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Home :: FAQ :: Basic Questions Social Security Disability

What administrative actions are initial determinations from which I can file a “Request for Reconsideration” or an appeal?

The following list covers the vast majority of administrative actions that are initial determinations.  However, they are not all inclusive.
For Title II Claims (Social Security Disability Insurance):

  1. Entitlement or continuing entitlement to benefits;
  2. Reentitlement to benefits;
  3. The amount of benefits;
  4. A recomputation of benefit;
  5. A reduction in disability benefits because benefits under a worker’s compensation law were also received;
  6. A deduction from benefits on account of work;
  7. A deduction from disability benefits because of claimant’s refusal to accept rehabilitation services;
  8. Termination of benefits;
  9. Penalty deductions imposed because of failure to report certain events;
  10. Any overpayment or underpayment of benefits;
  11. Whether an overpayment of benefits must be repaid;
  12. How an underpayment of benefits due a deceased person will be paid;
  13. The establishment or termination of a period of disability;
  14. A revision of an earnings record;
  15. Whether the payment of benefits will be made, on the claimant’s behalf to a representative payee, unless the claimant is under age 18 or legally incompetent;
  16. Who will act as the payee if the SSA determines that representative payment will be made;
  17. An offset of benefits because the claimant previously received Supplemental Security Income payments for the same period;
  18. