I-3-9-1.Administrative Finality — Reopening and Revising Determinations and Decisions

Last Update: 3/15/06 (Transmittal I-3-37)

Citations:

A determination or decision becomes “final and binding” if the claimant does not timely appeal. The regulations define certain criteria for reopening a determination or decision after it has become “final and binding.” Thus, adjudicators may reopen determinations and decisions under certain circumstances and within certain prescribed time periods.

A claimant may ask an adjudicator to reopen a final determination or decision by submitting additional information or evidence or by otherwise requesting reopening. The regulations at 20 CFR 404.989 and 416.1489 specify when we will find that there is good cause to reopen a determination or decision.

An adjudicator may reopen a determination or decision for any reason within 12 months of the date of notice of the initial determination and for good cause within 2 years in SSI cases or 4 years in Title II cases. Under certain conditions, the adjudicator may reopen a determination or decision at any time. The following sections describe how to compute the time periods within which reopening is permitted and the conditions and time limitations for reopening.

NOTE:

The Appeals Council (AC) may review cases selected under the unappealed review process pursuant to its own motion authority contained in 20 CFR 404.969 and/or 416.1469. However, when the AC is unable to decide whether to review a case on its own motion within the 60-day period in which to do so, it may consider whether the decision should be reopened under the provisions of 20 CFR 404.987 and/or 416.1487. These sections of the regulations authorize the Council to reopen a decision that has become administratively final either on its own initiative or at the request of a party to the decision, if a condition for reopening stated in 20 CFR 404.988 and/or 416.1488 is present.