HOME

SEVERE
Statutes

Return to SEVERE Home Page

HOME

I-2-140 CRITICAL CASES (REVISED 09/92)

A. General
OHA designates a case requiring special processing for one of the reasons listed in subsection B., below, a "critical case" to ensure that the appropriate component(s) takes prompt action on the case.

B. Critical Situations

Four situations warrant instituting critical case processing procedures:

1. The claimant's illness is terminal (see subsection C., below);

2. The claimant is without, and is unable to obtain, food, medicine or shelter;

3. There is an indication that the claimant is suicidal or homicidal (see NOTE, below); or

4. The case has been delayed an inordinate amount of time, i.e., pending more than 60 days longer than the average processing time for the office in question, and there is a public, congressional or other high priority inquiry on the case.
NOTE: If a claimant threatens suicide or homicide, immediately notify, through designated channels, the Office of the Regional Commissioner with jurisdiction over the claim. See - I-2-137 for additional information about handling such threats.
NOTE: If a claimant alleges one of the situations in item 2, and the allegation is suspect or questionable, request confirmation through the servicing SSA field office before designating the case critical. See subsection C., below, for documentation of terminal illness.

C. Terminal Illness
A critical case involving terminal illness (a "TERI" case) requires additional special handling. OHA tracks a TERI case while it is within OHA, and the SSA Regional Office also monitors the case to ensure that it is expedited. TERI cases include any case already identified as a TERI case (by the special "TERI CASE" flag, form SSA-2200) when received by the HO, and any case involving:

- An allegation (e.g., from the claimant or a friend, family member, doctor or other medical source) that the claimant's illness is terminal;

- An allegation or diagnosis of AIDS;

- A claimant registered in a Medicare designated hospice or receiving hospice care (e.g., in-home counseling or nursing care); or

- A claimant with a condition which medical records indicate cannot be reversed and is expected to end in death. Such cases include (but are not limited to) those involving a claimant:

-- with a chronic dependence on a cardiopulmonary life-sustaining device;

-- awaiting a heart, heart/lung, liver or bone marrow transplant (excluding kidney and corneal transplants);

-- with chronic pulmonary or heart failure requiring continuous home oxygen and who is unable to care for personal needs;

-- with a malignant disease (e.g., cancer) who is home confined or institutionalized, unable to care for personal needs and unresponsive to therapy;

-- with diabetes and one or more of the following: multiple amputations due to diabetic gangrene; recurrent cardiovascular events (e.g., infarction or failure); or recurrent cerebrovascular events with neurological deficit;

-- with chronic liver disease (e.g., cirrhosis or hepatitis) and a history of massive gastrointestinal hemorrhage;

-- who is comatose for 30 days or more; or

-- who is a newborn with a lethal or severe genetic or congenital defect.

The presence of one of the above criteria does not mandate a finding of disability. Evaluate the claimant's impairment under the sequential evaluation process.
NOTE: Do not question or attempt to verify an allegation of terminal illness or AIDS. If an allegation of hospice care is questionable, request confirmation through the servicing FO.

D. Critical Case Identification

Within the RO, the Regional Chief Administrative Law Judge (RCALJ) or the Regional Management Officer (RMO) is responsible for designating a case as critical and ensuring that the critical case procedures are followed. In the HO, the Hearing Office Chief Administrative Law Judge (HOCALJ) or his or her designee (who must be an ALJ) has this responsibility. All RO and HO employees are responsible for bringing any case which may meet the criteria in subsection B. or C., above, to the attention of the appropriate responsible official. The RMO will be the primary point of contact for all inquiries on TERI cases.

E. Reporting and Expediting Procedures (HO) Each RO and HO will maintain a list of its critical cases for monitoring, tracking and reporting purposes. The list must show the date (month/day/year) the case was designated as critical, the claimant's name and social security number, the designating office, the reason for the critical designation, and the current status of the case. If applicable, the list must also show the reason the status of a particular case has not changed from the previous report.
If the HO receives a designated critical (including TERI) case, or the HOCALJ (or designee) determines that a previously undesignated case is critical, the HO staff must:

1. Attach to the front of the claims file (to each claims file in a concurrent case) either:

a. a Critical Case/Dire Need flag (for all critical cases except TERI cases); or

b. a completed TERI CASE flag, Form SSA-2200 (unless the TERI case is already flagged when received);

NOTE: See - I-2-190 Samples, Sample 5, Critical Case Flag. HOs should reproduce Critical Case Flags locally. HOs may order TERI CASE flags (Form SSA-2200) through usual channels.

