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The new rules contain many changes regarding the submission of evidence to
the Administrative Law Judge. The rules set a goal for ALJs to set a hearing
date within 90 days of an appeal. The ALJ must provide 75 days notice before
the hearing. After receiving a hearing notice, the claimant has 30 days to
object to the time or place of the hearing. Objections to issues in the hearing
notice must be filed at least 5 business days before the hearing.
Of paramount importance to advocates are the procedural changes for submitting
evidence for an ALJ hearing. The new rules add new deadlines for evidence submission
(the current regulations allow evidence submission anytime, including at the
hearing). While the final version of the rules offer a more generous time table
for a claimant to submit evidence compared to prior versions of the rules,
there is still some concern whether the rules are consistent with the claimants
right to a hearing with a decision based on evidence adduced at the hearing,
42 U.S.C. 405(b), or whether the deadlines are realistic considering the fact
that representation is often obtained just before an ALJ hearing, or sometimes
even after the hearing. The following table lists the circumstances in which
an ALJ must accept and consider new evidence:
Deadlines and Circumstances for Submitting Evidence
to the
Administrative Law Judge:
Time: |
Circumstances: |
More than 5 days before hearing |
Any |
Within 5 days of hearing |
Good Cause* |
After hearing but before decision |
Good Cause* + reasonable possibility that evidence affects the outcome |
After decision (and DRB will not review) |
Good Cause* + reasonable probability that evidence changes the outcome + request is filed with the ALJ within 30 days of receiving the ALJ decision |
* - Good Cause means the claimant shows that: 1) SSA action misled the claimant;
or 2) the claimant has a physical, educational, or linguistic limitation
that prevented earlier submission of the evidence; or 3) some other unusual
unexpected, or unavoidable circumstance beyond the claimants control prevented
earlier submission. Examples of circumstances satisfying 3) can be found
in 20 C.F.R. 405.20(b) (ex. (b)(4): You were trying very hard to find necessary
information to support your claim but did not find the information within
the stated time period)
The rules no longer require claimants to submit adverse evidence. The ALJ also has the discretion, at the hearing, to hold the record open for new evidence if there is outstanding evidence or if the claimant is to undergo additional medical evaluation.
Hearing before an administrative law judge—general
(a) This subpart explains what to do if you are dissatisfied with a decision
by a Federal reviewing official. In it, we describe how you may ask for a hearing
before an administrative law judge, and what procedures SSA will follow when
you ask for a hearing.
(b) The Commissioner will appoint an administrative law judge
to conduct the hearing. If circumstances warrant after making the appointment
(for example, if the administrative law judge becomes unavailable), the Commissioner
may assign your claim to another administrative law judge.
(c) You may examine the evidence used in making the Federal reviewing
official's decision, submit evidence, appear at the hearing, and present and
question witnesses. The administrative law judge may ask you questions and will
issue a decision based on the hearing record. If you waive your right to appear
at the hearing, the administrative law judge will make a decision based on the
evidence that is in the file, any new evidence that is timely submitted, and
any evidence that the administrative law judge obtains.
Availability of a hearing before an administrative law judge
You may request a hearing before an administrative law judge if you are dissatisfied
with the Federal reviewing official's decision on your disability claim.
How to request a hearing before an administrative law judge
(a) Written request. You must request a hearing by filing a written
request. You should include in your request—
(1) Your name and social security number,
(2) If you have filed a claim for benefits based on disability
under title II of the Act under an account other than your own, the name and
social security number of the wage earner under whose account you are filing,
(3) The specific reasons you disagree with the decision made
by the Federal reviewing official,
(4) A statement of the medically determinable impairment(s)
that you believe prevents you from working,
(5) Additional evidence that you have available to you, and
(6) The name and address of your representative, if any.
(b) Time limit for filing request. An administrative law judge will
conduct a hearing if you request one in writing no later than 60 days after
the date you receive notice of the Federal reviewing official's decision (or
within the extended time period if we extend the time as provided in paragraph
(d) of this section). The administrative law judge may decide your disability
claim without an oral hearing under the circumstances described in §405.340.
