Reopening a Closed Disability Claim

When a new client comes to our office, one of the first questions we ask is whether they have ever applied for Social Security Disability or SSI benefits. If they have, we carefully review those prior claims to determine whether reopening may be possible.

This can be extremely important because reopening an earlier claim may allow a claimant to receive additional past-due benefits. Depending on the circumstances, reopening a prior application could result in a substantially larger award than filing a new claim alone.

What Is a Closed Claim?

When someone files an application for SSDI or SSI benefits and receives an unfavorable determination or decision, they generally have 60 days from receiving the notice to file an appeal. If an appeal is not filed within the required time, the decision usually becomes final, and the claim is considered closed.

Although a closed claim is generally final, Social Security regulations allow certain claims to be reopened under specific circumstances.

When Can a Claim Be Reopened?

Whether a claim may be reopened depends on several factors, including the type of claim, how much time has passed, and whether the Social Security Administration (SSA) determines that the legal requirements for reopening have been met.

Within 12 Months

A final determination or decision may generally be reopened within 12 months of the date of the notice for any reason.

After 12 Months

Once the first year has passed, reopening becomes more difficult.

·         SSDI claims may generally be reopened within four years if the SSA finds good cause.

·         SSI claims may generally be reopened within two years if the SSA finds good cause.

What Is “Good Cause”?

The SSA may find good cause to reopen a claim if:

·         New and material evidence becomes available that could change the prior decision.

·         A clerical error was made in the original determination or decision.

·         The evidence considered clearly shows that an error was made in the prior determination or decision.

Generally, any new evidence must relate to the period covered by the original application and be significant enough that it could reasonably change the outcome of the prior claim.

Are There Exceptions?

Yes. Although uncommon, SSA regulations permit reopening beyond the normal time limits in limited situations, including:

·         Fraud or similar fault.

·         Certain errors affecting entitlement or benefit payments.

·         Other limited circumstances specifically authorized by SSA regulations.

Because these exceptions are highly technical, each case must be evaluated individually.

Who Can Reopen a Claim?

The authority to reopen a claim depends on where the prior decision was issued.

·         Claims denied by Disability Determination Services (DDS) may be reopened by DDS, an Administrative Law Judge (ALJ), or the Appeals Council, depending on where the case is pending.

·         Claims denied by an Administrative Law Judge generally may only be reopened by an ALJ or the Appeals Council.

·         Claims denied by the Appeals Council generally may only be reopened by the Appeals Council.

In some situations, the issue of reopening cannot be addressed until the claim reaches the hearing level before an Administrative Law Judge.

If the SSA Refuses to Reopen My Claim, Can I Appeal?

In most situations, no. Under SSA regulations, a decision not to reopen a prior claim generally is not subject to administrative or judicial review, except in very limited circumstances involving constitutional issues or other narrow legal exceptions.

For that reason, it is important to evaluate reopening issues carefully and present the strongest possible argument before requesting that a prior claim be reopened.

Why Representation Matters

The Social Security disability process is governed by detailed federal regulations and strict filing deadlines. Missing an appeal deadline can cause a claim to become final, making future reopening much more difficult.

Disclaimer: The information provided in this article is for general educational and informational purposes only and is not intended as legal advice, medical advice, or a substitute for professional guidance. Reading this article does not create a representative-client relationship. Social Security laws, regulations, policies, and procedures may change over time, and the information presented may not reflect the most current legal or administrative developments. Every case is unique. If you have questions about your specific situation, you should consult with a qualified Social Security disability representative or attorney before making any decisions.