GN 03950: Administrative Review of Fee Authorizations Under the Fee Petition Process
BASIC (03-95)
A. Policy
1. Late Filed Request for Administrative Review
If a claimant, affected auxiliary beneficiary, or representative does not request administrative review timely, he/she must state in writing why the request was not filed within the 30-day period. (GN 03950.010A.4. discusses the period within which the requester must file.) SSA must review the fee authorization only if SSA decides that a proper requesting party had good cause for not filing on time. (See c. below for examples of good cause.)
Before deciding the good cause question, SSA may give the other party(ies) an opportunity to comment on the explanation given for late filing, if the reviewer believes the other party(ies) may have knowledge of the situation.
2. Definition of Good Cause
SSA defines “good cause” as any circumstance or event which prevents or impedes the efforts of a party from filing a request for administrative review within the required 30-day period.
Examples of such circumstances include:
serious illness or a physical or mental impairment, which prevented a party from contacting SSA in person or in writing;
death or serious illness in a party's family;
destruction of material records by fire or other accidental cause;
receipt of incorrect or incomplete information furnished by SSA about the right to request administrative review;
failure to receive timely notice of the fee authorization; and
good faith mistake of sending a request to another government agency within the 30-day period.
3. Good Cause Not Established
When the requester does not establish good cause, SSA sends:
written notice to the requester at his/her last known address explaining the reason(s) for deciding he/she did not show good cause, and that SSA will not review the fee authorization; and
a copy to the other party(ies).
4. Good Cause Established
When the requester has established good cause, SSA reviews its authorization. SSA includes the good cause finding and explains its basis in either the acknowledgment, interim, or final letter(s) to the parties.
B. Procedure - Late Filing
Follow the steps below when the request for administrative review is not filed timely.
1. Late Filing -No Explanation
If the requester has not provided the reason(s) for late filing with his/her request for administrative review:
ask the requester for an explanation (by telephone, if possible);
if by mail, include your request in the letter acknowledging receipt and diary the case for 30 days.
2. Late Filing - Explanation Included
If the requester provided the reason(s) for late filing with his/her request for administrative review, decide whether you can make the good cause determination without further contact with the parties.
If you can decide whether the requester has good cause for late filing, include your finding when acknowledging receipt of the request and informing the other party(ies) of the request for administrative review.
If you must defer deciding whether the requester has good cause for late filing in order to obtain further input as noted in A.1. above, include your good cause finding in an interim or the final letter(s).
EXAMPLES:
The claimant stated that she did not request administrative review timely because she had been hospitalized for five weeks and did not receive the notice until she returned home. She also submitted a copy of a hospital record confirming her hospitalization during the time in question. You decide the claimant has shown good cause; you include your finding in the letters acknowledging receipt and informing the other parties of the request.
The claimant requested administrative review on July 15. She stated that she filed the request timely because she received the notice, dated May 15, on June 15. Your review of the claim file shows a report of contact in which the claimant called SSA on May 22, reported receiving the notice of the fee authorization, and asked about SSA's payment of her attorney's fee. You decide that the claimant has not shown good cause; you include your finding in the final letter to the parties.