(c) Place for filing request. You should submit a written request
for a hearing at one of the SSA offices. If you have a disability claim under
title II of the Act, you may also file the request at the Veterans Administration
Regional Office in the Philippines, or if you have 10 or more years of service,
or at least five years of service accruing after December 31, 1995, in the
railroad industry, an office of the Railroad Retirement Board.
(d) Extension of time to request a hearing. If you
want a hearing before an administrative law judge, but you do not request it
timely, you may ask SSA for more time to request a hearing. Your request for
an extension of time must be in writing and must give the reasons the request
for review was not filed, or cannot be filed, in time. If you show SSA that
you have good cause for missing the deadline, they will extend the time period.
To determine whether good cause exists, they use the standards explained in §405.20.
(e) Waiver of the right to appear. After you submit
your request for a hearing, you may ask the administrative law judge to decide
your claim without a hearing, as described in §405.340(b).
The administrative law judge may grant the request unless he or she believes
that a hearing is necessary. You may withdraw this waiver of your right to
appear at a hearing any time before notice of the hearing decision is mailed
to you, and SSA will schedule a hearing as soon as practicable.
Time and place for a hearing before an administrative law judge
(a) General. The administrative law judge sets the time and place
for the hearing. The administrative law judge will notify you of the time and
place of the hearing at least 75 days before the date of the hearing, unless
you agree to a shorter notice period. If it is necessary, the administrative
law judge may change the time and place of the hearing. If the administrative
law judge changes the time and place of the hearing, he or she will send you
reasonable notice of the change.
(b) Where SSA holds hearings. They hold hearings in the 50 States,
the District of Columbia, American Samoa, Guam, the Northern Mariana Islands,
the Commonwealth of Puerto Rico, and the United States Virgin Islands.
(c) Determination regarding in-person or video teleconference appearance
of witnesses at the hearing. In setting the time and place of the hearing,
the administrative law judge will determine whether you or any other person
will appear at the hearing in person or by video teleconferencing. If you
object to appearing personally by video teleconferencing, SSA will re-schedule
the hearing to a time and place at which you may appear in person before
the administrative law judge. If you object to any other person appearing
by video teleconferencing, the administrative law judge will decide whether
to have that person appear in person or by video teleconference. Section 405.350 explains
how you and witnesses appear and present evidence at hearings. Except when
you object to appearing by video teleconferencing as described below, the
administrative law judge will direct that a person's appearance will be conducted
by video teleconferencing when:
(1) Video teleconferencing technology is available,
(2) Use of video teleconferencing technology would be more
efficient than conducting an examination of a witness in person, and
(3) The administrative law judge does not determine that there
is another reason why video teleconferencing should not be used.
Notice of a hearing before an administrative law judge
(a) Issuing the notice. After the administrative law judge sets the
time and place of the hearing, SSA will mail notice of the hearing to you at
your last known address, or give the notice to you by personal service. They
will mail or serve the notice at least 75 days before the date of the hearing,
unless you agree to a shorter notice period.
(b) Notice information. The notice of hearing will tell you:
(1) The specific issues to be decided,
(2) That you may designate a person to represent you during
the proceedings,
(3) How to request that we change the time or place of your
hearing,
(4) That your hearing request may be dismissed if you fail
to appear at your scheduled hearing without good reason under §405.20,
(5) Whether your or a witness's appearance will be by video
teleconferencing, and
(6) That you must submit all evidence that you wish to have
considered at the hearing no later than five business days before the date
of the scheduled hearing, unless you show that your circumstances meet the
conditions described in §405.331 for
missing the deadline.
(c) Acknowledging the notice of hearing. In the notice of hearing,
SSA will ask you to return a form to let them know that you received the notice.
If you or your representative do(es) not acknowledge receipt of the notice
of hearing, SSA will attempt to contact you to see if you received it. If you
let them know that you did not receive the notice of hearing, they will send
you an amended notice by certified mail.
Objections
(a) Time and Place. (1) If you object to the time or place of your
hearing, you must notify the administrative law judge in writing at the earliest
possible opportunity before the date set for the hearing, but no later than
30 days after receiving notice of the hearing. You must state the reason(s)
for your objection and propose a time and place you want the hearing to be
held.
