SSR 78-14: Rescinded 1984

SSR 78-14

PURPOSE:

To set out a new policy with respect to title II, title XVIII, and black

lung part B reconsideration processes and to provide information related

to the period of time within which a claimant and, where appropriate,

providers and suppliers of services (under title XVIII) can request

reconsideration of a title II, title XVIII, or black lung part B benefit

initial determination.

CITATIONS:

Program Simplification Proposal dated May 19, 1975. Public Law (P.L.

94-202, Sections 4 and 5. House and Senate Committee Reports regarding

H.R. 10727 (P.L. 94-202). Commissioner's testimony on September 19, 1975,

before the Subcommittee on Social Security of the Committee on Ways and

Means. Action memorandum dated November 21, 1975 (IDI-1), approved by the

Commissioner on December 1, 1975. Regulations No. 4, section 404.911;

Regulations No. 5, section 405.711; and Regulations No. 10, section

410.624.

PERTINENT HISTORY:

The prescribed period of time currently allowed for requesting a title

II, title XVIII, and black lung benefits reconsideration is 6 months from

the date of mailing of notice of an initial determination. The

administrative precedent of conforming the reconsideration time frame to

the hearing time frame was established as a title II administrative

procedure in 1940 when the reconsideration process was provided as an

option to a hearing without forfeiting the claimant's right to a hearing

if the claimant wished to pursue an unfavorable reconsideration

determination. The time frames for the reconsideration and hearing levels

were more closely linked in 1959 when the reconsideration step was made

mandatory by regulations before the title II hearing would be authorized.

Since the law provided at least 6 months for a hearing to be requested, it

was necessary to protect the rights of a claimant who was required to go

through the intervening reconsideration step before a hearing would be

held

and hearing levels

were more closely linked in 1959 when the reconsideration step was made

mandatory by regulations before the title II hearing would be authorized.

Since the law provided at least 6 months for a hearing to be requested, it

was necessary to protect the rights of a claimant who was required to go

through the intervening reconsideration step before a hearing would be

held. If a claimant had been limited to less than 6 months (e.g., 3

months) within which to request a reconsideration, and failing to file

timely had been precluded from going on to the hearing level (because of

the mandatory reconsideration step) the claimant would, in effect, have

been deprived of his/her right to a hearing under the law even though 6

months have not elapsed since notification of the determination.

Therefore, the time frame of 6 months as provided for title II hearings

became, in effect, an aggregate double 6- month prior for the combined

levels. This policy was also applied to title XVIII and the black lung

benefit program.

Historically, therefore, the reconsideration time frame duplicated the

statutory hearing time frame to protect the claimants' statutory rights to

a hearing. In addition, a common time frame for the reconsideration level

and hearing level alleviates any added confusion that would result on the

part of the public if the period of time allowed for each level were

different. The enactment of P.L. 94-22 (January 2, 1976) makes the time

period for requesting a hearing under the titles II, XVI, XVIII, and black

lung programs uniform, i.e., 60 days from the date of receipt of the

notice of a determination. Therefore, the implementation of this policy

will conform the reconsideration time frame to the newly enacted time

frame of 60 days for hearings requests in accordance with P.L. 94-202 and

thereby sustain the preexistent pattern of common time frames for the two

levels in the appeals process.

lung programs uniform, i.e., 60 days from the date of receipt of the

notice of a determination. Therefore, the implementation of this policy

will conform the reconsideration time frame to the newly enacted time

frame of 60 days for hearings requests in accordance with P.L. 94-202 and

thereby sustain the preexistent pattern of common time frames for the two

levels in the appeals process.

Additionally, the adoption of a uniform time frame of 60 days for the

reconsideration step for all Social Security Administration (SSA) programs

will provide more efficient processing when an issue at question is common

to more than one program (i.e., an issue involving both title II and tile

XVI). The policy recommendation to change the title XVI time frame to 60

days has been promulgated under separate cover.

The Commissioner indicated SSA was seeking a common time frame of 60 days

for the reconsideration and hearing level when he testified before the

House of Representatives Subcommittee on Social Security, Committee on

Ways and Means on September 1975, and endorsed this position again when he

approved an action memorandum (IDI-1 dated November 21, 1975),

recommendation on this subject on December 1, 1975.

