DI: Disability Insurance
A. Policy – Time Limit Considerations for SBC
The individual must request SBC of cash benefits or Medicare within 10 days of receipt of the notice, either at the initial or reconsideration level of medical cessation or a medical adverse reopening/revision determination. A request for SBC establishes the claimant’s intent to appeal; see DI 12026.015B
Presume that the notice was received 5 days from the actual notice date, unless there is reason to believe otherwise. (15-days from the date of notice, i.e., 10 days plus 5 days mail time.)
Separate SBC elections are required at both the reconsideration and Administrative Law Judge (ALJ) hearing levels.
The individual may change election options only within the 10-day timeframe, but may request to stop receiving SBC at any time.
NOTE: If he/she declines SBC during the specified 10-day period after the initial cessation, the individual will not have the opportunity to elect SBC again until he/she receives the notice of reconsideration determination on his/her disability appeal.
An election remains effective until a new determination or decision on the current appeal is issued.
The 60-day period for requesting reconsideration or an ALJ hearing is not affected.
See GN 03101.010 about time limits for filing an appeal.
B. Policy - Late Election of SBC and Good Cause
A request for SBC is late if it is after the 10-day period (15 days from the date of the notice presuming the receipt of notice is 5 days from the notice date). Consider a late election timely only if good cause for late election is established.
The field office (FO) will develop good cause for extending the SBC time limit and prepare a good cause determination if the SBC election filing of the request is after the 10-day period at the reconsideration level. Follow GN 03101.020A, GN 03101.020B, and GN 03101.020C for determining good cause for extending the time limit to request SBC.
The FO will determine good cause for late filing of the election of SBC at the hearing level only when an election for SBC is made beyond the 10-day period, and the hearing is filed within 60-day period.
The ALJ will determine good cause for late filing of the election of SBC if both the requests for hearing and election for SBC are filed more than 60 days after the date of receipt of the notice of the reconsidered determination. The Hearing Office (HO) will notify the FO about the ALJ’s good cause determination via memorandum or e-mail.