I-3-1-50.Office of Quality Assurance and Performance Assessment Referrals of Favorable ALJ Decisions

Last Update: 9/08/05 (Transmittal I-3-36)

  1. The Office of Quality Assurance (OQA) reviews selected favorable ALJ decisions on claims for Title II and Title XVI disability benefits for possible referral to the Appeals Council for own motion consideration. If, after their review, which includes a review of the medical evidence by staff physicians, OQA decides to refer the case to the Appeals Council for own motion consideration, OQA will prepare a memorandum outlining the reasons for the referral.

  2. Review of OQA Cases

    See I-3-1-30 C. and D. regarding the standard of review and the time limit for own motion review.

  3. Own Motion Consideration

    All OQA referrals are sent to the OAO Executive Director's office which coordinates distribution to AAJs for own motion consideration.

    If the AAJ concurs with OQA's recommendation, he or she will provide the analyst with instructions necessary to prepare the action document. The case will then be hand carried to the Branch Chief of the branch responsible for the geographic and numerical jurisdiction. The Branch Chief will immediately control and assign the case to an analyst who will audit the hearing recording, if available, and prepare the action document. Upon completion of the document, the case will be hand carried back to the “A” member AAJ and then hand carried to the “B” member AAJ.

    A copy of the OQA referral will be provided to the claimant and representative, if any, in all cases in which the Appeals Council takes own motion review of the ALJ decision.

    If the AAJ decides that the Appeals Council should not take own motion review, the AAJ will send OQA a memorandum explaining the basis for the Appeals Council's action.

    In all OQA referrals, OAO branch staff will complete a Results Form indicating the Appeals Council's action. Copies of all Appeals Council interim and final actions, the Results Form and an updated CICS query (HA04) (effectuations only) should be sent to the Executive Director's Office.