Audience:

:

Citations:

20 CFR 404.902 - 404.905, 416.1402 - 416.1405
20 CFR 404.987 - 404.996, 416.1487 - 416.1494

BASIC (06-08)

Citations:

20 CFR 404.902 – 404.905, 416-1402 – 416.1405, 404.987 – 404.996, 416.1487 – 416.1494

A. Definitions

1. Reopening

A formal review of an administratively final determination or decision to admit new and material evidence; or, where error is involved, a reevaluation of the evidence used in a prior determination or decision.

NOTE: The term “determination” refers to adjudications at the initial and reconsideration levels, and “decision” refers to adjudications at the Administrative Law Judge (ALJ), Appeals Council (AC), and Court levels.

2. Revision

Any change in the end result or basis of a final determination or decision.

3. Final Determination or Decision

A determination or decision (initial or revised) is final as of the date of the notice unless:

1. it is timely appealed (or a civil suit is filed); or

2. it is appealed late but good cause for late filing of an appeal or civil suit is found; or

3. the AC takes jurisdiction on its own motion within 60 days of the date of the ALJ decision; or

4. the AC denies a request for review (does not issue a decision), in which case the ALJ decision is the final decision as of the date of the notice that the AC denied review; or

5. it is reopened and revised.

NOTE: The Form SSA-L1157-U2- DI Medical Requirements Met / Non Medical Requirements To Be Determined, is an interim notice and is not a final notice.

B. References to Related Policy

1. Late Filing of an Appeal

Appeal Filing Issues (DI 27010.001)

2. Rules for Reopening

Conditions for Reopening a Final Determination or Decision (DI 27505.001)

3. Medical Improvement Review Standard (MIRS)

Cases Where MIRS Applies (DI 28005.001D.1.)

4. Adoption of the Prior Determination or Decision

Collateral Estoppel – General (DI 27515.001)

5. Refilings for the Same Period (Res Judicata)

Refilings for the Same Period (Res Judicata Cases) (DI 27516.001)

6. Period Adjudicated

Period Covered by a Final Determination or Decision: “Period Adjudicated” (DI 27510.001)

7. Reopening and Revision of a CDR Determination

Reopening in Continuing Disability Cases (DI 28501.015)

8. Good Cause

Good Cause for Reopening (DI 27505.010)