TN 2 (06-08)

A. Rules for Reopening

Generally, a determination or decision may be reopened and revised only when:

• The determination or decision was incorrect when made; and

• The time limits and conditions for reopening described in DI 27505.001A.1. – DI 27505.001A.4. are met.

A determination or decision, which may have appeared to be correct based on the available evidence at the time it was made, may be reopened if it is later shown to have been incorrect (e.g., DDS discovers new and material evidence showing the field office made a failure to cooperate determination, but did not recognize the claimant has a mental impairment that prevented him or her from cooperating). Refer to New and Material Evidence (DI 27505.010B) for clarification of when new and material evidence can be used to reopen a prior determination or decision.

There are exceptions to the general rule that only incorrect determinations or decisions may be reopened and revised. See:

• Change of Ruling or Legal Precedent (Change of Position) – Operating Policy (DI 27505.020B.1.), and

• Policy – Only Incorrect Determinations Can Be Reopened and Revised (SI 04070.010C.) for when a determination or decision which was correct when made may be reopened and revised.

See Also:

• Do Not Reopen Correct Determinations — Operating Policy (GN 04001.070) for additional reopening information and general guidance on this subject.

• Error and Reopening (MIRS) (DI 28020.375) for discussion about the requirements for adverse reopening of a disability determination under the “error” exception to the Medical Improvement Review Standard (MIRS).

1. 1-Year Reopening Rule (Title II and Title XVI)

A final determination may be reopened within 1 year from the date of notice of the initial determination “for any reason.” However, certain adverse reopenings and revisions cannot occur unless the medical improvement regulations permit a finding that disability has ceased or does not exist. See Policy - When the MIRS Applies (DI 28005.001D.).

Reopening within 12 months is not “automatic.” A request to reopen within 12 months can be denied if there is no reason to revise the prior determination or decision.

2. 2-Year Reopening Rule (Title XVI)

A title XVI determination may be reopened within 2 years from the date of notice of the initial determination for “good cause.”

See Also

• Good Cause for Reopening (DI 27505.010)

• Time Limits For Reopening And Revising—2-Year Rule (SI 04070.010F.4.b.)

• Good Cause For Reopening Under The 2-Year Rule (SI 04070.010F.5.)

3. 4-Year Reopening Rule (Title II)

A title II determination may be reopened within 4 years from the date of notice of the initial determination for “good cause.” See

• Good Cause for Reopening (DI 27505.010)

• Reopening Within 4 Years (Title II and Entitlement Under Title XVIII) (GN 04010.000).

4. “At any time” Reopening Rule

A determination may be reopened at any time as follows:

a. Title II Wholly or Partially Favorable Determination

Title II wholly or partially favorable determinations may be reopened:

• For fraud or similar fault (see Fraud or Similar Fault – Reopenings (DI 27505.015)); or

• To exclude a felony-related impairment from consideration because the claimant has been convicted of a felony (see Evaluation of Prisoner/Felon CDR Cases (DI 28065.010); Reopening and Revision After Conviction of a Felony or Reversal of Felony Conviction (DI 23501.075).

See Details

• Prior Favorable or Unfavorable Title II Determination or Decision - Felony Related Impairment (DI 27520.020)

• Unrestricted Reopening - The Determination or Decision Was Procured by Fraud or Similar Fault (GN 04020.010)

• Unrestricted Reopening - Criminal Conviction Affecting Benefit Rights — Policy Principle (GN 04020.110)

b. Title II Wholly or Partially Unfavorable Determination

Title II wholly or partially unfavorable determinations may be reopened to:

• Correct an error on the face of the evidence or clerical error, provided that the net result is more favorable to the claimant.

• Consider any excluded impairments because the claimant's felony conviction has been overturned.

See Details

• Error on the Face of the Evidence (DI 27505.010C.)

• Prior Favorable or Unfavorable Title II Determination or Decision - Felony Related Impairment (DI 27520.020)

• Unrestricted Reopening - Clerical Error or Error on the face of the Evidence (GN 04020.080)

• Unrestricted Reopening - Criminal Conviction Affecting Benefit Rights — Policy Principle (GN 04020.110)

c. Title XVI

Reopen only for fraud or similar fault.

Refer to Fraud or Similar Fault - Reopenings (DI 27505.015); and Fraud and Similar Fault – SSI (SI 04070.020).

5. Precluded from Reopening

When a favorable determination with error on the face of the evidence is precluded from reopening because the period for reopening has expired, process in accordance with the continuing disability review (CDR) procedures.

B. Time Limits

Time limits and other conditions for reopening allow entitled claimants to rely on a fully favorable final determination or decision, and they allow SSA to accommodate a valid reason to change a final determination or decision.

1. Computing Time Limits

Compute time limits beginning from the date of the notice of the initial determination.

2. Expiration of Time Limits

Expiration of time limits is at the end of the designated period as described in DI 27505.001A.

For additional information about computing time limits and expiration of time limits, refer to Operating Policy - Use of Notice to Count Time for Reopening (GN 04001.040B.) and Policy – How To Measure Time Limits (SI 04070.010G.).

a. Time Limit for Reopening Expires on Saturday, Sunday or Federal Holiday

Extend the period to the next full workday if the time limit for reopening expires on a Saturday, Sunday or Federal non-workday.

b. Armed Forces

Extend the period for that portion of time when the claimant is a member of the United States Armed Forces or on active duty for training, if it is favorable to the title II claimant.

3. Timely Completion of Revision

The reopening and revision should generally be completed before the applicable time limit established in Rules for Reopening (DI 27505.001A.) has elapsed. See Late Completion of Timely Investigation: Diligent Pursuit (DI 27505.005).

C. Obtaining the Date of the Notice When the Notice is Not in File

If a copy of the notice of the initial determination is not available in the official file, request the FO to obtain the information from the Online Retrieval System (ORS), or obtain the date of the notice in the following order:

1. Title II Allowance or Denial

Obtain a Master Beneficiary Record (MBR) and use the disability adjudication date. Use the last day of the month for the presumed notice date since the DSD field is a MM/YY entry. See Description of Fields - Disability Adjudication Date (DSD) (SM 00510.200C.18.).

2. Title XVI Allowance or Denial

Secure an SSIRD (SSI Record Display) per Exhibit – SSIRD Display Summary Line Data (SM 01601.400B.) which includes the NP and NOTC field data segments. These field data segments show the date of the last notice and the applicable form number.