2005. The Reconsideration Process

2005.1 What is the reconsideration process?

The reconsideration process is a thorough and independent reexamination of all evidence on record related to your case. It is based on the evidence submitted for the initial determination, and any additional evidence and information that you or your representative submits in connection with the reconsideration.

2005.2 What issues can be raised in the reconsideration process?

The reconsideration is a completely new and independent review of all the evidence in your case. It is not limited to the issues that you raise.

2005.3 Is the person who makes the reconsidered determination the same one who made the initial one?

No. The person who makes the reconsidered determination must have had no prior involvement with the initial determination.

2005.4 How is the claimant notified of the determination?

You will receive a notice of the reconsidered determination detailing the basis for the determination in your case. (See §111.2.)

2005.5 What are the options for the reconsideration process in Title XVI cases?

In Title XVI cases, the reconsideration process may be a case review, or, under certain circumstances, an informal conference, a formal conference, or a disability hearing.

1. Informal Conference. A review in which you may participate. You may present witnesses and may present the case in person.

2. Formal Conference. In addition to participating in an informal conference, you may request that adverse witnesses be issued a subpoena and cross-examined by you or your representative. This type of reconsideration is available only if you are eligible for SSI payments and are notified that the payments will be reduced, suspended, or terminated.

3. Disability Hearing. A disability hearing is a face-to-face evidentiary meeting that enables you to review the evidence, to introduce new evidence, and to present your objections of a medical determination to a disability hearing officer (DHO). This type of disability hearing is available if you have already been receiving disability benefits, and we find that your impairment has ceased, did not exist, or is no longer disabling

2005.6 Is the reconsidered determination binding?

The reconsidered determination is binding unless:

1. You or any other party to the reconsideration requests a hearing before an ALJ within the stated time period and a decision is made;

2. The expedited appeals process (see §2000.3 and §2001) is used; or

3. The reconsidered determination is revised.