2. Add the case to the HO's critical case list and annotate the Hearing Office Tracking System (by entering "Y" in the Critical Case field);

3. Take immediate action to expedite the case (including a review of the case to determine if an on-the-record decision is appropriate), and continue to expedite all actions taken while the case is pending; and

4. Monitor and track the HO's progress in processing the case.
NOTE: HOs may alter normal case processing procedures if such action will expedite payment of benefits (e.g., splitting a concurrent case to issue a favorable SSI decision when the title II claim requires development).
For TERI cases, the HO staff must also:

5. Ensure that the TERI flag is completed and correct, including attorney fee waiver information, if available;

6. Enter "TERI" in HO Field 1 of the HOTS;

7. Send a photocopy of the TERI flag to the RO (which will forward the copy to the appropriate SSA Office of the Regional Commissioner);

8. For TERI cases first identified at the HO, immediately notify the SSA field office to begin non-medical development; and

9. Clearly mark "TERI Case" on any transmittal forms or envelopes used to forward the claim to another component.

10. In certain cases, as identified in section II. A. of T.I. 5-311, send an OHA Early Development Notification via E-MAIL to the effectuating component(s).

NOTE: HOs may not transfer TERI cases for exhibit preparation, decision writing or typing without obtaining prior authorization (through the RO) from the Division of Field Operations and Liaison (DFOL) in the Office of the Chief Administrative Law Judge [(703) 305-0009]. If DFOL authorizes a transfer, it will impose strict processing-time limits and reporting requirements.

At the end of each month, the HO will provide a copy of its critical case list to the RO.

F. Reporting and Expediting Procedures (RO)

If the RO is handling a critical case, RO staff will follow the procedures set forth in E., above, to track the case in the RO.

By the 15th of each month, RO staff will prepare a consolidated listing of critical cases, in chronological order by the date a case was designated as critical. The report will list all critical cases pending in the RO and HOs at the end of the previous month. The RO will forward copies of the consolidated report via E-Mail to 1) the Division of Congressional and Public Inquiries in OHA Headquarters, and 2) DFOL in the Office of the Chief Administrative Law Judge.

G. Completion of HO or RO Action

When an ALJ is prepared to issue a final disposition on a critical case, proceed as follows:

1. ALJ Issues Fully or Partially Favorable Decision

If the ALJ issues a fully or partially favorable decision on a critical case, the HO will:

a. Expedite preparation and release of the decision; and

b. Use the most expeditious method practical to send the file to the effectuating component (e.g., express mail).

Use the following addresses for critical cases not involving terminal illness (Critical Cases) and critical cases involving terminal illness (TERI cases) being sent to the Office of Disability and International Operations (ODIO) for effectuation:

Critical Cases TERI Cases

SSA SSA

ODIO, Critical Case Unit ODIO, TERI Case Unit

1500 Woodlawn Drive 1500 Woodlawn Drive

Baltimore, Maryland 21241 Baltimore, Maryland 21241

For all other cases (including TERI cases being sent to Program Service Centers), use the standard effectuating component addresses.

NOTE: The SSA Office of the Regional Commissioner will continue to monitor processing until all retroactive benefits, if any, have been paid.

2. ALJ Dismisses Request for Hearing, or Issues Unfavorable Decision

If the ALJ issues a dismissal or an unfavorable decision, the HO will:

a. Expedite preparation and release of the decision or order; and

b. Follow standard procedures for claims file routing.

3. ALJ Issues Formal Remand

If the ALJ issues a remand to the State Agency on a critical case, the HO will:

a. Expedite preparation and release of the remand order; and

b. Use the most expeditious method practical to send the file to the State Agency (e.g., express mail).


For TERI cases, in addition to the procedures described in 1., 2. and 3., above, the HO will also:

- Clearly annotate transmittals and envelopes "TERI Case;" and

- Provide a copy of the remand order, dismissal order or decision to the RO (which will forward the copy to the SSA Office of the Regional Commissioner).

H. Conditions Which Justify Removing Critical Case Designation

HO or RO staff may remove the critical designation and discontinue tracking a case other than a TERI case when the condition(s) which formed the basis for the critical designation no longer applies. Offices may not remove TERI case flags or cancel TERI designations.

If an HO or RO decides to discontinue monitoring a critical case (other than TERI), the reason for the action must be annotated on the next critical case report in the current status column.

HALLEX I-2-145

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division II: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

June 30, 1994

Current through March 1997

I-2-145 PARTIES TO THE HEARING

Citations: - 20 CFR §§ 404.932, - 410.632 and 416.1432

A. General

Any individual(s) who was a party to the initial, reconsidered, or revised determination, or other person who makes a showing in writing that his or her rights may be adversely affected by the hearing decision, may be a party to the hearing.

B. Informing Individuals Who May Be Parties to the Hearing

When the HO staff has identified the potential parties, the Administrative Law Judge (ALJ) must inform each individual of his or her rights, unless the individual has waived his or her right to be made a party to the hearing.

NOTE: The ALJ will dismiss a request for hearing (RH) if it was not filed by a proper party. (See - I-2-430, Dismissal--No Right to a Hearing.)

C. Multiple Parties

When there are multiple parties, the ALJ will bring all parties together at one joint hearing, if possible. The parties will testify in the presence of each other unless one or more of the parties requests to testify separately and the other parties consent to the separate testimony. (See - I-2-165 B., Types of Hearings; and - I-2-660 D., The Hearing When There Are Multiple Parties.)

