GN 03950: Administrative Review of Fee Authorizations Under the Fee Petition Process
Citations:
Social Security Act §§206(a) and 1631(d)(2); and § 413(b) of the Federal Mine Safety and Health Act;
20 CFR 404.1720(d), 410.686b(e), and 416.1520(d).
BASIC (03-95)
A. Introduction
This subchapter describes administrative review under the fee petition process. (See also GN 03910.001 for a general overview of representation and representative's fees.)
B. Policy
When a claimant, affected auxiliary beneficiary, or representative disagrees with the Social Security Administration's (SSA's) fee authorization, he/she may protest that authorization by requesting an administrative review.
1. When Performed
SSA performs an administrative review of a fee authorization only upon receipt of a written request, timely filed by a proper party. SSA does not conduct administrative review on its own motion under the fee petition process.
2. Who May Request Review
Only a party to SSA's initial fee authorization under the fee petition process may request an administrative review, i.e., the claimant, an affected auxiliary beneficiary(ies), or the authorized representative(s). The request must be filed in writing with an SSA office. (See GN 03950.070 for an overprinted Form SSA-795 (Statement by Claimant or Other Person) that can be used to request administrative review. However, SSA will accept any signed statement that requests administrative review.)
3. Time Limit for Requesting Review
A request for administrative review of a fee authorization under the fee petition process must be filed with SSA within 30 days after the date of the notice of SSA's initial fee authorization. If a request is filed more than 30 days after the date of the notice, the requestor must state, in writing, why it was not filed on time. In such cases, SSA will conduct an administrative review only if it determines that there was good cause for not filing the request on time.
4. Issue on Review - Fee Petition Process
Administrative review under the fee petition process in § 206(a)(1) of the Social Security Act (the Act) involves an independent review of SSA's initial fee authorization. The claimant, affected auxiliary beneficiary(ies), and representative have the right to request administrative review of a fee authorization.
Only an authorized SSA official who did not make the initial fee authorization can conduct the review.
5. Finality of Determination
SSA's determination on administrative review under the fee petition process is final and binding. There is no further administrative or judicial review of this determination.
C. Process
Upon receipt of a request for administrative review under the fee petition process, SSA undertakes the following five-step review process:
step one - examines the request (see GN 03950.015);
step two - examines the claim file (see GN 03950.025);
step three - issues acknowledgment/interim letters and undertakes related development (see GN 03950.030);
step four - reviews the initial fee authorization (see GN 03950.035); and
step five - notifies parties of the decision and effectuates (see GN 03950.040).
D. Definitions
1. Affected Auxiliary Beneficiary
An affected auxiliary beneficiary is a beneficiary, in a life or death case, who has benefited from the representative's services to the claimant who appointed the representative. References to the "affected auxiliary beneficiary" as a party include any person authorized to act on the beneficiary's behalf, e.g., parent, legal guardian, or representative payee.
2. Attorney
An attorney is an individual in good standing who is admitted to practice law before a court of a State, Territory, District, or island possession of the United States or before the Supreme Court or a lower Federal court of the United States.
3. Claimant
A claimant is any individual whose asserted rights under titles II, XVI, or XVIII of the Act or title IV of the Federal Mine Safety and Health Act (referred to hereinafter as the Black Lung Benefits Act) are, or may be, affected by an SSA determination or decision. As used throughout this subchapter, the term includes a beneficiary. References to the “claimant” as a party include any person authorized to act on the claimant's behalf, e.g., parent, legal guardian, or representative payee.
4. Non-requester
A non-requester is a person who is a party to the authorization of the representative's fee, but who did not request administrative review under the fee petition process.
5. Representative
A representative is an individual who meets the qualifications shown in GN 03910.020B.1. and 2. and whom the claimant appoints.
6. Requester
A requester is the person who requested administrative review under the fee petition process.
7. Reviewer
A reviewer is the SSA reviewing official who has been delegated authority to conduct administrative review. “Processing Center (PC) reviewer” refers to a below hearing level reviewing official.