TN 4 (04-14)

Citations:

Social Security Ruling (SSR) 11-1p: Titles II and XVI: Procedures for Handling Requests to File Subsequent Applications for Disability Benefits

Effective July 28, 2011, we no longer accept a new disability application while the claimant has a prior disability claim for the same title and benefit type pending at any level of administrative review. However, if the prior claim is pending at the Appeals Council (AC) and the claimant has evidence of a new critical or disabling condition with an onset after the date of the administrative law judge (ALJ) hearing decision, the claimant may request to file a new disability application. See DI 51501.001E in this section.

A. When SSR 11-1p applies

Beginning July 28, 2011, this procedural change applies when:

• A claimant has a prior disability claim pending at any level of administrative review; and

• The claimant wants to file a new disability application under the same title of the Social Security Act and for the same benefit type.

References:

• DI 51501.005 Claimant Requests to File a New Disability Application

• DI 51501.020 Claimant Asks to Withdraw a Pending Appeal

B. When SSR 11-1p does not apply

This procedural change does not apply to subsequent disability applications (same title, same benefit type) with a protective filing date before July 28, 2011.

Also, this procedural change does not apply if the prior claim is:

• for a different title;

• for the same title, but for a different benefit type (e.g., claimant wants to file a new Title II disabled widow(er)’s benefit application and the claimant has a claim pending for Title II disability insurance benefits);

• a continuing disability review;

• an expedited reinstatement (EXR) claim;

• an age 18 medical redetermination; or

• in Federal court or was remanded from Federal court to the hearing or AC level.

NOTE: See DI 51501.001C and DI 51501.001D in this section when a claimant files a new application under a different title while a prior claim is pending administrative review.

C. Processing a new Title XVI disability application while a prior Title II disability claim is pending administrative review

If a claimant files a new Title XVI application while a prior Title II disability claim is pending administrative review, take the Title XVI application and treat it as a new application for all Title II benefits. A Title XVI application is also an application for Title II that requires adjudication per SI 00601.035, Adjudicating Title II When a Title XVI Application Is Filed.

1. Prior Title II disability claim pending at the reconsideration level

If the prior Title II disability claim is pending at the reconsideration level, treat the new Title II disability application as a duplicate claim and follow the instructions in DI 12045.030.

2. Prior Title II disability claim pending at the ALJ hearing level

• If the prior Title II disability claim is pending at the ALJ hearing level, forward any new evidence to the ALJ.

• Treat the new Title II disability application as a duplicate claim. See DI 12045.035, Same Title Claims – New Claim or Appeal Filed, Prior Claim Pending at the Hearing Level.

• The ALJ will determine whether to join the Title XVI application with the pending prior Title II disability claim. See also, DI 12045.015, Claims Under Different Titles – Common Issue at the ALJ Hearing Level.

3. Prior Title II disability claim pending at the AC level

If the prior Title II claim is pending at the AC level, develop and adjudicate the new Title II application using current procedures in GN 03104.370, Subsequent Application Filed While A Request For Review Is Pending At The Appeals Council (AC) On Prior Claim – Title II or XVI.

D. Processing a new Title II disability application while a prior Title XVI disability claim is pending administrative review

If a claimant files a new Title II application while a prior Title XVI disability claim is pending administrative review, treat the Title II application as an oral inquiry for Title XVI benefits. Take a new Title XVI application or issue the SSA-L991 closeout notice per GN 00201.005E and SI 00601.027C.

E. Definition of new critical or disabling condition

A “new” critical or disabling condition means that onset occurred after the date of the ALJ hearing decision on the prior claim, and the condition meets the criteria for a:

• Terminal Illness (TERI) as described in DI 11005.601;

• Compassionate Allowances (CAL) as described in DI 11005.604;

• Presumptive Disability/Presumptive Blindness (PD/PB) as described in DI 11055.230; or

• Medical listing.

F. Prior disability claim pending at the AC level

If the claimant has a prior disability claim pending at the AC and submits evidence of a new critical or disabling condition with onset after the date of the ALJ hearing decision on the prior claim, the claimant may request an exception to file a new disability application.

The AC must approve the request before the claimant can file a new application while the appeal is pending. If the AC does not approve the request, the claimant may file a new application after the AC completes its action on the request for review of the prior claim.

REMINDER: Do not take the new disability application until the AC approves the claimant’s request to file a new application based on this exception.

Reference:

DI 51501.010 Field Office Actions on Subsequent Disability Applications

G. Concurrent claims at the AC level

If the ALJ issued a consolidated concurrent Title II/Title XVI decision, the claimant cannot appeal the decision under one title and file a new application under the other title. We cannot separate a concurrent Title II/Title XVI disability claim at the AC level. The AC reviews the entire hearing decision, which includes both claims.