NOTE: When corresponding with one party, do not disclose information about another party which is not relevant to the issues in the case and which the other party has requested that we not disclose. For example, do not disclose a party's address to another party if the party has requested that we not disclose it. If the address appears on an exhibit that must be disclosed, the HO staff must disclose only a copy of the exhibit which has the address deleted. (Also see - I-2-115 B.3., for discussion of "confidential" documents.)

D. Special Situations

1. A wage earner's survivor (defined as the wage earner's widow or widower, surviving divorced spouse, mother or father, or surviving child) has the same rights as a wage earner (WE) to appeal a change in (or a refusal to change) the WE's earnings record. The survivor in such a case does not need to establish that he or she would be adversely affected by the ALJ's decision to be made a party to the hearing. A timely filed request in writing to be made a party to the hearing is sufficient. 2. When an RH involves a determination regarding the crediting of self-employment income between a husband and wife, the ALJ will make both of them parties to the hearing because the ALJ's decision regarding the income of one of the parties may adversely affect the rights of the other.

E. Geographic Considerations

The ALJ will not deny any proper party the right to a hearing or the right to present evidence because of geographic considerations.

1. If a party to the hearing lives outside the geographic area served by the HO, the ALJ will encourage that party to attend the hearing.

2. If a party is unable to attend a hearing in the geographic area served by the HO, the ALJ or the ALJ's designee should make arrangements to afford the party the opportunity to attend a supplemental hearing at a convenient location. (See - I-2-310, Scheduling Hearings.)

3. If a party requests to present sworn testimony instead of attending a hearing, see - I-2-620, Affidavits and Depositions.

4. The ALJ who schedules the hearing for the party who first filed the RH will have jurisdiction over the case. This ALJ will issue one decision which incorporates the proceedings of the primary hearing and any other hearing, e.g., the proceedings of a separate hearing held because of geographical considerations or a deposition taken by another ALJ. (See - I-2-624, Requesting an ALJ in Another Service Area to Take a Deposition.)

When the ALJ issues a decision, he or she will send copies to all parties with notice of the right to request review by the Appeals Council. (See - I-2-800ff, Administrative Law Judge Decisions.)

F. Waiver of the Right to Appear at the Hearing

A claimant may waive the right to appear at an oral hearing and request the ALJ to decide the case on the basis of the evidence of record. The regulations also provide, however, that the ALJ may schedule a hearing notwithstanding the waiver if he or she believes a personal appearance and testimony are necessary to properly decide the case (- 20 CFR §§ 404.950(b) and - 416.1450(b)).


The development of evidence and conduct of a case is the ALJ's responsibility and should be exercised to satisfy valid regulatory requirements, not the convenience of the representative.

If an ALJ schedules a hearing despite a waiver, and the claimant or the representative do not appear, the ALJ must set forth in the decision the reason for requesting the claimant's appearance and the efforts undertaken to put the claimant on notice of the need for the hearing. The ALJ must also include in the rationale any adverse presumptions regarding credibility, weight of the evidence, etc., which arose from the claimant's refusal to appear.

If it becomes apparent that the provisions which permit waiver of oral hearing are being abused, e.g., if a representative routinely advises his or her clients to waive appearance, or to ignore a hearing which was scheduled despite the waiver, it would be appropriate to issue a notice that failure to appear at the scheduled hearing could jeopardize successful resolution of the claim. The important consideration is that the claimant be fully advised of the possible consequences of his or her actions.

Under some circumstances, an ALJ may issue a more detailed notice of hearing to specify the facts and issues which require development at an oral hearing, or employ other procedures, such as a prehearing conference to narrow and clarify issues.

If a claimant states in the request for hearing (RH) that he or she waives the right to appear at a hearing, or otherwise notifies the hearing office (HO) that he or she intends to waive the right to appear, the ALJ or the HO staff must take the following actions:

1. If the claimant is unrepresented, advise the claimant of the right to representation.

2. Advise the claimant of the advantages of appearing at a hearing; ensure that the claimant is fully advised of the possible consequences of his or her waiver; and explain that even though he or she has waived the right to appear, the ALJ may schedule and conduct a hearing if the ALJ deems it necessary.

3. If the claimant still elects to waive the right to appear at a hearing, obtain written documentation of the claimant's election on a Form HA-4608, Waiver of Right to Oral Hearing.

NOTE: If a claimant waives the right to a hearing, the ALJ must afford the claimant the right to submit written comments, responses to interrogatories, or other evidence.

