Citations:

Social Security Act— Sec. 205(b)(2)

Regulations— 20 CFR 404.901, 404.907 - 404.922, 416.1401, 416.1407 - 416.1413b, 416.1414 - 416.1422

BASIC (09-09)

Citations:

Social Security Act – Section 205(b)(2);

Regulations – 20 CFR 404.901, 404.907 – 404.922, 416.1401, 416.1407-416.1413b, 416.1414-416.1422

A. Introduction

Reconsideration is the first step in the appeals process for a claimant who is dissatisfied with the initial determination on his or her claim, or for individuals (e.g. auxiliary claimants) who show that their rights are adversely affected by the initial determination. A reconsideration involves a thorough review of all evidence from the initial determination and any new evidence at reconsideration. A reconsidered determination is made by:

• An adjudicative team consisting of a disability examiner and a medical consultant or psychological consultant; or

• A disability hearing officer.

  The medical or psychological consultant person(s) who makes the reconsidered determination must be a different decision maker than the initial level medical or psychological consultant.  

B. Process for requesting reconsideration

1. Time period for filing a reconsideration request

A request for reconsideration must be filed within 60 days after the date the notice of the initial determination is received by the claimant. The notice is presumed to be received 5 days after the date on the notice unless it can be shown that the notice was not received within the 5-day period.

For DDS responsibilities in cases with a late filed request for reconsideration, see (DI 27010.001)—Appeal Filing Issues.

2. Who may file the reconsideration request

A request for reconsideration may be made by the claimant or his or her representative. For additional instructions on who may file a request for reconsideration, see (GN 03102.100C.1.)—The Reconsideration Process.

3. What constitutes a reconsideration request

A request for reconsideration can be expressed or implied; however, it must be in writing. A writing, for appeals purposes, is any documentation, e.g., a letter, facsimile, or submission of additional evidence, which clearly implies disagreement with the initial determination.

4. How to request reconsideration

A claimant or the claimant’s representative may request reconsideration by:

• Completing and submitting an SSA-561 (Request for Reconsideration); or

• Completing and submitting an i561 (Request for Reconsideration) online; or

• Submitting any writing (e.g., letter, facsimile, or additional evidence) indicating disagreement with the initial determination.

A request for reconsideration may be filed at any Social Security Administration (SSA) office. For additional information on certain other offices where an appeal request may be filed, see (GN 03102.100C.7)—The Reconsideration Process.

5. What is not a reconsideration request

Contacting the 800 number or field office (FO) by telephone to inquire about the process, or to request forms.

C. Implied request for reconsideration

An implied request for reconsideration is any writing or timely submission of additional evidence by a claimant or his or her representative which indicates disagreement with the initial determination.

For further instructions see (DI 81020.025B) — Processing Electronic Reconsideration Cases.

D. Claimant’s rights during the reconsideration process

The reconsideration process provides the claimant:

• An opportunity to present additional evidence;

• A review of the evidence considered in making the initial determination and any other evidence presented;

• An opportunity for a disability hearing in cases described in DI 29001.001—The Right to a Disability Hearing at Reconsideration Level;

• A reconsidered determination based on all evidence of record;

• A reconsidered determination by a disability examiner and a medical or psychological consultant, or disability hearing officer, other than the one(s) who made the initial determination.

E. Disability Determination Services (DDS) reconsideration processing actions

1. Affirmation of prior determination

For instructions, see (DI 27021.010) – Rationale for Affirming a Prior Determination.

2. Case development at reconsideration

Once a reconsideration case on an initial claim has been received from the FO, the disability examiner is responsible for reviewing the case to determine if additional development is warranted. If further case development is warranted, the disability examiner:

• Obtains additional information needed to document new allegations or a worsening of the claimant’s condition including information that was required but not obtained before the initial determination (e.g., SSA-3373 Function Report, MER, and work history).

• Contacts all medical sources from which the claimant received examination or treatment since the initial determination for any medical evidence they may be able to provide.

• Sends unsigned reports secured in connection with the initial determination which are material to the reconsidered determination to the medical source(s) for signature.

• Has a DDS medical or psychological consultant who was not involved in the initial determination review the medical evidence and provide a new medical assessment or, if supported by the evidence, an affirmation of the initial level medical assessment.

NOTE: The rules that apply for developing evidence at the initial level also apply at the reconsideration level of review. However, disability examiners may also submit MER requests to sources that were contacted, but did not submit MER, at the initial level.

For further instructions see:

• DI 27021.010 – Rationale for Affirming a Prior Determination

• DI 27015.001 -- Completing Form SSA-831–U3 for Reconsideration Cases

• DI 24510.066B – Options to Simplify Case Processing

• DI 81020.025—Processing Electronic Reconsideration Cases

3. Reconsideration of initial continuing disability review (CDR) determination or adverse reopening

For development and documentation instructions see:

• DI 28005.001—Legal Standard for Determining If Disability Continues

• DI 29005.001—Reconsideration Standards and Development Guidelines

• DI 22505.035—Follow-up on Requests for Medical Evidence of Record (MER)

• DI 29000.000 – Reconsideration of Continuing Disability Review (CDR) Cases, and Reopenings Applicable to Disability Hearings (Pre-DHU Processing) – Table of Contents