SSR 63-41: SECTION 205(b); 221(d). -- RIGHT TO HEARING

20 CFR 404.937(a)

SSR 63-41

A worker's claim for a period of disability and disability insurance benefits was disallowed. The disallowance was upheld by decision of a hearing examiner and ultimately by a Federal court. The worker later filed a new claim for a period of disability and disability insurance benefits, which also was disallowed, and a hearing on the new claim was timely requested. As a result of amendments to the Act, an dew issue arose in connection with the later claim. Held, the worker was entitled to a hearing on the new issue in the later claim.

X, a worker, filed application on July 7, 1957, for a period of disability and disability insurance benefits, and alleged that he had been under a disability since August 15, 1954. Among the requirements for a period of disability and for disability insurance benefits, the claimant must have had disability insured status while under a disability as defined in the Act, and his disability must have continued without interruption until his application was filed. In this case, X had such disability insured status on August 15, 1954 (the date he alleged as the date his disability began), and continued to have such status through June 30, 1955. Thus, to be entitled to the benefits claimed, he must have been under a disability beginning on or before June 30, 1955, and the disability must have continued without interruption through the application date (July 7, 1957). Based on a finding that he was not under a "disability" as defined in the Act, his claim was disallowed and he was notified of such disallowance by letter dated October 26, 1957.

From this initial determination of his claim, X appealed unsuccessfully through the prescribed levels of administrative appeal, which included a hearing and decision by a hearing examiner and a review by the Appeals Council. Having exhausted his administrative remedies, X brought an action in a Federal district court, for judicial review of the Department's decision. The court affirmed that decision. He did not appeal from the judgment of the court.

On August 1, 1961, X filed another claim for a period of disability and for disability insurance benefits, and again alleged that he had been under disability since August 15, 1954. He had done no work since the latter date; the only evidence he submitted in connection with his claim was a statement from his physician. This statement merely repeated information previously given by this same physician and considered in connection with X's 1957 claim.

A change in the disability provisions of the Act, made by the Social Security Amendments of 1958, had meanwhile liberalized the requirements for disability insured status. As a result of this change, X's disability insured status did not end until June 30, 1956, for purposes of his 1961 claim. To become entitled on this claim, X must have been, as of June 30, 1956, or earlier, under a disability which continued without interruption through August 1, 1961, the date his new claim was filed. The new claim was disallowed, based on a finding that this requirement had not been met. Upon reconsideration requested by X, the disallowance was affirmed. X then filed request for a hearing on July 16, 1962.

The question raised at this juncture is whether X is entitled to a hearing on his second claim.

Regulations No. 4, § 404.937, provides that a hearing examiner may, on his own motion, dismiss a hearing request, either entirely or as to any stated issue, under certain circumstances, including:

* * * (a) Res judicata. -- Where there has been a previous determination or decision by the Secretary with respect to the rights of the same party on the same facts pertinent to the same issue or issues which has become final either by judicial affirmance or, without judicial consideration, upon the claimant's failure timely to request reconsideration, hearing, or review, or to commence a civil action with respect to such determination or decision (see §§ 404.911, 404.918, 404.946, and 404.951). * * *

Res judicata, under this regulation, does not apply unless the second claim involves the same party, rights, issues and material facts as those in the prior decision. In connection with the 1961 claim the time during which the claimant had a disability insured status was extended because of the liberalized provision of law. Thus, there had been no prior decision on the issue of whether the claimant was under a disability, as defined in the law, which began at any time when he had such extended insured status, i.e., July 1, 1955 through June 30, 1956, and continuing through the filing date of the last application. Since there is a new issue involved, it is held that X has a right to hearing on the merits of the claim filed in 1961, and dismissal of the request for hearing is not appropriate.

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