HALLEX I-2-150

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 2: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

April 26, 1995

Current through March 1997

I-2-150 DEATH OF CLAIMANT (REVISED 06/94)

A. Claimant Dies Before the Hearing Is Held

If a claimant dies before the ALJ holds a hearing, and the record indicates that there is another party or person who may be adversely affected by the determination to be reviewed at the hearing (e.g., in a title XVI case, if the claimant dies before SSA has paid all benefits due or before the claimant endorses the check for the correct payment, SSA may pay the amount due to the deceased claimant's surviving eligible spouse or to his or her surviving spouse who was living with the underpaid claimant within the meaning of § 202(i) of the Act (see > 20 CFR § 404.347) in the month he or she died or within 6 months immediately preceding the month of death, or if the deceased underpaid claimant was a disabled or blind child when the underpayment occurred, SSA may pay the amount due to the natural or adoptive parent(s) of the underpaid claimant who lived with the underpaid claimant in the month he or she died or within 6 months immediately preceding the month of death), ascertain that individual's intentions by:

1. contacting the individual directly, if the record shows the individual's name and address; or

2. requesting the servicing field office (FO) to determine the individual's name and address, and obtain a statement of the individual's intentions. Use Form HA-539, Notice Regarding Substitution of Party Upon Death of Claimant, as appropriate.

NOTE: FOs are instructed to notify the servicing hearing office (HO) when they become aware that a party awaiting a hearing has died. The FO's notification should indicate whether a survivor's claim has been or will be filed, the name and address of the survivor(s), or if no survivor's claim has been filed and none is being developed, the name and address of the nearest known relative.

If there is another claimant or person who may be adversely affected by the ALJ's decision, that individual wishes to proceed with the hearing, and there is no other reason to dismiss the request for hearing (RH), the ALJ must hold a hearing and issue a decision. (See > I-2-800ff, Administrative Law Judge Decisions.)

If there is no other claimant or person who may be adversely affected by the determination to be reviewed at the hearing, or if that individual has stated in writing that he or she does not wish to proceed with the hearing, the ALJ may dismiss the RH. (See > I-2-435, Dismissal Due to Death of a Claimant.) The ALJ may also dismiss the RH if any of the other conditions for dismissal are met. (See > I-2-405, Dismissing a Request for Hearing.)

B. Claimant Dies After the Hearing Has Been Held

If the claimant dies after the hearing is held, the ALJ will proceed with the actions necessary to complete the record and issue a decision. (See > I-2-837, Decision When Claimant Dies.)

C. Appealed Issue Is Earnings Record Revision

If the primary issue being appealed is revision of the wage earner's earnings record, and a survivor establishes potential entitlement based on that earnings record, make the survivor a substitute party upon request. It is not necessary for the survivor to establish that he or she would be adversely affected by the ALJ's decision.

NOTE: A survivor may choose not to pursue the appeal rights of the deceased as a "substitute party." However, the survivor may later decide, after receiving an initial and reconsidered determination on his or her claim, to request a hearing in his or her own right. Under these circumstances, the issues appealed by the deceased may still be the subject of the hearing.

HALLEX I-2-155

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 2: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

April 26, 1995

Current through March 1997

I-2-155 ASSIGNMENT OF SERVICE AREA CASES TO ADMINISTRATIVE LAW JUDGES

When the hearing office (HO) receives a valid RH or an Appeals Council remand and completes the procedures set forth in > I-2-000ff, Initial Processing of a Request for Hearing, the Hearing Office Chief Administrative Law Judge (HOCALJ), acting as the Associate Commissioner's "delegate," shall assign the case to an ALJ.

A. Master Docket

HOs maintain a "master docket" which lists all RHs and remands received. The HOCALJ generally assigns cases to ALJs from the master docket on a rotational basis, with the earliest (i.e., oldest) RHs receiving priority, unless there is a special situation which requires a change in the order in which a case is assigned. (See I-2-155 D.)

B. HO and Remote Hearing Sites

The Regional Chief Administrative Law Judge (RCALJ) determines which areas within an HO's service area are to be served from the HO and which are to be served from a remote hearing site(s). In making such determinations, the RCALJ considers recommendations from the HOCALJ. Such areas may require modification periodically based on case receipts and other service and cost factors.

C. Case Assignments Requiring Travel Within the Hearing Office Service Area

1. Rotate Assignments

Generally, the HOCALJ will rotate the assignments requiring travel among all ALJs in the HO consistent with the objective of scheduling older cases first.

2. Travel Dockets

ALJs will generally accumulate a docket of cases to be heard at the remote site so as to minimize administrative travel and related costs.

3. Advance Administrative Approval for Travel

An ALJ must obtain advance administrative approval of proposed travel. The procedure for securing approval will vary from region to region, depending upon the specific methods prescribed by the RCALJ.

D. Special Situations Which Require a Change in the Order in Which Cases are Assigned

1. Critical/Terminal Illness case. This is a case which involves a "critical" [including terminal illness (TERI)] situation. Flag and assign the case immediately. (See > I-2-140, Critical Cases.)

2. Time-limited court remand case. This is a case in which the court has ordered the Secretary to complete a specific action(s) within a set period of time. Flag and assign the case immediately.

3. Section 8001 case. In these cases, the Appeals Council has assumed jurisdiction on its own motion of an ALJ's favorable disability decision and remanded the case for further proceedings. If certain times are not (or have not been) met, the Social Security Administration must pay interim benefits to the claimant until the proceedings on remand have been completed. Flag and assign the case immediately.

