BASIC (03-86)

A. General

When a request for review of an ALJ's decision is filed, the AC may deny or dismiss the request, or it may grant the request for review and either issue a decision or remand the case to the ALJ. If the AC decides to review a claim on its own motion, it may issue a decision or remand the case to an ALJ.

The AC will review a case on its own motion if:

1. There appears to be an abuse of discretion by the ALJ;

2. There is an error of law (including a possible misapplication or nonapplication of the administrative finality rules);

3. The action, findings or conclusions of the ALJ are not supported by substantial evidence; or

4. There is a broad policy or procedural issue that may affect the general public interest. Furthermore, once the AC has decided to review a case, it may review it de novo unless it states in its decision that a different standard is being used.

Call the matter to ODAR's attention by memorandum promptly if an ALJ decision cannot be effectuated because a basis for ODAR review clearly exists; the decision contains contradictory findings and/or conclusions (e.g., effectuation of one aspect of the decision would prevent effectuation of another aspect); or the decision is so vaguely worded as to make the ALJ's intent unclear (e.g., the date of onset is not specified.) Also, refer to ODAR any decision in which the ALJ clearly overlooked a material factor of eligibility or did not resolve the issue before him or her.

B. Effectuation or processing of AC actions

The appropriate DRS or ODO Recon Staff will process these cases where the AC dismissed or denied the review request, and there are no indications on the AC's transmittal (HA-505) that further ODO/PSC claims action is required. If an AC decision contains an absolute error which renders impracticable effectuation, prepare a memorandum to the AC following the guides in DI 42010.070.

To effectuate an AC decision, prepare an SSA-831-U5 or SSA-833-U5 as in DI 42010.020, except in item 2 of the SSA-831-U5 (Item 23 in SSA-833-U5): “Decision of Appeals Council  (Date of Decision)  ,” and change insert of paragraph C13 to “AC”.

Where the AC has remanded a case to the ALJ for hearing, the ALJ will either affirm, modify or reverse the prior decision. Process such decisions as in DI 42010.020 through DI 42010.040.

Handle subsequent materials and applications received in cases involving AC decisions in accordance with DI 42010.040. In applying the guides in DI 42010.020 through DI 42010.040 for AC cases, substitute “AC” or “AC Decision” where the reference “ALJ” or “ALJ Decision” is made.

C. SSI folders/SSI material that ODO receives in error after AC actions

The AC offices sometimes route the SSI material to ODO in error. ODO should immediately send the SSI folder or SSI material to the proper regional SSI effectuating component. The SSI folder or material should be specially flagged as relating to a favorable AC decision in need of effectuation. A copy of the AC decision should be included with the forwarded material.

D. Notification to DDS of AC reversal decision

If the AC has reversed any findings made by a DDS, send a photocopy of the decision to the DDS. Where the AC partly incorporates by reference ALJ findings of fact, also send a photocopy of the ALJ's decision. Do not send copies of short form AC reversals to DDS's.