DI 27001.001 The Reconsideration Process

NOTE: The examiner and medical or psychological consultant must be different from the reviewers who made the initial determination.

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 claimant receives notice of the initial determination.

For the Disability Determination Services (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

The claimant or his or her representative may file a request for reconsideration. 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 these 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:

Submitting any documentation (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, is not a reconsideration request.

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:

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 the Medical Continuing Disability Review (CDR) Reconsideration Level;

E. DDS reconsideration processing actions

1. Affirmation of prior determination

An initial determination may be affirmed as written if all of the following conditions are met:

The prior determination was substantively and technically correct and the prior decision rationale correctly presented and resolved all pertinent issues to be adjudicated;and

NOTE: These bulleted conditions do not apply for DI 24510.066B. Adopting the initial level RFC or PRTF does not require affirming the initial determination as written.

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:

Determines whether the folder shows all necessary development, including appropriate follow-up, for the initial claim. If any required development action was overlooked, complete that development.

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, Medical Evidence of Record (MER), and work history).

Contacts all medical sources from which the claimant received examination or treatment since the initial determination for any new medical evidence.

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

Requests 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: Disability examiners must follow up with sources that were contacted, but did not submit MER, at the initial level.

For further instructions see: