GN 03103.010: The Hearing Process

changes
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~~Effective Dates: 02/15/2018 - Present~~
Effective Dates: 06/26/2018 - Present
TN 26 (02-18)
GN 03103.010 The Hearing Process
A. What you need to know about the hearing policy and process
1. Determinations and decisions for which a claimant may request a hearing
The hearing is the next level of appeal when a claimant disagrees with one of the listed determinations or decisions.
* A reconsideration determination
* A revised determination of an initial determination, unless the revised determination concerns the issue of whether, based on medical factors, the claimant is disabled
* A reconsideration of a revised initial determination concerning the issue of whether, based on medical factors, the claimant is disabled
* A revised reconsidered determination
* A revised decision based on evidence not included in the record on which the prior decision was based
* An initial determination denying waiver of recovery or adjustment of an overpayment based on a personal conference
* An initial determination denying waiver of adjustment or recovery of an overpayment based on a review of the written evidence of record, and the determination was made concurrent with, or subsequent to, our reconsideration determination regarding the underlying overpayment but before an administrative law judge (ALJ) holds a hearing
* An initial disability determination in a prototype state per DI 12015.100
* A reconsideration determination on Medicare Part A and B entitlement associated with a disability determination or disability determination on a Medicare Qualified Government Employee (MQGE) claim
2. Description of a hearing
A hearing is a proceeding before an ALJ from the Office of Hearings Operations (OHO).
* Claimant’s appearance at the hearing
* A claimant may appear at the hearing in person or through video teleconference.
* If a claimant does not wish to appear at the hearing, he or she may waive the right to personal appearance and request that the ALJ make a decision based on the evidence in file and newly submitted evidence if any. To waive the right to appear at a hearing, a claimant must complete and sign the form HA-4608 Waiver of Right to Oral Hearing per GN 031030.30
* Under extraordinary circumstances, a claimant may appear at a hearing by telephone.
* Claimant’s rights concerning evidence and witnesses for a hearing
A claimant may:
* submit evidence;
* examine the evidence used to make the determination under review;
* introduce and question witnesses; and
* present oral or written arguments as to why the ALJ should make a favorable decision.
* Claimant’s right to representation
A claimant may appoint an attorney or other person to represent him or her at the hearing.
See also:
* GN 03910.010 Claimant’s Right to Representation and
* GN 03103.070 Requirements if the Claimant Has a Representative.
3. Who may request a hearing
* A claimant or another party to a determination or decision listed in subsection A may request a hearing.
* A person who shows in writing that the decision may adversely affect his or her rights may request a hearing.
* An appointed representative or another third party may request a hearing on the claimant’s behalf.
4. How to request a hearing
A claimant must submit a written request for hearing by submitting:
* an HA-501-U5 or iAppeals i501 (formal request)
* a written document that indicates disagreement with a determination or decision listed in subsection A (informal request); or
* submission of additional evidence (informal request).
A claimant may submit a request for hearing to us:
* in-person;
* via iAppeals Medical or iAppeals Non-Medical;
* mail,
* fax, or
* email.
5. Where to submit a request for hearing
* A claimant may submit a request for hearing at:
* any Social Security Administration (SSA) Office;
* the Veterans Administration Regional Office in the Philippines; or
* any Foreign Service Post.
* A claimant who has at least 10 years of service or 5 years of service after December 31, 1995 in the railroad industry may file a request for hearing at a Railroad Retirement Board (RRB) office.
6. Time limit for filing a request for hearing
* A claimant has 60 days, after he or she receives notice of a determination or decision, to file a request for hearing. We presume that a claimant receives a notice 5 days after the date on a notice.
* When a claimant files a request for hearing late, see GN 03101.020D.2.
* When a claimant files a request for hearing before we make a reconsideration determination, see GN 03103.120.
7. What is not a request for hearing
Do not consider the following requests or submissions a request for hearing.
* Request for information about or an explanation of our determination
* Request for a waiver of an overpayment
* Submission of an amended annual report
* A verbal (phone or in-person) request for a hearing or a letter that asks for a hearing form is not a request for hearing. In these situations, consider the time that a claimant has left to file a request for hearing and follow the instructions as appropriate in GN 03103.010B of this section.
B. Field office (FO) procedures for the request for hearing
1. Interview with claimant
Interview the claimant following the instructions in GN 03101.120.
* Phone interview
If the interview is over the phone and the claimant has not submitted a request for hearing, advise the claimant to access the SSA.gov Forms page to complete and submit the pdf version of HA-501-U5 by mail or in-person or access iAppeals Medical or iAppeals Non-Medical to complete and submit a request for hearing over the Internet.
* In-office interview
If the claimant is in the office, help the claimant complete the request for hearing; and explain the information detailed in this section. When possible, use the Modernized Claim System (MCS) to document and file the request for hearing. Otherwise, document and file the request for hearing on the paper form HA-501-U5.
If the claimant is in the office, help the claimant complete the request for hearing; and explain the information detailed in this section. When possible, use the Modernized Claim System (MCS) to document and file the request for hearing. For Title XVI, document the hearing request in MS MSSICS 020.001. Otherwise, document and file the request for hearing on the paper form HA-501-U5.
* Late request for hearing
If the request for hearing is late and the claimant is in the office, obtain a written statement that explains the reason for late filing of the request for hearing. Explain that the ALJ will decide whether to extend the time to file the request for hearing, see GN 03101.020D.2.
* The hearing process
Explain the hearing process described in GN 03103.010A.2 of this section.
* Appearing at the hearing
Explain the importance of appearing at the hearing. If the claimant wants to waive the right to appear at the hearing, he or she must complete and sign the HA-4608 per GN 03103.030.
* Right to representation
Explain the right to representation if the claimant does not have a representative. If a claimant needs help with obtaining a representative, provide a list of legal referral and service organizations. For information about appointing a representative, see GN 03910.010B.
* Hearing location
Explain that the ALJ will determine whether hearing is held in-person or by video teleconference. Explain the locations where we usually hold hearings in the local area per GN 03103.050 and the video hearing per DI 80850.005.
* Reimbursement for travel
Explain the possible reimbursement of travel expenses when it is necessary to travel more than 75 miles to attend the hearing. See also:
* GN 03101.140 Appeals of Payment for Certain Travel Expenses
* GN 03103.060 Policy for Payment of Certain Travel Expenses to Hearings
* Change of address or telephone number
Explain to the claimant that he or she must report any change of his or her address or telephone number to SSA.
* Hearing notice
Explain the hearing notice, which gives the time and place of the hearing, the issues to be decided, and the following information.
* If the claimant cannot attend at the time of or place of where the hearing is scheduled, explain that he or she should contact the hearing office (HO) prior to the hearing and give a reason (objection) in writing. See HALLEX I-2-3-10 Scheduling Hearings.
* The ALJ will consider the reason and may find good cause for changing the time or place of the hearing.
If the ALJ does not find good cause, the claimant or his or her appointed representative should appear at the hearing or before the scheduled hearing, request waiver of an oral hearing in writing and ask the ALJ to decide the case based on the evidence in the file, see GN 03103.030.
If the claimant fails to appear at a scheduled hearing after an ALJ has determined that there is no good cause for rescheduling the hearing, and the claimant has not filed a waiver of the oral hearing, the ALJ may dismiss the hearing without reviewing the evidence in the file. For information about dismissal of hearing, see GN 03103.220.
2. Transcribe the request for hearing received by mail, email, fax, or iAppeals Medical or Non-Medical
Complete the form HA-501-U5 (GN 03103.020) or MCS request for hearing appeal screens (MSOM MCS 010.002), and maintain the original request for hearing along with the completed form.
Complete processing and development of the request for hearing as instructed in this section. For concurrent Title 2 and Title 16 cases, complete the Modernized Supplemental Security Income Claim System (MSSICS) appeal screens.
* The receipt date for the request for hearing is the walk-in date, email date, fax date, or postmark date.
* The submit (receipt) date the claimant submits the request for hearing via iAppeals.
* See additional information on how to process the paper HA-501 or other written appeal request GN 03103.080B.
3. Process and complete development for the request for hearing
FO technicians send request for hearings to the HO or Processing Center (PC) as appropriate per GN 03103.080. Before sending a request for hearing, on a non-medical issue, to the HO, an FO or PC technician must complete the eNDSS per GN 03103.130.
4. Disability issue
When a claimant is appealing a disability issue:
* complete the SSA-3441-BK Disability Report per DI 12010.005, and
* process the request for hearing in the Electronic Disability Collect System (EDCS) when possible.
See Also:
DI 81010.150A.2 Mainframe requirements, Disability hearings
DI 81010.150B Documenting receipt of an appeal request
DI 81010.257 electronic Continuing Disability Review Cessation Appeals-ALJ Hearing
5. Overpayment issue
If a claimant requests a hearing on an overpayment issue,
* determine whether he or she is appealing the overpayment amount, waiver decision, or both; and
* obtain and attach, to the HA-501-U5, the claimant’s statement that explains why he or she believes there is no overpayment, the overpayment amount is lower, or why we should not recover the overpayment.
6. RRB involvement
When a claimant’s case involves railroad retirement compensation or transfer of claims to RRB is involved, see GN 03102.400.
C. References
* DI 12010.000 Hearings Level Review – Initial Claims – Tables of Contents
* GN 2250.000 Waiver Provisions for Title II and Title XVI Overpayments – Table of Contents
* GN 03101.125 iAppeals General and Title II Instructions
* GN 03101.127 iAppeals Non-Medical General and Title II Instructions
* GN 03101.150 Medicare Entitlement Appeals
* GN 03103.010 The Hearing Process
* GN 03103.080 Forwarding the Form HA-501-U5 (Request for Hearing by Administrative Law judge) and Folder to the Servicing Hearing Office
* GN 03103.090 Hearing Request Filed Somewhere Other Than the Servicing Field Office
* GN 03103.130 – Development in Hearing Cases
* HA I-2-3-11 Claimant Timely Objected to Appearing at Hearing by Video Teleconferencing
* HA I-2-3-12 Objections to Manner or Appearance or Time and Place Set For Hearing
* HI 01205.005 Provider’s, Physician’s and Supplier’s Services - Claims
* MSOM MCS 010.001 title II Appeal Screens - Overview
* SI 04030.000 Administrative Law Judge (ALJ) Hearings – SSI – Table of Contents

POMS Reference

GN 03103.010: The Hearing Process