4. Delayed court remand case. This is a court remand case which is over 125 days old (counting from the date of the court's order) or which the Appeals Council has remanded to an ALJ a second time. Flag and assign the case immediately.

5. Other court remand case. Flag and assign the case immediately.

6. Title XVI non-disability case. Assign the case immediately as the hearing decision must be issued within 90 days from the date of the RH.

7. Disability cessation case. Assign the case immediately to avoid or minimize overpayments.

8. Case which appears to meet the criteria for dismissal. Assign the case immediately as the ALJ may be able to issue a dismissal order quickly. (See > I-2-400ff, Dismissals.)

9. Case in which the claimant has waived the right to an oral hearing. Assign the case immediately as the ALJ may be able to issue a decision quickly.

NOTE: The ALJ may determine, based on his or her examination of the record, that a hearing should be held despite the waiver.

10. Case in which a claimant has waived his or her right to regular advance notice of hearing. A claimant's waiver of the right to regular advance notice indicates that he or she does not need advance notice to prepare for the hearing, and desires a hearing as soon as possible. Therefore, if the HO staff can accommodate the claimant because of a cancellation by another claimant or any other reason, it should assign the case to an ALJ and schedule a hearing as soon as possible, without the usual advance notice.

11. Appeals Council remand. Flag and assign the case immediately. Appeals Council remands, including those generated by the courts, are assigned to the same ALJ who issued the decision or dismissal unless:

a. the case was previously assigned to that ALJ on a prior remand from the Appeals Council and the ALJ's decision or dismissal after remand is the subject of the new Appeals Council remand, or

b. the Appeals Council or the court directs that the case be assigned to a different ALJ.

 

HALLEX I-2-157

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 2: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

April 26, 1995

Current through March 1997

I-2-157 ASSIGNMENT OF NON-SERVICE AREA CASES TO ADMINISTRATIVE LAW JUDGES

A. Statement of Purpose

The practice of assigning non-service area cases to Administrative Law Judges (ALJs) for hearing must be viewed as a measure for resolving temporary workload imbalances or increasing productivity until more permanent measures can be taken. Before making such assignments, management must consider alternative approaches to balancing workloads: (1) temporary or permanent service area realignments (both intraregional and interregional); (2) temporary staff details/reassignments; and (3) if the problem appears to be a long-term one, the hiring or transferring of ALJs. If assigning non-service area cases to ALJs is necessary, Regions must use their own ALJs first, before requesting out-of-region assistance. Because the primary purpose of assigning non-service area cases to ALJs is to process workloads more quickly, do not assign non-service area cases to ALJs unless the assisting office can hear and decide them sooner than the assisted office. In addition to reducing processing times, other added benefits to assigning non-service area cases to ALJs include increased productivity and improved use of personnel.

B. Procedures of Policy

1. Authority for Assigning Non-Service Area Cases to ALJs

a. RCALJs are authorized to determine the need for and arrange the assignment of non-service area cases to ALJs within their regions. Non-service area case assignments between Regions I and II, and among Regions VII, VIII and X are considered intraregional for purposes of this policy. (This information will be reported, however, on the Monthly Activity Report.)

b. The Office of the Chief ALJ (OCALJ) is responsible for determining the need for and the arrangement of the interregional assignment of non-service area cases to ALJs. To control costs, such assignments will be arranged between contiguous regions, when practicable.

2. Assignment of Non-Service Area Dockets to ALJs

a. Generally, the Hearing Office Chief ALJ (HOCALJ) of the assisting office will assign non-service area dockets to ALJs on a rotational basis. Once the assignment is made, cases cannot be returned to the assisted office for any reason without Regional Chief ALJ (RCALJ) approval (in the case of intraregional assignments), or OCALJ approval (in the case of interregional assignments). Disagreements between the assisted and assisting offices will be resolved by the RCALJ, or OCALJ and both RCALJs in the case of interregional assignments.

ä The HOCALJ will assign non-service area cases to ALJs in a manner that will afford each ALJ, to the extent practicable, the opportunity to travel to all available locations. While there are advantages to establishing "companion" offices, HOCALJs must make reasonable efforts to accommodate ALJs who prefer varied travel assignments.

ä If it is necessary to assign non-service area cases to ALJs when they do not wish to travel (but are capable of handling travel dockets) or do not wish to travel to a particular location, the HOCALJ will make the assignment on an established rotational basis. In the event an ALJ refuses to accept the docket, the HOCALJ will make the assignment in writing. If the ALJ continues to refuse, the HOCALJ will bring the matter to the attention of the RCALJ, and if necessary, the RCALJ will refer the matter to the CALJ for further action.

ä In general, the only acceptable reason for failure to accept an assigned docket is medical incapacity to travel. This applies both to intraregional and interregional travel.

