I-3-1-1.Filing a Request for Review

Last Update: 4/28/16 (Transmittal I-3-140)

A. General

If a claimant is dissatisfied with an administrative law judge's (ALJ) decision or order of dismissal, the claimant may request that the Appeals Council (AC) review the decision or action. The claimant must submit the request in writing within 60 days after receipt of the ALJ's decision or dismissal by completing form HA-520, Request for Review of Hearing Decision/Order, or by submitting a letter or other written document requesting review. The AC presumes the claimant received the notice of the ALJ's decision or dismissal five (5) days after the date of the notice, unless there is a reasonable showing to the contrary.

NOTE 1:

The claimant may specifically ask for a review or may imply that they are requesting review. A request for review is implied when the claimant expresses disagreement or dissatisfaction with the ALJ's action or states the intent to pursue appeal rights.

NOTE 2:

While a writing is required to request review, the regulations do not require that the writing be signed. See 20 CFR 404.968 and 416.1468.

NOTE 3:

If a request for review is submitted prematurely (i.e., the hearing office action is not complete on a case), see the instructions in Hearings, Appeals and Litigation Law (HALLEX) manual I-3-4-6. If a case was established in the Appeals Review Processing System, but there appears to be no request for review associated with the record, see the instructions in HALLEX I-3-4-10.

The HA-520 advises that if the claimant:

  • Has additional evidence, they must inform the AC or submit it with the request for review unless they request an extension of time to submit it;

  • Needs additional time to submit evidence or legal argument, the claimant must request an extension of time on the form;

  • Neither submits evidence or legal argument with the request for review nor within any extension of time the AC grants, the AC will take its action based on the evidence of record.

B. Who May Request Review

The claimant, or their appointed representative (or representative payee), can file a request for review.

If a third party files the request for review on behalf of the claimant and it is unclear whether the claimant is aware of the pending appeal, additional action may be necessary. Depending on the circumstances, staff assisting the AC may need to contact the claimant to notify the claimant of the appeal and determine whether the claimant wants to proceed with the appeal. In other instances, assisting staff may need to contact the claimant to inquire whether the claimant was attempting to appoint the third party as a representative. For more instruction, see HALLEX I-3-4-5.

NOTE 1:

In all cases, unless the claimant has authorized the release of information to a third party in writing (see HALLEX I-1-4-3 E), the AC will not provide the third party with any information relating to the receipt or processing of the request for review.

NOTE 2:

If the claimant is deceased, the AC can dismiss a request for review filed by a third party if there is not an eligible substitute party to pursue the claim. See HALLEX I-3-4-4.

C. Where to File

A claimant must generally file the request for review at a Social Security field office (FO), at a hearing office (HO), or directly with the AC. However, please note the following:

  • A claimant residing in the Philippines may file the request at the Department of Veterans Affairs Regional Office (RO) in the Philippines.

  • A claimant with ten or more years of service in the railroad industry may file a request for review at a Railroad Retirement Board (RRB) office.

  • A claimant residing in a foreign country may file a request with an office maintained by the Foreign Service of the United States Department of State.

D. Date of Filing Request for Review

Ordinarily, the AC considers a request for review filed as of the date it is received in any Social Security Administration (SSA) office. If the 60-day time period for filing a request for review ends on a Saturday, Sunday, Federal holiday, or other non-workday for Federal employees, the AC extends the time for filing to the next full workday. The AC also accepts as the date of filing:

  • The U.S. Postal Service stamp cancellation or “postmark” date on the envelope in which the request is mailed, if using the date of receipt would result in the loss of the claimant's rights. If the postmark is unreadable or there is no postmark, the AC considers the request timely filed if received by the 70th day after the date on the notice of the ALJ's decision or dismissal. The AC will also consider other evidence of when the individual mailed the request for review;

  • The date the request is received at the Department of Veterans Affairs RO in the Philippines or by an employee of that Department in the Philippines authorized to receive such request at a place other than the RO; or

  • The date the RRB receives the request, if an individual having 10 or more years of service in the railroad industry files the request.

E. Extension of Time to Request Review

1. General

If a claimant does not file the request for review within the 60-day time period, the claimant must explain the reason for the late filing in writing. The AC will also consider any information provided by the FO or HO. If the AC concludes that good cause for the untimely filing is established, it will extend the time period to request review.

If the AC finds good cause, it will note the finding in the AC action document. If good cause is not established, the AC may dismiss the request for review. See HALLEX I-3-4-2.

2. Considerations When Evaluating Good Cause

When evaluating whether an individual has shown good cause for missing a deadline to request review, the AC considers whether:

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

  • Agency action misled the individual;

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

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

3. Examples

The AC must evaluate 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 claimant was seriously ill and was prevented from contacting 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;

  • There were mailing delays, including central print process or U.S. Postal Service delays, causing the claimant to not receive the notice of the ALJ's decision or dismissal on time. For more information regarding central print mailing times at the hearings level, see HALLEX I-2-0-80;

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

  • The claimant was trying very hard to find necessary information to support their 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, or within 30 days of receiving the explanation the claimant requested AC review or filed a civil suit;

  • 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 or decision;

  • 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 exist 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:

The AC 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 established 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, the AC will consider whether circumstances warrant a referral to the Office of the General Counsel (OGC) as a possible violation of our rules. See HALLEX I-1-1-50 for instructions on making referrals to OGC.

For additional examples and information, see Social Security Ruling 91-5p, Policy Interpretation Ruling Titles II and XVI: Mental Incapacity and Good Cause for Missing the Deadline to Request Review and Acquiescence Ruling 90-4(4), Culbertson v. Secretary of Health and Human Services,859 F.2d 319 (4th Cir. 1988); Youngv. Bowen, 858 F.2d 951 (4th Cir. 1988) – Waiver of Administrative Finality in Proceedings Involving Unrepresented Claimants Who Lack the Mental Competence to Request Administrative Review – Titles II and XVI of the Social Security Act.