20 C.F.R. Subpart C—Review of Initial Determinations by a Federal Reviewing Official
Title 20 - Employees' Benefits
If you are dissatisfied with the initial determination on your disability claim, you may request review by a Federal reviewing official. (a) Written request. You must request review by filing a written request. You should include in your request— (1) Your name and social security number, (2) If you have filed a claim for benefits based on disability under title II of the Act under an account other than your own, the name and social security number of the wage earner under whose account you are filing, (3) The reasons you disagree with the initial determination on your disability claim, (4) Additional evidence that you have available to you, and (5) The name and address of your representative, if any. (b) Time limit for filing request. We will review an initial determination if you request review in writing no later than 60 days after the date you receive notice of the initial determination (or within the extended time period if we extend the time as provided in paragraph (d) of this section). (c) Place for filing request. You should submit a written request for review at one of our offices. If your disability claim is under title II of the Act, you may also file the request at the Veterans Administration Regional Office in the Philippines, or if you have 10 or more years of service, or at least five years of service accruing after December 31, 1995, in the railroad industry, an office of the Railroad Retirement Board. (d) Extension of time to request review. If you want us to review the initial determination on your disability claim, but you do not request review timely, you may ask us for more time to request review. Your request for an extension of time must be in writing and must give the reasons the request for review was not filed, or cannot be filed, in time. If you show us that you have good cause for missing the deadline, we will extend the time period. To determine whether good cause exists, we will use the standards explained in §405.20 of this part. (a) General. The Federal reviewing official will review existing evidence and accept and obtain new evidence in order to make a decision on your claim. The decision will be based on all evidence in the record. (b) Developing the record. If you have additional evidence that you did not submit with your request for review, you should submit that evidence to the Federal reviewing official as soon as possible. If there is additional evidence that you wish to submit and you are having difficulty obtaining it, the Federal reviewing official may issue a subpoena for the evidence using the process and standards described in §405.217. If the Federal reviewing official determines that additional evidence is necessary, we may obtain such evidence from other sources, including the State agency. (c) Seeking State agency clarification. In reviewing your claim, if the Federal reviewing official determines that additional information, beyond that provided by the claimant, is necessary, the Federal reviewing official may obtain it from other sources, including the State agency or a treating source. The State agency will provide such clarification or additional information to the Federal reviewing official on a timely basis. In such circumstances, the Federal reviewing official will retain the authority to make the decision as to whether or not you are disabled. (a) When it is reasonably necessary for the full presentation of a claim, we may issue subpoenas for the production of any documents that are relevant to an issue before the Federal reviewing official. (b) To have documents subpoenaed, you must file a written request for a subpoena with us. The written request must: (1) Identify the documents with sufficient detail to find them; (2) State the important facts that the document is expected to show; and (3) Indicate why these facts could not be shown without that document. (c) We will pay the cost of issuing the subpoena. (d) Within five days of receipt of a subpoena, the person against whom the subpoena is directed may ask us to withdraw or limit the scope of the subpoena, setting forth the reasons why the subpoena should be withdrawn or why it should be limited in scope. (e) Upon failure of any person to comply with a subpoena, the Office of the General Counsel may seek enforcement of the subpoena under section 205(e) of the Act. (a) The Federal reviewing official will make a decision based on all of the evidence. The written decision will explain in clear and understandable language the specific reasons for the decision, including an explanation as to why the Federal reviewing official agrees or disagrees with the rationale in the initial determination. (b) Before making his or her decision, the Federal reviewing official may consult with a medical, psychological, or vocational expert through the Medical and Vocational Expert System if the Federal reviewing official determines that such consultation is necessary. If the Federal reviewing official disagrees with the initial determination, or if you submit, or the Federal reviewing official otherwise obtains, new and material medical evidence, the Federal reviewing official will consult with a medical or psychological expert through the Medical and Vocational Expert System before making a decision. At all times, the Federal reviewing official retains the authority to make the decision as to whether you are disabled under our rules. We will mail a written notice of the Federal reviewing official's decision to you at your last known address. We will inform you of your right to a hearing before an administrative law judge. The Federal reviewing official's decision is binding unless— (a) You request a hearing before an administrative law judge under §405.310 of this part within 60 days of the date you receive notice of the Federal reviewing official's decision and a decision is made by the administrative law judge, (b) The expedited appeals process is used, or (c) We revise the Federal reviewing official's decision under subpart G of this part.
Title 20: Employees' Benefits
PART 405—ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS
Subpart C—Review of Initial Determinations by a Federal Reviewing Official
§ 405.201 Reviewing an initial determination—general.
§ 405.210 How to request review of an initial determination.
§ 405.215 Procedures before a Federal reviewing official.
§ 405.217 Subpoenas.
§ 405.220 Decision by the Federal reviewing official.
§ 405.225 Notice of the Federal reviewing official's decision.
§ 405.230 Effect of the Federal reviewing official's decision.