In situations in which the ALJ asserts a medical condition to be such that he or she cannot travel, the ALJ must obtain a physician's statement indicating the nature of the impairment, its effect on his or her ability to travel, and the expected period of incapacitation. The ALJ must forward the statement, through the HOCALJ and RCALJ, to the CALJ for review and decision.

In situations in which the ALJ indicates some other reason for his or her refusal to accept travel dockets (e.g., the need for the ALJ's presence at home to care for an ill family member), the RCALJ or CALJ will evaluate the situation on a case-by-case basis. RCALJs may authorize temporary exemptions from travel requirements (i.e., up to six months). ALJs requesting exemptions of more than six months must forward their requests through the RCALJ to the CALJ for approval.

b. To permit expeditious processing of cases, the following types of non-service area cases will not be assigned to ALJs: cases without current claim files, health insurance cases, retirement and survivors insurance cases, cases involving supplemental security income for the aged, continuing disability review cases in which the claimant has opted to continue receiving payment of benefits pending the hearing decision, and cases requiring research into state law (if being assigned to an ALJ in another state). In addition, since Title XVI does not apply to Puerto Rico, the only non-service area cases which should be assigned to Puerto Rico ALJs are Title II cases and SSI cases in which disability is the only issue. When these limitations on the composition of a non-service area docket cause difficulty in forming a complete docket, exceptions to the limitations may be made if agreeable to the HOCALJs in both office.

If a hearing office receives non-service area transfer cases that do not appear to require hearings (e.g., the ALJ decides that a case(s) may be paid on the record, or should be dismissed), the assisting HO will keep and process these cases to completion, but will obtain additional cases from the assisted office to ensure that the visiting ALJ will have a full docket of hearings.

c. Generally, the assisted HO will give preference to remote site cases over local (HO) cases. This will help keep travel costs to a minimum and free HO support staff to work on local cases. However, if the HO has a large percentage of local cases
pending that are considerably aged, the HO will give preference to the local cases. Reducing processing times must be the primary objective when deciding whether to assign remote site cases or local cases to non-service area ALJs.

d. To the extent possible, the assisting HO will schedule hearings on non-service area cases within 60 days of receipt, or within a reasonable amount of time to permit a processing time that is comparable to or less than the average processing time for the assisted HO. (In the case of interregional assignments, OCALJ will advise the assisting RO of the assisted HO's average processing time; in the case of intraregional assignments, the RO will provide the information to the assisting HO.) Assisting HOs that frequently accept travel dockets may not always be in a position to schedule hearings within 60 days. In such situations, OCALJ and the affected RO (or just the affected RO in the case of intraregional assignments) will arrange to match these offices with the most heavily backlogged offices.

e. Assisting HOs must assign a sufficient number of cases to ALJs to comply with the Departmental Travel Regulations. The appropriate number will vary, of course, depending on whether the non-service area cases are local or remote site cases and, particularly in the latter instance, the amount of official time required to travel to the remote site. To increase the cost-effectiveness of ALJ travel, the Chief Judge's Office will encourage ALJs to accept two or more weeks of hearings in any location in the country that needs help.

3. Coordination of Visits, Observance of Local Practices and Responsibilities of Assisting and Assisted Offices

a. The HOCALJ of the assisted HO will prepare a memorandum containing all pertinent information on local HO practices and court requirements. The memorandum must include data on scheduling practices, use of expert witnesses, acquiescence rulings, local practices on the provision of file copies to claimants, representatives and witnesses, and any other information which would assist the visiting ALJ. This information must be provided to the assisting HO at the same time that the cases are mailed.

b. The assisted HO must also provide the assisting HO the names and phone numbers of expert witnesses, hearing reporters and interpreters. (As a rule, assisting ALJs must use expert witnesses from the rosters of the assisted HO rather than those on their own rosters. It is the assisting HO's responsibility to arrange for the appearance of expert witnesses, hearing reporters and interpreters and to prepare any necessary purchase orders (Contractors' Invoice Form 347). When preparing the purchase document, the assisting office's Common Accounting Number (CAN) must be used, and the information included in the assisting office's Resources Expenditure Accounting and Planning System (REAPS). This is so that cost-per-case data will be as accurate as possible. Because the case disposition will be credited to the visiting ALJ's office, the costs associated with processing the case must also be credited to that office.

c. The assisted HO must print and forward to the assisting HO, copies of frequently needed professional qualifications statements.

d. Once the assignment of non-service area cases to ALJs is arranged, the assisted HO must mail the cases to the assisting HO within 5 days. At the same time that the cases are mailed, the assisted HO must transmit via E-Mail a Hearing Office Tracking System (HOTS) list of the cases to the assisting HO. If the assisted HO is not able to mail the cases within the five-day period, the Hearing Office Manager must contact the assisting HO to advise of an expected delivery date.

e. It is the responsibility of the assisting HO to notify the claimants and their representatives of the case reassignment. This must be done as soon as possible after receipt of the cases in the assisting HO.