The House and Senate Committee Reports which describe the effects of H.R.

10727 refer to a common time frame of 60 days for the reconsideration and

hearing level. The text of the reports indicate that Congress intended the

legislative action of H.R. 10727 to embrace both time frames even though

the reconsideration step to the appeals process is administrative and not

contained in the law.

he House and Senate Committee Reports which describe the effects of H.R.

10727 refer to a common time frame of 60 days for the reconsideration and

hearing level. The text of the reports indicate that Congress intended the

legislative action of H.R. 10727 to embrace both time frames even though

the reconsideration step to the appeals process is administrative and not

contained in the law.

The establishment of a common time frame for all levels of the appeals

process was included in the recommendations proposed by the Office of

Program Operations Legislative Task Force to Simplify Procedures in this

report of May 19, 1975. The reduction in the period of time allowed to

request a reconsideration is not expected to deprive the claimant of his

or her right to protest a decision. Although the length of time he or she

will have to request a reconsideration will be shortened, the 60-day

period is considered adequate time for a person to express dissatisfaction

with a determination. In fact, statistics found in the Hearings Report of

the House of Representatives (based on an analysis done in 1972) show that

about 62 percent of the persons appealing for reconsideration do so by 60

days and about 45 percent have done so within 30 days. Even in cases where

the time limit has expired and the initial determination has become final

as defined in Section 404.908, Subpart J of Regulations No. 4 (20 CFR

404.908), an initial determination may be reopened when there is new and

material evidence presented up to 4 years after the initial determination.

In addition, Section 404.953 (20 CFR 404.953), Subpart J provides for an

extension of the time allowed to file for a reconsideration if good cause

is established.

e final

as defined in Section 404.908, Subpart J of Regulations No. 4 (20 CFR

404.908), an initial determination may be reopened when there is new and

material evidence presented up to 4 years after the initial determination.

In addition, Section 404.953 (20 CFR 404.953), Subpart J provides for an

extension of the time allowed to file for a reconsideration if good cause

is established.

For purposes of effectuating administrative actions flowing from an

initial determination, at the inception of the title XVI program, the

assumption was founded that the party to the determination shall be

presumed to have received the notice within 5 days from the date shown on

that notice unless there is reasonable evidence to the contrary. Then the

request for reconsideration must be filed with SSA within a prescribed

period from the date of the receipt of the notice. However, title II,

title XVIII, and black lung part B benefits do not have such a provision.

In these latter three programs, the time for requesting reconsideration

runs from the date of the mailing of the notice of the initial

determination. In order to further guarantee consistency among the various

SSA programs, the adoption of the 5-day presumption rule (as found in

Section 416.1419, Subpart N) would alleviate any confusion which variance

in the programs may produce.

POLICY DIRECTIVE STATEMENT:

A claimant, the representative of a claimant, or a provider or a supplier

of services (under title XVIII) who is dissatisfied with an initial title

II, XVIII or black lung part B determination may request a reconsideration

of such determination if the request is filed within 60 days after receipt

of such notice. Therefore, SSA's initial determination shall become final

upon the expiration of that 60-day period from the receipt of the notice

of such determination to the claimant unless a request for reconsideration

has been filed

e

II, XVIII or black lung part B determination may request a reconsideration

of such determination if the request is filed within 60 days after receipt

of such notice. Therefore, SSA's initial determination shall become final

upon the expiration of that 60-day period from the receipt of the notice

of such determination to the claimant unless a request for reconsideration

has been filed. In addition, the receipt of a notice shall be presumed to

have occurred no later than 5 days after the date shown on the notice

unless there is reasonable evidence to the contrary. (This is the same

presumption that has applied in title XVI programs.) Reconsideration

remains a required step in the appeals process that must take place prior

to a hearing.

FURTHER INFORMATION:

This directive applies to all procedures authorized by the provisions of

Title XVIII of the Social Security Act which incorporate Section 205(b) of

the Act (i.e., 1862(d)(3), 1869(b) and (c), 1876(f) and 1879(d)).