(2) The administrative law judge will consider your reason(s) for requesting
the change and the impact of the proposed change on the efficient administration
of the hearing process. Factors affecting the impact of the change include,
but are not limited to, the effect on the processing of other scheduled hearings,
delays which might occur in rescheduling your hearing, and whether SSA previously
granted to you any changes in the time or place of your hearing.
(b) Issues. If you believe that the issues contained in the hearing
notice are incorrect, you should notify the administrative law judge in writing
at the earliest possible opportunity, but must notify him or her no later than
five business days before the date set for the hearing. You must state the
reason(s) for your objection. The administrative law judge will make a decision
on your objection either at the hearing or in writing before the hearing.
Administrative law judge hearing procedures—general
(a) General. A hearing is open only to you and to other persons the
administrative law judge considers necessary and proper. The administrative
law judge will conduct the proceedings in an orderly and efficient manner.
At the hearing, the administrative law judge will look fully into all of the
issues raised by your claim, will question you and the other witnesses, and
will accept any evidence relating to your claim that you submit in accordance
with §405.331.
(b) Conduct of the hearing. The administrative law judge will decide
the order in which the evidence will be presented. The administrative law judge
may stop the hearing temporarily and continue it at a later date if he or she
decides that there is evidence missing from the record that must be obtained
before the hearing may continue. At any time before the notice of the decision
is sent to you, the administrative law judge may hold a supplemental hearing
in order to receive additional evidence, consistent with the procedures described
below. If an administrative law judge requires testimony or other evidence
from a medical, psychological, or vocational expert in your claim, the Medical
and Vocational Expert Unit will provide an appropriate expert who has not
had any prior involvement in your claim.
Issues before an administrative law judge
(a) General. The issues before the administrative law judge include
all the issues raised by your claim, regardless of whether or not the issues
may have already been decided in your favor.
(b) New issues. Any time after receiving the hearing request and before
mailing notice of the hearing decision, the administrative law judge may consider
a new issue if he or she, before deciding the issue, provides you an opportunity
to address it. The administrative law judge or any party may raise a new issue;
an issue may be raised even though it arose after the request for a hearing
and even though it has not been considered in an initial or reconsidered determination.
(c) Collateral estoppel—issues previously decided. In one of
SSA's previous and final determinations or decisions involving you, but arising
under a different title of the Act or under the Federal Coal Mine Health and
Safety Act, SSA already may have decided a fact that is an issue before the
administrative law judge. If this happens, the administrative law judge will
not consider the issue again, but will accept the factual finding made in the
previous determination or decision, unless he or she has reason to believe
that it was wrong, or reopens the previous determination or decision under
subpart G of this part.
Prehearing conferences
(a)(1) The administrative law judge, on his or her own initiative or at your
request, may decide to conduct a prehearing conference if he or she finds that
such a conference would facilitate the hearing or the decision on your claim.
A prehearing conference normally will be held by telephone, unless the administrative
law judge decides that conducting it in another manner would be more efficient
and effective in addressing the issues raised at the conference. SSA will give
you reasonable notice of the time, place, and manner of the conference.
(2) At the conference, the administrative law judge may consider matters such
as simplifying or amending the issues, obtaining and submitting evidence, and
any other matters that may expedite the hearing.
(b) The administrative law judge will have a record of the prehearing conference
made.
(c) SSA will summarize in writing the actions taken as a result of the conference,
unless the administrative law judge makes a statement on the record at the
hearing summarizing them.
(d) If neither you nor the person you designate to act as your representative
appears at the prehearing conference, and under §405.380(b),
you do not have a good reason for failing to appear, SSA may dismiss the hearing
request.
Submitting evidence to an administrative law judge
(a) You should submit with your request for hearing any evidence that you have
available to you. Any written evidence that you wish to be considered at the
hearing must be submitted no later than five business days before the date
of the scheduled hearing. If you do not comply with this requirement, the administrative
law judge may decline to consider the evidence unless the circumstances described
in paragraphs (b) or (c) of this section apply.