f. It is also the responsibility of the assisting HO to send copies of the ALJ itineraries to the hearing reporter and the assisted HO.

g. Local court requirements, to the extent consistent with SSA regulations and acquiescence policy, must be followed by visiting ALJs.

h. Though use of privately owned vehicles (POVs) may be the most inexpensive means of transportation, it is usually not cost-effective to use POVs to travel long distances which the visiting ALJ could reach more quickly by other means. To ensure that as much time as possible is devoted to holding hearings, determinations (by the RCALJs) as to the means of transportation must include consideration of the time spent in travel as well as transportation costs.

i. To prevent overtaxing the resources in the assisted HO, no more than one assisting ALJ will visit the assisted HO at one time without the consent of the HOCALJ of the assisted office. This will require coordination on the part of the assisting and assisted HOs. Generally, this restriction does not include remote hearing sites, i.e., several ALJs may travel to assist the same HO simultaneously at a remote site as long as space and contract reporter services are available.

4. Remote Site Versus Local (HO) Cases

a. Remote Site Cases

ä The assisted HO is responsible for providing to the assisting HO all necessary information regarding the availability of remote site hearing space. If the hearing space is not free, the assisting HO is responsible for preparing the purchase order (Form 347). The assisting HO's CAN is to be used, and the information input into that office's REAPS. The assisting and assisted HOs must coordinate their efforts to enable scheduling the hearings in conjunction with the availability of the hearing space.

ä HOs that require extensive assistance with local cases will consider arranging for hearing space and hearing reporter services outside, but in close proximity to, the HO. (For the purpose of this policy, this type of space will be considered remote site space.)

ä The assisted HO must provide the assisting HO with the names and phone numbers of contract hearing reporters. It is the responsibility of the assisting HO to
schedule the hearings in conjunction with the hearing reporters' availability and to prepare the purchase orders. Again, the assisting HO's CAN is to be used, and the information coded into that office's REAPS.

ä With respect to making exhibit files available for review by claimants, representatives, or expert witnesses, or providing copies directly to them, the usual practice in the assisted HO will be followed. Whatever the practice, the assisting HO will be responsible for responding to the requests and for ensuring that the file copies or files are mailed early enough to reach, or be available to, the requesters two weeks prior to the scheduled hearing. Exceptions to this policy may be made when agreeable to both assisted and assisting HOs.

b. Local (HO) Cases

ä The assisting and assisted HOs must coordinate efforts to schedule the hearings in conjunction with the availability of hearing room space and recording equipment.

ä The rules in I-2-157 B. 4. a., above, with respect to making exhibit files available for review by claimants, representatives, or expert witnesses, or providing copies directly to them, apply to local cases as well as remote site cases.

5. Continuances and Postponements

Cases which are postponed or continued will be returned to the assisted (originating) HO. However, when practicable (i.e., the assisting HO is still in a position to assist and to reschedule the cases timely, and the assisted HO still requires assistance), the HOCALJ in the assisted HO may work through his or her RO to assign the postponed or continued case to the ALJ who granted the postponement or continuance, or to another ALJ from the same HO. When only one Region is involved (i.e., both assisting and assisted HOs are in the same Region or combined Regions), the RO will be responsible for ensuring that enough cases, in addition to the postponed or continued cases, are made available by the assisted HO to constitute a full docket. When the assisting and assisted HOs are in different regions, OCALJ must coordinate the reassignment and addition of cases to the docket.

6. Remands

Remands on non-service area cases will be routed by the Appeals Council to the servicing HO. However, when practicable (i.e., the assisting HO is still in a position to assist and to reschedule the cases timely, and the assisted HO still requires assistance), the HOCALJ in the assisted HO may work through his or her RO to assign the remand to the visiting ALJ or another ALJ from the same office. When only one Region is involved (i.e., both assisting and assisted HOs are in the same Region or combined Regions), the RO will be responsible for ensuring that enough cases, in addition to the remand(s), are made available by the assisted HO to constitute a full docket. When the assisting and assisted offices are in different Regions, the OCALJ must coordinate the reassignment and addition of cases to the docket.

 

HALLEX I-2-160

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division II: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

June 30, 1994

Current through March 1997

I-2-160 DISQUALIFICATION OF ADMINISTRATIVE LAW JUDGES

Citations: > 20 CFR §§ 404.940, > 410.635 and 416.1440

A. General

The Administrative Law Judge (ALJ) must disqualify or recuse himself or herself from adjudicating a case if the ALJ believes he or she would be unable to give the claimant a "fair hearing," or believes his or her participation in the case would give an appearance of impropriety. Disqualification, however, is not a matter of personal preference or reluctance to handle a particular case. The ALJ must have reasonable and proper grounds for such action.

For example, the ALJ must withdraw from the case if:

1. the ALJ is prejudiced or partial with respect to claimant;

2. the ALJ has any interest in the issues pending for decision; or

3. the claimant has a valid objection.

NOTE: Once a case has been assigned to an ALJ, only the ALJ may disqualify or recuse himself or herself from adjudicating the case.

