SSR 78-15: Title XVI Reconsideration Step of the Administrative Appeals Process—Change in Time Frame in Which a Claimant Can Request Reconsideration of an Initial Determination
To set out a new policy with respect to title XVI reconsideration requests related to the period of time within which a claimant can request reconsideration of a title XVI initial determination.
Program Simplification Proposal dated May 19, 1975. House and Senate Committee Reports regarding H.R. 10727 (Public Law (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. 16, section 416.1410.
The period of time currently allowed for requesting a reconsideration of a title XVI determination is 30 days from the date of receipt of notice of the initial or revised determination. This administrative policy has been in effect since the inception of the title XVI program, January 1, 1974. (Regulations No. 16, Section 416.1410, Subpart N.)
The 30-day time frame for requesting reconsideration was established to reflect a common approach with the 3-day period within which a claimant may request a hearing as previously provided by statute (Section 1631(c)(1) of the Social Security Act).
The Social Security Administration (SSA) established a title II administrative procedure of conforming the reconsideration time frame to the hearing time frame in 1940 when the reconsideration step 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 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 authorized. Therefore, if a claimant had been limited to less than 6 months (e.g., 3 months) within which to request 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 may not have 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 period for the two levels; i.e., reconsideration and hearing. This policy was subsequently applied also by SSA to title XVIII and the black lung benefit program. Furthermore, the title XVI appellate structure evolved from the earlier title II pattern: the reconsideration time frame for title XVI duplicated the statutory 30-day hearing time frame.
The enactment of P.L. 94-202 (January 2, 1976) makes the titles II, XVI, XVII, and black lung part B appellate processes uniform and extends the title XVI hearing time frame to 60 days from the date of receipt of the notice of a determination. Therefore, the change from 30 days to 60 days for a title XVI reconsideration will conform to the hearing time frame as enacted.
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 19, 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 indicates that Congress intended the legislative action of P.L. 94-202 to embrace both time frames even though the reconsideration step of the appeals process is administrative and not dealt with 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 its report of May 19, 1975.
The alleviation of public confusion as well as improvement in administrative handling of appeals is expected by the implementation of this policy. Additionally, the adoption of a uniform time frame for all reconsideration will provide more efficient processing when an issue at question is common to title II, XVI, and XIII. (The policy recommendation to change the titles II, XVIII, and black lung part B reconsideration time frame from 6 months to 60 days will be promulgated under separate cover.)
POLICY DIRECTIVE STATEMENT:
Reconsideration is a mandatory administrative appeals process and a condition precedent to a hearing (except for appeals involving cessation of blindness or disability due to medical improvement). A claimant (or the claimant's representative) who is dissatisfied with an initial or revised title XVI determination may request reconsideration of such determination if the request is filed within 60 days (rather than 30 days) after receipt of notice of such determination or the determination made by SSA will become final. For purposes of effectuating administrative actions flowing from an initial determination, the party shall be presumed to have received the notice within 5 days from the date thereon, unless there is a reasonable showing to the contrary.
Claims Manual section 13613.