(b) If you miss the deadline described in paragraph (a) of this section and
you wish to submit evidence during the five business days before the hearing
or at the hearing, the administrative law judge will accept the evidence if
you show that:
(1) SSA action misled you;
(2) You had a physical, mental, educational, or linguistic limitation(s) that
prevented you from submitting the evidence earlier; or
(3) Some other unusual, unexpected, or unavoidable circumstance beyond your
control prevented you from submitting the evidence earlier.
(c) If you miss the deadline described in paragraph (a) of this section and
you wish to submit evidence after the hearing and before the hearing decision
is issued, the administrative law judge will accept the evidence if you show
that there is a reasonable possibility that the evidence, alone or when considered
with the other evidence of record, would affect the outcome of your claim,
and:
(1) SSA action misled you;
(2) You had a physical, mental, educational, or linguistic limitation(s) that
prevented you from submitting the evidence earlier; or
(3) Some other unusual, unexpected, or unavoidable circumstance beyond your
control prevented you from submitting the evidence earlier.
Subpoenas
(a) When it is reasonably necessary for the full presentation of a claim, an
administrative law judge may, on his or her own initiative or at your request,
issue subpoenas for the appearance and testimony of witnesses and for the production
of any documents that are relevant to an issue at the hearing.
(b) To have documents or witnesses subpoenaed, you must file a written request
for a subpoena with the administrative law judge at least 10 days before the
hearing date. The written request must:
(1) Give the names of the witnesses or documents to be produced;
(2) Describe the address or location of the witnesses or documents with sufficient
detail to find them;
(3) State the important facts that the witness or document is expected to show;
and
(4) Indicate why these facts could not be shown without that witness or document.
(c) We will pay the cost of issuing the subpoena and pay subpoenaed witnesses
the same fees and mileage they would receive if they had been subpoenaed by
a Federal district court.
(d) Within five days of receipt of a subpoena, but no later than the date of
the hearing, the person against whom the subpoena is directed may ask the administrative
law judge to withdraw or limit the scope of the subpoena, setting forth the
reasons why the subpoena should be withdrawn or why it should be limited in
scope.
(e) Upon failure of any person to comply with a subpoena, the Office of the
General Counsel may seek enforcement of the subpoena under section 205(e) of
the Act.
Submitting documents
All documents prepared and submitted by you, i.e., not including medical or
other evidence that is prepared by persons other than the claimant or his or
her representative, should clearly designate the name of the claimant and the
last four digits of the claimant's social security number. All such documents
must be clear and legible to the fullest extent practicable and delivered or
mailed to the administrative law judge within the time frames that he or she
prescribes. Documents that are typewritten or produced with word processing
software must use type face no smaller than 12 point font.
Prehearing statements
(a) At any time before the hearing begins, you may submit, or the administrative
law judge may request that you submit, a prehearing statement as to why you
are disabled.
(b) Unless otherwise requested by the administrative law judge, a prehearing
statement should discuss briefly the following matters:
(1) Issues involved in the proceeding,
(2) Facts,
(3) Witnesses,
(4) The evidentiary and legal basis upon which your disability claim can be
approved, and
(5) Any other comments, suggestions, or information that might assist the administrative
law judge in preparing for the hearing.
Deciding a claim without a hearing before an administrative law judge.
(a) Decision wholly favorable. If the evidence in the record supports
a decision wholly in your favor, the administrative law judge may issue a decision
without holding a hearing. However, the notice of the decision will inform
you that you have the right to a hearing and that you have a right to examine
the evidence on which the decision is based.
(b) You do not wish to appear. The administrative law judge may decide
a claim on the record and not conduct a hearing if—
(1) You state in writing that you do not wish to appear at a hearing, or
(2) You live outside the United States and you do not inform us that you want
to appear.
(c) When a hearing is not held, the administrative law judge will make a record
of the evidence, which, except for the transcript of the hearing, will contain
the material described in §405.360.
The decision of the administrative law judge must be based on this record.
Presenting evidence at a hearing before an administrative law judge
(a) The right to appear and present evidence. You have a right to
appear before the administrative law judge, either in person or, when the administrative
law judge determines that the conditions in §405.315(c)
exist, by video teleconferencing, to present evidence and to state your position.
You also may appear by means of a designated representative.
(b) Admissible evidence. The administrative law judge may receive
any evidence at the hearing that he or she believes relates to your claim.
