I-2-0-60.Good Cause for Late Filing

Last Update: 5/1/17 (Transmittal I-2-202)

Citations:

20 CFR 404.911, 416.1411, and Social Security Ruling 91-5p

A. Considerations When Evaluating Good Cause

When evaluating whether a claimant has shown good cause for missing a deadline to request a hearing, an administrative law judge (ALJ) considers whether:

  • Circumstances kept the claimant from making the request on time;

  • The claimant did not understand the requirements of the Social Security Act (Act) because of amendments to the Act, other legislation, or court decisions; and

  • Agency action(s) misled the claimant; or

  • The claimant had any physical, mental, educational, or linguistic limitations (including any lack of facility with the English language) which prevented him or her from filing a timely request or from understanding or knowing about the need to file a timely request for review.

NOTE:

When evaluating good cause determinations for a late filing of a statutory benefit continuation (SBC) election, if the request for a hearing is filed within the 60-day appeal period, and the SBC election is received after the 15-day period, the field office (FO) will determine good cause for late filing of the SBC election. If both the requests for hearing and SBC election are filed more than 60 days after the date of receipt of the notice of the reconsidered determination, an ALJ will determine whether good cause exists for late filing of both the request for hearing and the election of SBC. The FO will route the appeal and SBC election request to the hearing office (HO) and request that an ALJ make a good cause determination. The HO will notify the FO about an ALJ's good cause determination via an Assistance Request (AR) specifying that a memorandum containing the pertinent information is posted in eView for FO review and action (or, for paper cases, via email to the FO email address specifying that a memorandum containing the pertinent information is posted to the Electronic Non-Medical (ENM) application). See Program Operations Manual System DI 12027.008.

B. Examples

An ALJ must evaluate whether a claimant has shown good cause based on the circumstances of the case. Examples of when good cause for late filing may exist include, but are not limited to, the following:

  • The claimant was seriously ill and was prevented from contacting the Social Security Administration (SSA) in person, in writing, or through a friend, relative, or other person;

  • There was a death or serious illness in the claimant's immediate family;

  • Important records were destroyed or damaged by fire or other accidental cause;

  • The claimant was trying very hard to find necessary information to support his or her claim but did not find the information within the stated time periods;

  • The claimant asked us for additional information explaining our action within the time limit, and within 60 days of receiving the explanation the claimant requested reconsideration or a hearing;

  • SSA gave the claimant incorrect or incomplete information about when and how to request administrative review;

  • The claimant did not receive notice of the determination;

  • The claimant sent the request to another government agency in good faith within the time limit, and the request did not reach SSA until after the time period had expired;

  • Unusual or unavoidable circumstances existed which show that the claimant could not have known of the need to file timely, or which prevented the claimant from filing timely; or

  • The claimant relied on a representative to timely file a request, and the representative failed to do so.

NOTE:

An ALJ must not infer good cause for late filing merely because a claimant has a representative, but must consider a claimant's good cause statement indicating reliance on a representative. If a representative has a pattern of filing untimely appeals, or the claimants of a particular representative develop a pattern of submitting good cause statements for late filing citing reliance on the representative, an ALJ will consider whether circumstances warrant a referral to the Office of the General Counsel (OGC) as a possible violation of our rules. See Hearings, Appeals and Litigation Law (HALLEX) manual I-1-1-50 for instructions on making referrals to OGC.

C. Developing Good Cause

If there is no evidence in the claim file indicating the reason for the late filing, send the claimant and the claimant's representative a letter requesting an explanation. Place a copy of the communication sent to the claimant in the claim file as an exhibit.

If the file is paper, ask the servicing field office to forward any pertinent information in its files, e.g., any letter or communication from the claimant, representative, or the claimant's family, a copy of any records containing information regarding pertinent contacts, etc. If the case is electronic, look in the electronic claim(s) file for any new pertinent information that may have been entered by another office.

D. Hearing on Issue of Good Cause

The ALJ may also elect to hold a hearing for the sole purpose of obtaining information on the issue of good cause for untimely filing.

To avoid confusion about the nature of the hearing, the notice of hearing on a good cause issue alone must be limited to that issue. The notice must indicate that it is not a hearing on disability issues.

  • If good cause does not exist, then the request for hearing should be dismissed as the ALJ has no jurisdiction. See HALLEX I-2-4-15.

  • If the ALJ finds that the claimant had good cause for his or her untimely filing, the case will be returned to Master Docket for further processing.