2000.Administrative Review Process

2000.1What does this chapter cover?

This chapter provides a general description of the administrative review process and explains the rules for reopening determinations and decisions after they become final. Exceptions to these rules apply under certain circumstances. Where the exceptions apply, individuals are made aware of them in the notice of the determination or decision.

2000.2What is the administrative review process?

The administrative review process provides for an appeal if you are dissatisfied with our initial determination concerning your entitlement or continuing entitlement to benefits, or other matters. After we make an initial determination, we may request further information from you or another person who disagrees with our determination or shows in writing that his or her rights may be adversely affected by the initial determination.

2000.3What are the steps in the administrative review process?

The administrative review process consists of several steps that must be requested in writing, usually within specified time periods (see §2001), and in the following order:

1. In most states, you may request that the initial determination be reconsidered. Reconsideration is a re-examination of the administrative record in your case and an opportunity to submit additional evidence that results in a reconsidered determination;

2. If you disagree with the reconsidered determination or initial determination in some states, you may reques a hearing before an Administrative Law Judge (ALJ) of the Office of Disability Adjudication and Review;

3. If you disagree with the ALJ's decision or dismissal, you may request a review by the Appeals Council of the Office of Disability Adjudication and Review.

4. If you are dissatisfied with the Appeals Council's action, you may be able to file a civil action in a Federal district court.

The written request for further review at any step of the administrative appeals process may be on a special form, available at any Social Security office, or it may be in a letter. This request may be filed at any Social Security Office, the Department of Veterans Affairs (VA) Regional Office in the Philippines, or an office of the Railroad Retirement Board, if the claimant has 10 or more years of service in the railroad industry. If you received a disability determination finding you do not meet our medical criteria and wish to file a request for reconsideration or a request for hearing, you now have the option of filing your appeal via the internet (https://secure.ssa.gov/apps6z/iAppeals/ap001.jsp).

2000.4What is the expedited appeals process?

In certain cases, at the reconsideration level or higher where the determination has not become final, you may use the expedited appeals process. This process permits you to go directly to a Federal district court if the only issue is the constitutionality of a provision of the Social Security Act that prevents the payment of benefits or receiving a favorable determination in a non-claim earnings discrepancy case. The Social Security office can advise you or your authorized representative of the exact requirements and procedure for requesting this process. (See also §2001 for time limit for requesting the expedited appeals process.)