Filing a Request for Reconsideration - SSI Overpayments Lawyer Manual

Request for Reconsideration 

Reconsideration is the first level of review in SSA's administrative appeal process. 20 C.F.R. §§ 404.907; 416.1407.

Filing Deadline

A claimant has 60 days from the date of the decision to file a request for reconsideration. Because SSA gives time for mailing, it assumes that a decision is received by the claimant within five days of the date of the decision. As a result, a claimant has 65 days from the date on the decision to file a request for reconsideration. 20 C.F.R. §§ 404.909(a)(1) and 404.901; 416.1409 and 404.1401.

How to File Appeal

The Request for Reconsideration is filed at a Social Security Field Office. It can be mailed (use certified mail to have proof of receipt) or hand-delivered. While not required, it may be advisable to file the appeal at the Social Security Field Office that is closest to the client’s home. If you know your client’s zip code, you can find their Social Security Field Office locator.

Decision-making

Staff at the Social Security Field Office decide on reconsideration requests involving overpayment appeals, requests for waiver, and requests to negotiate an overpayment amount. The standard of review is de novo. The claimant may submit additional evidence.

Steps for Requesting Reconsideration

Complete SSA's Form

When seeking reconsideration, the first thing to do is fill out the Request for Reconsideration form.

Requesting a Conference in SSI cases

The Request for Reconsideration form allows a request for either a formal or informal conference in SSI cases. POMS SI 04020.050 discusses the differences between an informal and formal conference. With an informal conference, an SSA official will conduct the proceeding and ultimately make the reconsidered determination. In addition to following case review procedures, a beneficiary may present witnesses. A summary record of the conference becomes part of the case record.

Advocates should ask for a conference when filing their client's Request for Reconsideration in an SSI overpayment case. As soon as the request is received the time, date, and place will be set. A notice is sent to the beneficiary, their representative, and all other involved parties at their last known addresses at least 10 days before the conference. In theory, the conference should be scheduled within 15 days after it is requested; in practice, it rarely happens this quickly. If needed, the conference may be delayed if it is necessary to ensure that it is conducted efficiently and properly. Conferences are typically conducted at an SSA office either by telephone or in person, but may be held elsewhere if reasonably necessary.

A formal conference follows most of the same rules of an informal conference with several additional options. In a formal conference the beneficiary may also ask SSA to subpoena documents and adverse witnesses who will be available for direct and cross-examination. Again, the summary record becomes part of the case record, and the official conducting the conference makes the decision on the reconsideration. The POMS also provides further information on how the conference should be conducted and how to request subpoenas in such cases. SI 04020.50.

Letter in Support

In addition to the Request for Reconsideration form, you should also write a letter to the local office detailing the following:

• The rationale for the appeal;
• The evidence that supports the appeal;
• The evidence that needs to be produced by the District Office; and
• A request, if desired, for an informal or formal conference.

Evidence for Work-Related Overpayments

Determining the accuracy of a work-related overpayment can be complex and time consuming. It normally involves a review of monthly pay stubs to determine actual monthly income as well as determinations of possible work-related deductions such as Subsidies or Impairment Related Work Expenses. In addition, it may involve contacting the beneficiary’s employee or employment service provider for information to determine the level of a subsidy or special condition. Given the short time frame for filing the Reconsideration, it is important to let the Social Security Administration know that you are gathering evidence to be submitted and request that no decision be made until that evidence is developed and submitted.

Submitting Your Paperwork

The form and letter, along with any evidence to be submitted, should be mailed to the District Office. Certified mail or Federal Express should be used to make sure there is proof that the documents were delivered in case SSA fails to process the reconsideration request. While not required, it is usually best to file with the SSA Field Office closest to the beneficiary's home. The SSA website has a list of the locations of Field Offices by zip code. Once the paperwork is sent, advocates need to follow up with the Field Office Attorney Liaison to ensure the paperwork was received and to attempt to schedule a conference.

Next Step if Denied at Reconsideration Level

If SSA denies reconsideration, the next step is to file a request for a hearing with an Administrative Law Judge (ALJ). If a request is filed, the case is transferred to the local Office of Disability Adjudication and Review (ODAR) for assignment to an ALJ for a hearing. More information about SSA's administrative appeals process is discussed in SSI and SSDI Overpayment: Overview.