I-3-9-5.Diligent Pursuit

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

Citations:

The Appeals Council may revise a determination or decision after the applicable time period specified in I-3-9-3 or I-3-9-4 expires if the Social Security Administration (SSA) begins an investigation into whether to revise the determination or decision before the applicable time period expires. SSA may begin the investigation either based on a request by the claimant or by an SSA action. The investigation is a process of gathering facts, after a determination or decision has been reopened, to determine if a revision of the determination or decision is appropriate.

A. Definition

Diligently pursued: Diligently pursued means that in light of the facts and circumstances of a particular case, the necessary action was undertaken and carried out as promptly as the circumstances permitted. Diligent pursuit will be presumed to have been met if SSA concludes the investigation and, if necessary, revises the determination or decision within 6 months from the date the investigation was begun.

B. Investigation Diligently Pursued to its Conclusion

If SSA has diligently pursued the investigation to its conclusion, the Appeals Council may revise the determination or decision. The revision may be favorable or unfavorable to the claimant.

C. Investigation not Diligently Pursued to its Conclusion

If SSA has not diligently pursued the investigation to its conclusion, the Appeals Council will only revise the determination or decision if a revision favorable to the claimant is warranted. The Appeals Council will not revise the determination or decision if it will be unfavorable to the claimant.