Background

This transmittal amends chapter I-1-3 in the Hearings, Appeals and Litigation Law (HALLEX) manual. The amendments to the chapter update existing instructions and add new instructions. The new instructions include several new sections setting forth the general policy for the Office of Disability Adjudication and Review (ODAR) to refer suspected criminal violations and adjudicate cases involving an issue of fraud or similar fault.

Explanation of Content and Changes

I-1-3-9 – We added a new NOTE cross-referencing new provisions and made other minor editorial changes.

I-1-3-15 – We added a new section titled “Adjudicating Fraud or Similar Fault Issues.” We incorporated information previously in Temporary Instruction I-5-1-15. We define fraud and similar fault, and explain the standard of proof used when adjudicating a fraud or similar fault issue. We also explain how an adjudicator will consider evidence in a case involving fraud or similar fault.

I-1-3-18 – We added a new section titled “Submitting a Referral For Investigation of Possible Fraud or Similar Fault Discovered During Disability Claim Adjudication—Administrative Law Judges.” We incorporated and updated information previously in Temporary Instruction I-5-1-15. In the section, we explain when an administrative law judge will request an investigation and how to request an investigation. We also explain what an administrative law judge will do if the issue is raised after a decision is issued.

I-1-3-21 – We added a new section titled “Submitting a Referral For Investigation of Possible Fraud or Similar Fault Discovered During Disability Claim Adjudication—Appeals Council.” We incorporated and updated information previously in Temporary Instruction I-5-1-15. In the section, we explain when the Appeals Council will request an investigation and how to request an investigation. We also explain what the Appeals Council will do if the issue is raised after a final action.

Date: May 13, 2014