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May 22, 2014

If We Can't Do It One Way, We'll Do It Another Way

     From a transmittal of changes to Social Security's HALLEX Manual: 
The AC will not consider referrals or requests from OIG [Office of Inspector General] to review an administrative law judge (ALJ) decision for the following reasons:
  • OIG does not have the authority to refer a case to the AC for possible own motion review.
  • OIG is not a party to the decision and therefore cannot request review of an ALJ decision.
  • OIG units are statutorily precluded from participating in program operating functions, and may not express opinions about whether benefits should be awarded or denied. ...
 B. If the folder contains OIG evidence that the claimant has not previously had the opportunity to review, the AC will also notify the claimant in the Notice of Review that the file contains OIG evidence. If the OIG evidence is associated after the Notice of Review is sent, and the AC anticipates granting review, the AC will send an interim notice to the claimant with a copy of the evidence, providing the claimant the opportunity to comment before the AC takes action. See HALLEX I-3-6-1 C.
     So what's the rule? OIG can't refer a case to the Appeals Council for review but it can just give whatever evidence it has to some other component of the agency and that other component can refer the case to the Appeals Council? How else would the Appeals Council come by evidence developed by OIG that the claimant hadn't seen? Isn't this an open invitation to do by indirection that which cannot be done directly?

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