Last Update: 9/08/05 (Transmittal I-3-36)
Citations:
The Appeals Council may review an ALJ's decision or order of dismissal on its own motion within 60 days after the date of notice of the ALJ's action. The Council may review a decision on its own motion for the same reasons it may grant a request for review. (See I-3-3-1 ff.) The Council will not ordinarily review a case on its own motion when the end result would remain unchanged unless there is a compelling reason to do so.
The Appeals Council considers for own motion review a random sample of unappealed Title II disability decisions and dismissals as well as Title II and Title XVI decisions referred by effectuating and reviewing components.
National Random Sample cases (a national random sample of favorable ALJ disability decisions) are referred to the Appeals Council directly from the hearing offices. After analyzing the case, an AAJ may approve effectuation of the decision or assume own motion review.
An effectuating component of SSA may question an ALJ or Appeals Council decision or may refer the case to the Office of Hearings and Appeals (OHA) for consideration of additional evidence.
When a substantive protest memorandum is received within 60 days of the date of the ALJ's action, the analyst will consider whether to refer the case to the Appeals Council with a recommendation for own motion review.
The Office of Quality Assurance (OQA) reviews selected favorable ALJ decisions on claims for Title II and Title XVI disability benefits for possible referral to the Appeals Council for own motion consideration. If, after their review, which includes a review of the medical evidence by staff physicians, OQA decides to refer the case to the Appeals Council for own motion consideration, OQA will prepare a memorandum outlining the reasons for the referral.
All OQA referral are sent to the OAO Executive Director's office which coordinates distribution to AAJs for own motion consideration.
After reviewing the referral memorandum, the AAJ may either concur with OQA's recommendation or decide not to review the claim based on the standards contained in 20 CFR 404.970 and 416.1470.
If the AAJ concurs with OQA's recommendation, he or she will provide the analyst with instructions necessary to prepare the action document. The case will then be hand carried to the branch chief of the branch responsible for the geographic and numerical jurisdiction. The Branch Chief will immediately control and assign the case to an analyst, who will audit the hearing recording (if available) and prepare the action document. Upon completion of the document, the case will be hand carried back to the “A” AAJ and then hand carried to the “B” member.
If the AAJ decides that the Appeals Council should not take own motion review, the AAJ will send OQA a memorandum explaining the basis for the Appeals Council's action
In all OQA referrals, OAO will complete a Results Form indicating the Appeals Council's action. Copies of all Appeals Council final actions and the Results Form should be sent to the Executive Director's office in Room 1400.