20 C.F.R. Subpart B—Initial Determinations
Title 20 - Employees' Benefits
The State agency, unless it makes a quick disability determination under §§405.105–.110, will adjudicate your claim using the applicable procedures in subpart Q of part 404 or subpart J of part 416 of this chapter or both and will apply subpart P of part 404 or subpart I of part 416 of this chapter or both. The disability examiner will make a determination based on all of the evidence. The written determination will explain in clear and understandable language the specific reasons for and the effect of the initial determination. It will also inform you of your right to review by a Federal reviewing official and your right to representation. (a) If we identify your claim as one involving a high degree of probability that you are disabled, and we expect that your allegations will be easily and quickly verified, we will refer your claim to a Quick Disability Determination Unit, comprised of experienced State agency disability examiners. (b) If we send your claim to a Quick Disability Determination Unit, within 20 days of the date your claim is received by the unit, that unit must: (1) Have a medical or psychological expert (as defined in §405.5 of this part) verify that the medical evidence in the file is sufficient to determine that, as of your alleged onset date, your physical or mental impairment(s) meets the standards we establish for making quick disability determinations, and (2) Subject to the provisions of paragraph (c) of this section, make the quick disability determination as described in §405.110. (c) If the Quick Disability Determination Unit cannot make a determination that is fully favorable to you within 20 days of receiving it or if there is an unresolved disagreement between the disability examiner and the medical or psychological expert, the State agency will adjudicate your claim using the applicable procedures in subpart Q of part 404 or subpart J of part 416 of this chapter or both, and will apply subpart P of part 404 or subpart I of part 416 of this chapter or both. Subject to §405.105, when making a quick disability determination, the State agency will apply subpart P of part 404 or subpart I of part 416 of this chapter or both. We will mail a written notice of the initial determination to you at your last known address. The written notice will explain in clear and understandable language the specific reasons for and the effect of the initial determination. The notice also will inform you of the right to review by a Federal reviewing official and explain your right to representation. An initial determination is binding unless— (a) You request review by a Federal reviewing official within the 60-day time period stated in §405.210 of this part, or (b) We revise the initial determination under subpart G of this part.
Title 20: Employees' Benefits
PART 405—ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS
Subpart B—Initial Determinations
§ 405.101 Disability determinations.
§ 405.105 Quick disability determination process.
§ 405.110 Standards for making quick disability determinations.
§ 405.115 Notice of the initial determination.
§ 405.120 Effect of an initial determination.
