Last Update: 3/15/06 (Transmittal I-3-37)
Unappealed Title II and/or Title XVI disability decisions, both favorable and unfavorable to the claimant, are randomly selected based on the terminal digits of the social security number and forwarded to the appropriate OAO branch.
Upon receipt of the case, the claim file(s) will be reviewed to determine whether the Appeals Council should take own motion review. An Own Motion Review Data Sheet indicating the Appeals Council's action will be completed in each case.
If the AAJ decides not to take own motion review, he or she will initial and date the review block on the decision transmittal form (HA-5051) and forward the file(s) and Data Sheet to the branch for transmittal to the effectuating component. If the decision is partially or fully favorable, OAO branch staff will forward the file(s) for effectuation of the ALJ decision. If the decision is unfavorable, the file(s) will be stored in the branch mini-docket pending receipt of a request for review.
If the AAJ determines that the Council should take own motion jurisdiction, the AAJ will forward the file(s) and the Data Sheet to the Branch Chief for immediate assignment to an analyst for preparation of the own motion notice (and retrieval of the hearing recording(s) for cases in which a hearing was held).
In determining whether to review a case on its own motion, the Appeals Council will apply the same standard used in request for review cases (20 CFR 404.970 and 416.1470), except that the Council generally will not review a case on its own motion to correct a decisional error which does not change the ALJ's ultimate conclusion unless the error might affect subsequent entitlement.
The Appeals Council must send a claimant and representative written notification of its intent to review a case on its own motion by certified mail no later than the 60th day after the date of the ALJ's action. If the Council reviews a favorable disability decision on its own motion, the notice must advise the claimant that interim benefits may be payable if a final decision is not issued within 110 days after the date of the ALJ's decision.
The review of unappealed random sample cases is conducted under the Appeals Council's own motion authority, not the reopening provisions. However, when the Appeals Council is unable to decide whether to review a case on its own motion within the 60-day period in which to do so, it may consider whether the decision should be reopened under the provisions of 20 CFR 404.987 and/or 416.1487 (see I-3-9-1).
Because the Appeals Council must take own motion review within 60 days after the ALJ's action, the analyst must ensure that the case is returned to the AAJ in a timely manner. The analyst will follow the procedures in I-3-6-50 ff in preparing and routing the action document. Upon completion of the action document, the analyst will return the file to the AAJ for his or her review. If the AAJ approves the action document, the case will be sent to the “B” member for signature.