Social Security Disability Claimants are often relieved to finally get an ALJ hearing only to get an unfavorable decision, which is disappointing. However, many decide to appeal the ALJ decision hoping for a favorable finding by the SSA’s Appeal Council or United States District Court, and/or at least remanded back to the ALJ for a second chance. In the meantime, Claimants desperate for a final decision and financial assistance will file an additional claim(s) while waiting on a determination for the first claim. This is perfectly legitimate; however, it can create some issues and/or solve problems. As the saying goes, “Solutions often create problems.” This can be the case here.
Sometimes, Claimants are found disabled on the second claim while waiting on the first claim to be decided. Good news, problem solved… not so fast. After filing the second claim, the first claim is either decided by the AC or USDC or remanded back to the ALJ. If remanded back to the ALJ, some ALJs will mistakenly think they need to reopen and adjudicate both claims even if one has already been decided - a final determination. One may argue that only the remanded claim is in their jurisdiction. Maybe. Can the ALJ just reopen a final determination because there is an open claim in his/her jurisdiction for the same Claimant? Can the ALJ reopen the final determination because s/he does not like the finding? Short answer, no.
Long answer. Claimants and ALJs are treated similarly by SSA policy when it comes to reopening final determinations/decisions. In order to streamline processes, SSA limits who and how final determinations can be reopened because it is re-adjudicating a claim. This can be timely and expensive for SSA. Nonetheless, to ensure a full and fair adjudication process, Claimants and SSA adjudicators can reopen a final determination.
Claimants: Reopening a prior application typically helps Claimants but are frequently denied by ALJs. Claimants who want a prior application reopened because they now have a favorable decision will request a prior claim reopened; this gets them more money. However, first, under HALLEX I-2-9-20, the claims must have the same alleged onset dates, same adjudicative period of time. If no, reopening is not likely possible. Second, if the claims have the same adjudicative periods of time, they may be reopened if within the time period for reopening based on date of initial determination of the first claim and filing date of the second claim (1 year for any reason, 4 years for good cause under Title II claims, 2 years for good cause under Title XVI claims, and anytime for fraud or technical denial issue changes). Third, there must be good cause to reopen the claim. Good cause is typically granted if new and material evidence is submitted that shows a different decision is likely, there was an error on its face, OR a clerical error, under 20 CFR 404.987 and 404.988 and 404.989.
ALJs: Why would an ALJ reopen a final determination and can s/he reopen the claim? Well, there are many reasons but let’s say, hypothetically, the ALJ has a hearing on the first claim that was remanded and plans on issuing an unfavorable decision. However, the ALJ does not like that SSA found Claimant was disabled on the second claim. Can the ALJ reopen the final determination on the favorable claim hoping to merely change the decision so that it is consistent with the unfavorable decision issued on the first claim? Not legally but it does happen. The ALJ must follow procedures for reopening final determinations. First, ALJs are limited to reopening final determinations at the ALJ level and below, not at the AC level and above. Second, SSA discourages ALL adjudicators from merely reopening claims because there is new evidence under GN 04001.070: “A determination which was correct when it was made is still correct even if there is subsequently a change in the factual situation.” Third, ALJs must follow the same reasoning for good cause as outlined in HALLEX I-2-9-20, mentioned above. Notably, SSA should not find good cause to reopen the case if the only reason is a change of legal interpretation or administrative ruling upon which the determination or decision is made.
Overall, be cautious when an ALJ initiates reopening a favorable final determination Implied or Explicitly; this may be reopening a ‘can of worms’ for Claimant if the ALJ makes a decision that Claimant was not disabled after all. If the ALJ reopens the final determination and issues an unfavorable or partially favorable decision, changing the final determination, in most cases, the ALJ must apply either a medical improvement (MI) standard or continuing disability review (CDR) standard in the decision. Remember, merely indicating that a different decision is possible is not grounds for reopening a determination or decision under 20 CFR 404.987, 404.988, or 404.989.
Please share your experiences around ALJs reopening final determinations.
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