I-1-10-1.Subsequent Applications and Social Security Ruling 11-1p
Last Update: 8/26/13 (Transmittal I-1-67)
A. General
On December 30, 1999, the Social Security Administration (SSA) issued instructions allowing a claimant to file a subsequent application when a request for review was pending before the Appeals Council (AC). However, SSA required that onset in any subsequent application be limited to the period beginning the day after the date of the administrative law judge's (ALJ) decision on the prior claim.
On July 28, 2011, SSA issued Social Security Ruling (SSR) 11-1p: Titles II and XVI: Procedures for Handling Requests to File Subsequent Applications for Disability Benefits. The SSR generally precludes SSA from accepting a new disability application if the claimant has a prior disability claim for the same title and benefit type pending at any level of administrative review, unless the prior claim is pending at the AC and the claimant has evidence of a new critical or disabling condition with an onset after the date of the hearing decision.
If a claimant wants to file a new disability application under the same title and of the same type as a disability claim pending at the AC but does not have evidence of a new critical or disabling condition, the claimant must choose to continue the appeal of the prior claim or ask in writing to withdraw the appeal and file a new application. For additional information, see Program Operations Manual System (POMS) DI 51501.005.
B. When SSR 11-1p Applies
1. Subsequent Applications Before July 28, 2011
SSR 11-1p does not apply to subsequent applications filed before July 28, 2011. If a subsequent application was filed before that date, hearing offices (HO) and the AC will process the subsequent application using the applicable procedures in HALLEX I-1-10.
2. Subsequent Applications After July 28, 2011
a. When SSR 11-1p applies
For claims filed after July 28, 2011, SSR 11-1p applies when:
a claimant has a claim pending at any level of administrative review, and
the claimant wants to file a new claim under the same title of the Social Security Act and for the same benefit type.
Though a claimant is generally precluded from filing an application in these circumstances, as discussed in HALLEX I-1-10-1 C below, a claimant may request an exception to the policy in SSR 11-1p.
b. When SSR 11-1p does not apply
Despite SSR 11-1p, there are several circumstances under which a claimant may still file a subsequent application. A claimant may still file a subsequent application if a prior claim is pending at the AC and the subsequent application is:
under a different title; or
under the same title, but for a different benefit type (e.g., the claimant wants to file a new title II disabled widow(er)'s benefit application and the claimant has a claim pending for title II disability insurance benefits).
NOTE 1:
If a claimant files a new title XVI application while a prior title II disability claim is pending administrative review, the field office (FO) will take the title XVI application and treat it as a new application for all title II benefits. A title XVI application is also an application for title II that requires adjudication. For more information, see POMS DI 51501.001C.
A claimant may also file a subsequent application if the prior claim is:
a continuing disability review;
an expedited reinstatement claim;
an age 18 redetermination;
in Federal court or was remanded from Federal court to the hearing or AC level; or
a fraud redetermination (see HALLEX I-1-3-25).
NOTE 2:
SSR 11-1p also does not apply when the AC takes own motion review on an ALJ decision. The SSR only contemplates situations in which the claimant chooses to pursue an appeal of the prior claim at the AC level.
C. Exception to SSR 11-1p Policy
If the prior claim is pending at the AC, and a claimant has evidence of a new critical or disabling condition with onset after the date of the hearing decision, the claimant may request to file a new application.
A “new” critical or disabling condition generally means that onset occurred after the date of the hearing decision on the prior claim. Though not exhaustive, SSA considers any condition that meets the criteria of a listed impairment or meets the criteria under Terminal Illness (TERI), Compassionate Allowances (CAL), or Presumptive Disability/Presumptive Blindness (PD/PB) a “critical or disabling condition.”
If the claimant requests an exception to file a new disability application while a request for review is pending, the AC, through the Office of Appellate Operations (OAO) Executive Director's Office (EDO), must approve the request before the claimant can file a new application. If the EDO does not approve the request, the claimant may not file a new application until the AC completes its action on the request for review of the prior claim or the claimant chooses to withdraw the request for review, as explained in HALLEX I-3-4-3.
