I-3-9-36. Actions of Appeals Council After Notifying Claimant of Proposed Revision of Prior Decision

A. Proposed Action Not Based On Additional Evidence

In Title II cases and Title XVI cases in which the claimant is not in SSI payment status, the claimant may reply that he or she wishes to submit something additional and/or appear before the Appeals Council. When nothing further is to be submitted, or additional material has been received, and an appearance has been completed, has not been sought, or has been denied, the Council may proceed to its decision. See below when the claimant is a Title XVI claimant in payment status.

B. Proposed Action Based on Additional Evidence or Claimant is in Title XVI Payment Status

In Title II cases, when the proposed revision is based on new and material evidence, the claimant has a right to a hearing.

In addition, in a Title XVI case with continuing payments, the claimant must be afforded the right to a hearing, even though no new and material evidence is submitted.

When a hearing is requested, the case must be remanded to an ALJ. When the claimant waives the right to a hearing, but the Appeals Council believes that additional evidence should be obtained to complete the record, the case must also be remanded.

When the Appeals Council finds that the record is complete and the claimant has waived the right to a hearing, the Council may proceed to issue a decision.