B. Actions on the Disqualification of an ALJ

1. If an ALJ disqualifies himself or herself from a case on his or her own initiative, and the notice of hearing has not been sent to the claimant, no notice of disqualification to the claimant is necessary.

2. If an ALJ disqualifies himself or herself either as a result of an objection received from a claimant, or on his or her own initiative when the notice of hearing has already been sent to the claimant, the ALJ must:

a. send notice of the disqualification to the claimant; and

b. inform the claimant that the date set for the hearing has been cancelled (if cancellation is necessary) and that he or she will receive an amended notice of hearing when another ALJ is assigned to conduct the hearing.

3. If an ALJ disqualifies himself or herself at the hearing, the ALJ's oral statement on the record of the hearing is sufficient notice to the claimant.

C. ALJ Does Not Disqualify Himself or Herself Despite Claimant's Objections

1. If a claimant objects to an ALJ conducting the hearing in his or her case, but the ALJ decides before the hearing that the claimant's reasons for objecting do not warrant disqualification, the ALJ must:

a. advise the claimant in writing, setting forth the reasons for the decision; and,

b. note his or her refusal to disqualify himself or herself in the opening statement at the hearing as part of the procedural history of the case.

2. If an ALJ refuses at the hearing to disqualify himself or herself, the ALJ's explanation in the transcript will be sufficient notice to the claimant.

NOTE: When an ALJ is assigned to conduct a hearing in a case in which another ALJ has disqualified himself or herself, and the claimant is aware of the disqualification of the first ALJ, the current ALJ should mention the matter as part of the procedural history in his or her opening statement at the hearing. However, the ALJ need not discuss the reasons for the disqualification.

 

HALLEX I-2-165

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 2: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

April 26, 1995

Current through March 1997

I-2-165 HEARINGS

A. Determining the Right to a Hearing

A claimant who has requested a hearing before an ALJ is entitled to appear and present evidence or information at such a hearing unless:

1. the claimant has waived his or her right to appear before an ALJ at a hearing (See > I-2-145 F., Waiver of the Right to Appear at the Hearing.);

2. the ALJ decides to issue a fully favorable decision based on the evidence of record; or

3. the case is subject to dismissal. (See > I-2-400ff, Dismissals.)

A claimant whose case has been remanded by the Appeals Council must be offered an opportunity to appear and present evidence or information at a hearing before an Administrative Law Judge (ALJ) even if the claimant initially waived his or her right to such appearance.

EXCEPTION: In title II disability claims in which the period at issue expired before the date of the hearing decision, the claimant need not be offered the opportunity to appear and present evidence at a hearing unless the ALJ finds that the facts warrant it. (See > I-3-740 E.)

B. Types of Hearings

1. Joining Multiple Cases at One Hearing (when more than one claimant files a request a hearing and each request for hearing represents a different case)

If a request for hearing is filed in two or more cases, all issues to be decided in such cases are the same, and each claimant has agreed to waive the right to privacy and consented to have his or her case heard with the other(s), the ALJ may (although there is no specific statutory authority for it) join the cases at one hearing. If, however, any claimant objects to having his or her case heard with the other(s), the ALJ must honor the claimant's objection and afford him or her a separate hearing and decision.

The reason for joining two or more cases at one hearing is to avoid obtaining the same evidence and calling the same witnesses to give the same testimony at different hearings. For example, it would be appropriate to join two or more cases when deciding the issue of coverage based on work for a particular employer, and all of the persons requesting hearings were employed by the same employer under the same circumstances, and the evidence to be presented in each case would be pertinent to all of the claimants.

When considering whether to join two or more cases at one hearing, the ALJ should consider whether all claimants are within reasonable travel distance of the hearing site, and whether each claimant can be expected to participate fully so that each claimant will receive a fair hearing.

When an ALJ joins two or more cases at one hearing, the ALJ will make a single record of the proceedings, and consider all of the evidence of record in deciding each case. The ALJ may issue one decision which applies to all claimants, or issue separate decisions for each claimant.

2. Consolidated Hearings

The Regulations provide for consolidated hearings so we may dispose of cases involving the same individual with one hearing when practicable. Pursuant to the regulations at §§ 404.952 and 416.1452, an ALJ may hold a consolidated hearing when:

a. Requests for hearing are pending on more than one claim under any Social Security Administration administered law.

An ALJ, if practicable, shall conduct a consolidated hearing. Common issues are not required for consolidating pending requests for hearing.

b. A request for hearing is pending on one claim and another claim involving one or more of the same issues (common issues) is also pending at another level in SSA.

An ALJ may remove the other claim to himself or herself to conduct a consolidated hearing even if SSA has not made an initial or reconsidered determination on that claim.

When a consolidated hearing is held, make a single record of the hearing proceedings. Evidence introduced in one case is considered evidence in the other case(s). The ALJ may issue a consolidated decision or a separate decision.


SEVERE

Return to SEVERE Home Page