I-3-1-30.Workup of Case by Analyst — Unappealed Review

Last Update: 10/13/11 (Transmittal I-3-42)

A. Selection of Case

The Office of Appellate Operations' Division of Quality (DQ) may select unappealed title II and title XVI disability hearing decisions, both favorable and unfavorable to the claimant, and dismissals and forward them to the appropriate Quality Review Branch (QRB). Case selection occurs when the hearing office enters the disposition of a claim into the Case Processing and Management System (CPMS), and the selection is based on a sample size that will yield statistically valid results at the Regional level. Though the selection criteria may change as the mission of DQ evolves, currently the selection process excludes the following types of cases:

  • Compassionate allowances;

  • Terminal illness (TERI) or critical cases;

  • Non-disability cases; and

  • Cases that are not fully electronic.

B. Appeals Council Consideration

Upon receipt of the case, the QRB staff reviews the evidence of record and the decision or dismissal to determine whether the Appeals Council (AC) should take own motion review. The analyst will complete a case analysis and recommendation indicating the AC's action in each case and, if applicable, will prepare the own motion notice.

In addition to administrative appeals judges (AAJ) and administrative law judges on detail as acting AAJs, appeals officers may act as the “A” member for cases where the AC decides not to take own motion review. If the AC decides not to take own motion review, the “A” member approves the action and forwards the case to the QRB for transmittal to the effectuating component. If the decision is partially or fully favorable, the QRB staff closes out the record, which will automatically forward the case for effectuation of the hearing decision.

If the AC determines that it should take own motion jurisdiction, the “A” and “B” members approve the recommended action and forward the case to the QRB for release of the own motion notice.

C. Standard of Review

In determining whether to review a case on its own motion, the AC applies the same standard used in request for review cases (20 CFR 404.969, 404.970, 416.1469, and 416.1470). However, the AC generally will not review a case on its own motion to correct a decisional error that does not change the hearing office's ultimate conclusion unless there is a compelling reason to do so.

D. Time Limit for Own Motion Review

The AC must send a claimant and his or her representative written notification of its intent to review a case on its own motion by certified mail no later than the 60th day after the date of the hearing office's action. If the AC reviews a favorable disability decision on its own motion, the notice must advise the claimant that interim benefits will be payable if a final decision is not issued within 110 days after the date of the hearing decision.

E. Appeals Council Authority

The AC considers unappealed hearing decisions and dismissals under its own motion review authority. However, when the AC is unable to decide whether to review a case on its own motion within the prescribed 60-day period, it may consider whether to reopen the decision under the provisions of 20 CFR 404.987 and 416.1487. (See I-3-9-1.)

F. Own Motion Warranted

Because the AC must take own motion review within 60 days after the hearing office's action, the analyst must ensure that the case is routed to the AAJ in a timely manner. The analyst follows the procedures in I-3-6-50 ff to prepare and route the action document. Upon completion of the action document, the analyst returns the file to the AAJ for his or her review. If the AAJ approves the action document, he or she sends the case to the “B” member for signature.