When is a decision final?

pHandPenPaper_Depositphotos_9491294_mThe Social Security Administration’s rules state that a Social Security Disability determination cannot be reopened after 12 months without good cause. Even with good cause, Chicago applicants only have four years from the decision date to request that a determination be revisited. Generally, a decision is final after this deadline. However, applicants who failed to request review within the relevant deadlines due to mental incapacity or other good cause may be eligible for extensions.

Incapacity or good cause

The SSA considers each individual’s situation to determine whether there is good cause for reopening a claim. The SSA may consider the reasons the applicant failed to reopen the claim before; the potential role the SSA’s actions played; and the applicant’s ability to understand the relevant rules.

An applicant may qualify for a deadline extension if the applicant suffers from a mental limitation that prevented him or her from understanding the review process. The SSA may consider the following factors when evaluating mental incapacity:

  • The applicant’s level of education
  • The applicant’s ability to communicate in English
  • The applicant’s literacy or ability to speak
  • The disabling conditions that limit the applicant’s ability to perform tasks independently

These factors are only relevant if the applicant lacked a legal representative, such as a parent or attorney, who was responsible for pursuing the claim. The SSA typically will not grant an extension because of a representative’s mistakes or oversights. However, if an applicant lacks a representative and has significant mental incapacity, the claim decision may be reopened, regardless of how much time has passed.

Reconsidering claim decisions

When revisiting a past decision, a Social Security adjudicator must obtain as much evidence as possible. The adjudicator must assist the applicant in acquiring the relevant evidence if the applicant still lacks a legal representative. If reasonable doubt remains after the evidence is gathered, the adjudicator must decide the issue in the applicant’s favor.

If the adjudicator finds the applicant does not have good cause for a deadline extension, the adjudicator will dismiss the request for review. If the applicant chooses to file a new claim, the original request for reconsideration can serve as a written notice of intent to file for benefits. This establishes a protective filing date, even if the application is not filed until later. A protective filing date ensures that applicants do not lose eligibility for SSD benefits while they wait to file a claim. It may also help applicants qualify for greater retroactive benefits if the new claim is ultimately approved.

 

 

By |2014-11-21T18:39:15+00:00November 21st, 2014|Appeals|Comments Off on When is a decision final?