NOTE:
1. How Exception Requests are Submitted
Exception requests may be submitted in any of the following ways:
A representative or claimant may submit an exception request to the FO. The FO follows the procedures in POMS DI 51501.015C to notify the EDO of the request.
A representative or claimant may contact the AC via telephone to submit an exception request. Telephone requests are handled by OAO's Claimant and Public Assistance Branch (CPAB) at 877-670-2722, using the same general procedures noted in POMS DI 51501.015.
A representative or claimant may submit a written request directly to the AC. However, these requests are discouraged due to delay in processing time. See HALLEX I-1-10-1 C.3. below.
NOTE:
Some members of the public may submit a written request to an OAO email box. Due to firewall and privacy issues, the EDO will not reply by email to members of the public. To avoid significant delay in processing or misrouting exception requests, the staff handling the email account should notify the individual by telephone that future requests should be directed to the FO or CPAB.
2. EDO Response to Exception Requests
The EDO generally evaluates and responds to exception requests from the FO or CPAB within two days. After the EDO evaluates the request, an email response is sent to the FO or CPAB, the file and eView are documented (when applicable), and the EDO enters one of the following case characteristics into the Appeals Review and Processing System (ARPS):
SUBN (Subsequent Application Not Permitted)
SUBR (Subsequent Application Permitted)
When the EDO is notified of a written request that was submitted directly to the AC (see HALLEX I-1-10-1 C.3. below), the EDO will act on the request as soon as possible to avoid further delay. After reviewing the request, the EDO will determine the appropriate method to notify the representative or claimant of the exception decision.
3. Branch Actions When Exception Is Submitted to Branch or a New Application Is Pending Without Approved Exception
a. Exception Requests
If a representative or claimant submits a written exception request directly to the AC, the person who first identifies the request must immediately make a notation in the "remarks" section in ARPS and send an email to ^DCARO OAO. The email must include the claimant's name, Social Security Number (SSN), and a brief explanation, specifically noting the location of the written request in the file. The EDO will review the request, and direct the processing branch to notify the representative or claimant of the exception decision.
b. Erroneous Subsequent Applications
OAO produces a monthly report to identify cases where a subsequent application was erroneously accepted after July 28, 2011 (i.e., the subsequent application is for the same title and benefit type as the case pending with the AC, and there is no case characteristic for an exception noted in ARPS). This report is used to notify the FO regarding erroneous subsequent applications. OAO staff does not need to separately notify the FO if an analyst or adjudicator discovers an erroneous subsequent application.
The FO will continue processing the subsequent application if an initial determination has been issued. If the subsequent application has reached the hearing level and the AC action is still pending, the HO will handle the claim as outlined in HALLEX I-1-10-5. The analyst will add a remark in ARPS and continue processing the request for review using the procedures in HALLEX I-1-10-25 or I-1-10-30. The AC will not add a SUBN or SUBR case characteristic to these cases. However, if the subsequent claim is pending at the hearing level, the AC will add a SUBA (R/H of Sub App Pending in HO) case characteristic.
D. When Priority Processing Is Warranted
If the claimant files a subsequent application while a prior claim is pending before the AC, the EDO may designate priority processing on the prior claim. As noted below, these cases are identified with either a critical processing case characteristic or an internal AC priority processing case characteristic in ARPS.
The AC gives priority processing based on a subsequent application in the following situations:
New and material evidence is submitted that relates to the period on or before the date of the hearing decision and shows a critical or disabling condition (CAL or TERI case characteristic);
New evidence is submitted that shows a new critical or disabling condition after the date of the hearing decision (CAL or TERI case characteristic);
The State agency finds the claimant disabled based on a subsequent application (SUBC case characteristic); or
The subsequent application is pending at the hearing level (SUBA case characteristic).
The AC gives priority processing to subsequent allowances to mitigate the possibility of overpayments.
Additionally, the AC gives priority processing to subsequent applications pending at the hearing level because the HO cannot schedule a hearing or issue a decision until the AC acts on the prior claim. Priority processing helps reduce the likelihood of these cases becoming “aged” at either the HO or AC level.