I-3-4-4.Party Who Requested Review Dies

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

A. General

The Appeals Council may dismiss a request for review if the party who files the request dies and certain other conditions are met.

B. Operating Procedure

1. Title II and Black Lung

The Appeals Council may dismiss a request for review if the party who filed the request dies while the request is pending and the Council has no information to show that another person may be adversely affected by the ALJ decision or dismissal.

The Appeals Council will not dismiss the request for review if a substitute party shows that he or she may be adversely affected by the ALJ decision. A substitute party is one who could be entitled to benefits under 20 CFR 404.503.

2. Title XVI

a. Dismissal Rules

The Appeals Council may dismiss a request for review when the supplemental security income (SSI) applicant or recipient dies if:

  • there is no eligible spouse;

  • there is no other surviving spouse or parent of an SSI child who could receive an underpayment and who wishes to pursue the request for review; and

  • the applicant or recipient did not authorize interim assistance reimbursement (IAR) to a State pursuant to section 1631(g) of the Social Security Act (the Act).

b. Qualified Individual

An eligible spouse, or other surviving spouse or parent who shows that he or she may potentially qualify to receive an underpayment due the deceased applicant or recipient, may pursue the request for review as a qualified individual. See section 1631(b) of the Act regarding who may qualify to receive an underpayment.

c. IAR Authorization

A State or a political subdivision may not pursue the claim of a deceased applicant or recipient as a qualified individual. However, even if there is no qualified individual, the Appeals Council may not dismiss a request for review if there is an IAR authorization in effect, but will either grant or deny the request for review.

d. Medicaid Determinations After Death

Medicaid eligibility determinations often flow from SSI eligibility determinations. When the Social Security Administration is not required to issue an SSI eligibility determination or decision, Medicaid determinations, appeals and payments are the responsibility of the State. Even if there are unpaid medical expenses, the Appeals Council will dismiss a request for review if there is no information showing the existence of a person who may pursue the SSI claim as a qualified individual and there is no IAR in effect. If a survivor, who is not a qualified individual as specified above, wishes to pursue Medicaid eligibility, the survivor must contact the appropriate agency of the State which administers the Medicaid program.

C. Preparing Recommendation to the Appeals Council

1. A Proper Substitute Party or Qualified Individual Wishes to Continue the Appeal or an IAR Was In Effect

Consider the case on its merits. (See I-3-1, Workup of Case by Analyst).

2. No Proper Substitute Party or Qualified Individual Wishes to Continue the Appeal and no IAR Was In Effect

Complete forms HA-52 and HA-52A or the computerized disability fact sheet. Explain in narrative form that there is no adversely affected individual (Title II and black lung). For Title XVI cases, explain in narrative form that there is no party who could qualify to receive an underpayment and no indication of an IAR agreement in effect. Prepare an Appeals Council Dismissal Order. See Appeals Text Guide.

3. If Record Unclear as to Proper Substitute Party or Qualified Individual

If the analyst learns that the party who filed a request for review has died and cannot determine, either from the notice of death or from any information in the claim file, whether there is a substitute party or qualified individual, the analyst will:

  • contact the representative, if any, for information concerning a possible substitute party or qualified individual; or

  • if there is no representative, prepare a memo to the servicing FO and a draft appointment form. See Appeals Text Guide.