became, in effect, an aggregate double 6- month prior for the combined levels. This policy was also applied to title XVIII and the black lung benefit program.
Historically, therefore, the reconsideration time frame duplicated the statutory hearing time frame to protect the claimants' statutory rights to a hearing. In addition, a common time frame for the reconsideration level and hearing level alleviates any added confusion that would result on the part of the public if the period of time allowed for each level were different. The enactment of P.L. 94-22 (January 2, 1976) makes the time period for requesting a hearing under the titles II, XVI, XVIII, and black lung programs uniform, i.e., 60 days from the date of receipt of the notice of a determination. Therefore, the implementation of this policy will conform the reconsideration time frame to the newly enacted time frame of 60 days for hearings requests in accordance with P.L. 94-202 and thereby sustain the preexistent pattern of common time frames for the two levels in the appeals process.
Additionally, the adoption of a uniform time frame of 60 days for the reconsideration step for all Social Security Administration (SSA) programs will provide more efficient processing when an issue at question is common to more than one program (i.e., an issue involving both title II and tile XVI). The policy recommendation to change the title XVI time frame to 60 days has been promulgated under separate cover.
The Commissioner indicated SSA was seeking a common time frame of 60 days for the reconsideration and hearing level when he testified before the House of Representatives Subcommittee on Social Security, Committee on Ways and Means on September 1975, and endorsed this position again when he approved an action memorandum (IDI-1 dated November 21, 1975), recommendation on this subject on December 1, 1975.
The House and Senate Committee Reports which describe the effects of H.R. 10727 refer to a common time frame of 60 days for the reconsideration and hearing level. The text of the reports indicate that Congress intended the legislative action of H.R. 10727 to embrace both time frames even though the reconsideration step to the appeals process is administrative and not contained in the law.
The establishment of a common time frame for all levels of the appeals process was included in the recommendations proposed by the Office of Program Operations Legislative Task Force to Simplify Procedures in this report of May 19, 1975. The reduction in the period of time allowed to request a reconsideration is not expected to deprive the claimant of his or her right to protest a decision. Although the length of time he or she will have to request a reconsideration will be shortened, the 60-day period is considered adequate time for a person to express dissatisfaction with a determination. In fact, statistics found in the Hearings Report of the House of Representatives (based on an analysis done in 1972) show that about 62 percent of the persons appealing for reconsideration do so by 60 days and about 45 percent have done so within 30 days. Even in cases where the time limit has expired and the initial determination has become final as defined in Section 404.908, Subpart J of Regulations No. 4 (20 CFR 404.908), an initial determination may be reopened when there is new and material evidence presented up to 4 years after the initial determination. In addition, Section 404.953 (20 CFR 404.953), Subpart J provides for an extension of the time allowed to file for a reconsideration if good cause is established.
For purposes of effectuating administrative actions flowing from an initial determination, at the inception of the title XVI program, the assumption was founded that the party to the determination shall be presumed to have received the notice within 5 days from the date shown on that notice unless there is reasonable evidence to the contrary. Then the request for reconsideration must be filed with SSA within a prescribed period from the date of the receipt of the notice. However, title II, title XVIII, and black lung part B benefits do not have such a provision. In these latter three programs, the time for requesting reconsideration runs from the date of the mailing of the notice of the initial determination. In order to further guarantee consistency among the various SSA programs, the adoption of the 5-day presumption rule (as found in Section 416.1419, Subpart N) would alleviate any confusion which variance in the programs may produce.
POLICY DIRECTIVE STATEMENT:
A claimant, the representative of a claimant, or a provider or a supplier of services (under title XVIII) who is dissatisfied with an initial title II, XVIII or black lung part B determination may request a reconsideration of such determination if the request is filed within 60 days after receipt of such notice. Therefore, SSA's initial determination shall become final upon the expiration of that 60-day period from the receipt of the notice of such determination to the claimant unless a request for reconsideration has been filed. In addition, the receipt of a notice shall be presumed to have occurred no later than 5 days after the date shown on the notice unless there is reasonable evidence to the contrary. (This is the same presumption that has applied in title XVI programs.) Reconsideration remains a required step in the appeals process that must take place prior to a hearing.
This directive applies to all procedures authorized by the provisions of Title XVIII of the Social Security Act which incorporate Section 205(b) of the Act (i.e., 1862(d)(3), 1869(b) and (c), 1876(f) and 1879(d)).