Good Cause Statement – Late Appeals in Social Security Disability Claims

This is where many claimants go wrong. I cannot tell you how many times I have spoken with claimants who received an unfavorable Notice of Determination or Notice of Reconsideration, and then failed to take immediate action. This is for many reasons. They put the letter aside out of frustration or despair. The claimant may have moved. The claimant was dealing with a family emergency or personal hospitalization. In such cases, the claimant should file a “Good Cause Statement”, explaining the reasons for his or her untimely appeal. The Social Security Administration may or may not accept this Good Cause Statement.

The Social Security Rules and Regulations specify what circumstances may qualify as good cause the late filing (20 CFR 404.911 and 416.1411).

In determining whether an individual has shown good cause for missing the deadline to request review, the claims handler, Administrative Law Judge, or Appeals Council will consider whether the failure was the result of:

  • circumstances which impeded the individual’s efforts to pursue the claim;
  • an action by SSA which misled the claimant;
  • misunderstanding as to the requirements of the Act resulting from amendments to the Act, other legislation, or court decisions; or
  • any physical, mental, educational or linguistic limitations (including any lack of facility with the English language) which prevented the individual from filing a timely request or from understanding or knowing about the need to file a timely request.

For example, in accordance with the Regulations at 20 CFR 404.911 and 416.1411, there may be good cause for failure to file a timely request when the failure resulted from one of the following circumstances:

  1. The individual was seriously ill or had a physical or mental impairment, and the illness or impairment prevented the individual from contacting SSA in person, in writing, or through a friend, relative, or other person.
  2. There was a death or serious illness in the individual’s immediate family.
  3. A fire or other accidental cause destroyed or damaged pertinent records.
  4. The individual was actively seeking evidence to perfect the claim and did not complete the search before the time period expired.
  5. The individual requested an additional explanation concerning the ALJ’s action within the time limit, provided that within 30 days after receipt of the explanation the individual requested review.
  6. SSA furnished the individual incorrect or incomplete information about the right to request review.
  7. The individual or his representative did not receive notice of the ALJ’s action.
  8. The individual transmitted the request for review to another Government agency in good faith and within the time limit, but the request did not reach SSA until after the time period had expired.
  9. The Appeals Council concludes that there were unusual or unavoidable circumstances which demonstrated that the individual was not aware of the need to file timely, or that circumstances prevented the individual from filing timely.

Also see Social Security Ruling (SSR) 91-5p, SSR 95-1p and Acquiescence Ruling (AR) 90-4(4).

Be the first to comment!
Post a Comment