(c) Witnesses at a hearing. Witnesses who appear at a hearing shall
testify under oath or by affirmation, unless the administrative law judge finds
an important reason to excuse them from taking an oath or making an affirmation.
The administrative law judge, you, or your representative may ask the witnesses
any questions relating to your claim.
Closing statements
You or your representative may present a closing statement to the administrative
law judge—
(a) Orally at the end of the hearing,
(b) In writing after the hearing and within a reasonable time period set by
the administrative law judge, or
(c) By using both methods under paragraphs (a) and (b).
Official record
All hearings will be recorded. All evidence upon which the administrative law
judge relies for the decision must be contained in the record, either directly
or by appropriate reference. The official record will include the applications,
written statements, certificates, reports, affidavits, medical records, and
other documents that were used in making the decision under review and any
additional evidence or written statements that the administrative law judge
admits into the record under §§405.320(a)
and 405.331.
All exhibits introduced as evidence must be marked for identification and incorporated
into the record. The official record of your claim will contain all of the
marked exhibits and a verbatim recording of all testimony offered at the hearing;
it also will include any prior initial determinations or decisions on your
claim. Subject to §405.373,
the official record closes once the administrative law judge issues his or
her decision regardless of whether it becomes the final decision.
Consolidated
hearing before an administrative law judge
(a) General. (1) SSA may hold a consolidated hearing if—
(i) You have requested a hearing to decide your disability claim, and
(ii) One or more of the issues to be considered at your hearing is the same
as an issue involved in another claim you have pending before SSA.
(2) If the administrative law judge consolidates the claims, he or she will
decide both claims, even if SSA has not yet made an initial determination
or a Federal reviewing official decision on the other claim.
(b) Record, evidence, and decision. There will be a single record
at a consolidated hearing. This means that the evidence introduced at the hearing
becomes the evidence of record in each claim adjudicated. The administrative
law judge may issue either a consolidated decision or separate decisions for
each claim.
Posthearing conferences
(a) The administrative law judge may decide, on his or her own initiative or
at your request, to hold a posthearing conference to facilitate the hearing
decision. A posthearing conference normally will be held by telephone unless
the administrative law judge decides that conducting it in another manner would
be more efficient and effective in addressing the issues raised. SSA will give
you reasonable notice of the time, place, and manner of the conference. A record
of the conference will be made and placed in the hearing record.
(b) If neither you nor the person you designate to act as your representative
appears at the posthearing conference, and under §405.380(b),
you do not have a good reason for failing to appear, SSA will issue a decision
based on the information available in your claim.
Decision by the administrative law judge
(a) The administrative law judge will make a decision based on all of the evidence,
including the testimony adduced at the hearing. The administrative law judge
will prepare a written decision that explains in clear and understandable language
the specific reasons for the decision. While the administrative law judge will
not consider the Federal reviewing official's decision to be evidence, the
written decision will explain in detail why the administrative law judge agrees
or disagrees with the substantive findings and overall rationale of the decision.
(b) During the hearing, in certain categories of claims that SSA identifies
in advance, the administrative law judge may orally explain in clear and understandable
language the specific reasons for, and enter into the record, a wholly favorable
decision. The administrative law judge will include in the record a document
that sets forth the key data, findings of fact, and narrative rationale for
the decision. Within five days after the hearing, if there are no subsequent
changes to the analysis in the oral decision, SSA will send you a written decision
that incorporates such oral decision by reference and that explains why the
administrative law judge agrees or disagrees with the substantive findings
and overall rationale of the Federal reviewing official's decision. If there
is a change in the administrative law judge's analysis or decision, SSA will
send you a written decision that is consistent with paragraph (a) of this section.
Upon written request, SSA will provide you a record of the oral decision.
Notice of the decision of an administrative law judge
SSA will send a notice and the administrative law judge's decision to you at
your last known address. The notice accompanying the decision will inform you
whether or not the decision is SSA's final decision, and will explain your
right to representation. If it is not SSA's final decision, the notice will
explain that the Decision Review Board has taken review of your claim.
