2000. Administrative Review Process

2000.1 What does this chapter cover?

This chapter provides a general description of the administrative review process and explains the rules for reopening determinations and decisions. 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.

Note: For information concerning the hospital and medical insurance review process, see Chapter 24. See Chapter 21 for information concerning the supplemental security income (SSI) review process.

2000.2 What is the administrative review process?

The administrative review process provides for an appeal if you are dissatisfied with our action 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 shows in writing that his or her rights may be adversely affected by the initial determination.

2000.3 What 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. You may request that the initial determination be reconsidered. Reconsideration is a re-examination of the administrative records and an opportunity to submit new and material evidence that results in another determination;

2. If you disagree with the reconsidered determination, you may request 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. If you are dissatisfied with the Appeals Council's action, you may file a civil action in a Federal district court.

2000.4 What 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.)

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.

Last Revised: Jul. 10, 2006