From Emergency Message EM-24023:
Beginning June 22, 2024, adjudicators will reopen a prior final agency determination or decision based on the PRW CoP [Past Relevant Work Change Of Policy] if the application of the PRW rule at the time of the prior determination or decision would have resulted in a more favorable determination or decision.
All of the following conditions must be met to reopen based on the PRW CoP:
- The claimant or SSA/Disability Determination Services (DDS) (or both) questioned the determination or decision in writing within one year of the date of the notice of the initial level determination on the prior claim.
- The questioning occurred after, or was pending as of, June 22, 2024.
- The prior claim was denied at step four or five.
- The denial depended on a finding that the person had PRW that was last done more than 5 years earlier, transferrable skills from PRW that was last done more than 5 years earlier (without continuity of skills to PRW within 5 years of the prior determination, see DI 25005.015C), or PRW that started and stopped in fewer than 30 calendar days.
- A revised determination or decision applying the current rules (PRW rule) would be more favorable to the claimant than the prior final determination or decision that would be reopened. ...
What do we mean by questioning the prior final agency determination or decision in writing?
We consider the claimant or SSA/DDS to have questioned the prior final determination or decision in writing if one or more of the following conditions exist:
- The claimant files a written request to reopen the prior final determination or decision.
- The claimant files a new claim alleging disability began in the period adjudicated in the prior final determination or decision (implied request for reopening).
- The claimant files a new claim and the adjudicator, on the adjudicator’s own initiative, finds the reopening conditions above are met.
- SSA or the DDS questions the prior final determination or decision meeting the reopening conditions above. ...
I don't see anything in Social Security's statutes or regulations requiring that reopening must be requested within one year of a prior determination. The standard is four years for Title II and two years for SSI. This dramatically limits the effect.
Reopening is discretionary. You should be thankful it’s being ordered as a matter of policy in this situation. And nothing in the EM precludes reopening under the broader circumstances described in the regulations.
ReplyDeleteYou’re getting up in arms about nothing.
Since res judicata does not apply we can still set onset in the period previously adjudicated without reopening. They would just not get as much back payments
ReplyDeleteThe standard for reopening a Title II claim is within one year (measured from the prior initial determination) for "any reason" and within four years for good cause shown. For Title XVI it is within one year for any reason and within two years for good cause.
ReplyDeleteY'all are missing the point: the one year limit is for requests to reopen and revise based on the change in policy. As noted, in the EM, that allows for reopening and revision even when the original decision was correct at the time. Requests to reopen and revise for other reasons fall within the current regulatory time limits.
ReplyDeleteGreat for the few this will affect/ VERY few step 4 or step 5 for older prw out there.
ReplyDeleteIt will affect a lot of people and without reopening cases that were denied 12 years ago could now be allowed because res judicata does not apply Only one year of back benefits if no reopening but at least they could be allowed now.
ReplyDelete