Finality of an administrative law judge's decision
The decision of the administrative law judge becomes SSA's final decision and
is binding on you unless—
(a) The Decision Review Board reviews your claim,
(b) An administrative law judge or the Decision Review Board revises the decision
under subpart G of this part,
(c) A Federal court reverses the decision or remands it for further administrative
action, or
(d) The administrative law judge considers new evidence under §405.373.
Requesting
consideration of new evidence
(a) If the administrative law judge's decision is SSA's final decision, the
administrative law judge will consider new evidence submitted after the issuance
of the decision if your claim has not been referred to the Decision Review
Board. To obtain such consideration, you must request consideration by the
administrative law judge at the earliest possible opportunity, but no later
than 30 days after the date you receive notice of the decision.
(b) The administrative law judge will accept the evidence if you show that
there is a reasonable probability that the evidence, alone or when considered
with the other evidence of record, would change the outcome of the decision,
and:
(1) SSA action misled you;
(2) You had a physical, mental, educational, or linguistic limitation(s) that
prevented you from submitting the evidence earlier; or
(3) Some other unusual, unexpected, or unavoidable circumstance beyond your
control prevented you from submitting the evidence earlier.
(c)(1) The administrative law judge will notify you within 10 days whether
or not he or she will reconsider the final decision.
(2) If the administrative law judge declines to reconsider his or her decision,
the decision remains final. If you choose to seek judicial review, you must
file in Federal court within the 60-day period beginning with the date you
originally received the final decision.
(3) If the administrative law judge agrees to reconsider his or her decision
based on the new evidence, the final decision is vacated and not subject to
judicial review. After considering the new evidence, the administrative law
judge will take appropriate action, including rendering a decision under §405.370,
and SSA will send you notice of the decision under §405.371.
(d) If the administrative law judge's decision is not SSA's final decision,
you must submit your evidence to the Decision Review Board, and the Board will
consider it if you make the showings required in paragraph (b) of this section.
Dismissal of a request for a hearing before an administrative law judge
An administrative law judge may dismiss a request for a hearing:
(a) At any time before notice of the hearing decision is mailed, when you withdraw
the request orally on the record at the hearing or in writing;
(b)(1) If neither you nor the person you designate to act as your representative
appears at the hearing or at the prehearing conference, SSA previously notified
you that your request for hearing may be dismissed if you did not appear, and
you do not give a good reason for failing to appear; or
(2) If neither you nor the person you designate to act as your representative
appears at the hearing or at the prehearing conference, SSA had not previously
notified you that your request for hearing may be dismissed if you did not
appear, and within 10 days after SSA sends you a notice asking why you did
not appear, you do not give a good reason for failing to appear.
(3) In determining whether you had a good reason under this paragraph, SSA
will consider the factors described in §405.20(a)
of this part;
(c) If the doctrine of res judicata applies because SSA has made a previous
determination or decision on your disability claim on the same facts and on
the same issue or issues, and this previous determination or decision has become
final;
(d) If you have no right to a hearing under §405.305;
(e) If you did not request a hearing in time and SSA has not extended the
time for requesting a hearing; or
(f) If you die and your estate or any person to whom an underpayment
may be distributed under §§404.503 or 416.542 of
this chapter has not pursued your claim.
Notice of dismissal of a request
for a hearing before an administrative law judge
SSA will mail a written notice of the dismissal of the hearing request to you
at your last known address. The notice will tell you that you may ask the administrative
law judge to vacate the dismissal (see §405.382),
and will explain your right to representation. The notice will also tell you
that you may ask the Decision Review Board to review the dismissal if the administrative
law judge does not vacate it.
Vacating a dismissal of a request for
a hearing before an administrative law judge
If you ask in writing within 30 days after the date you receive the notice
of dismissal, an administrative law judge may vacate a dismissal of a hearing
request. The administrative law judge will vacate the dismissal if he or she
finds that it was erroneous. SSA will notify you of whether the administrative
law judge granted or denied your request.
Effect of dismissal of a request for a hearing before an administrative
law judge
The administrative law judge's dismissal of a request for a hearing is binding
and not subject to further review, unless it is vacated by the administrative
law judge under §405.382 or
by the Decision Review Board under §405.427 of
this part.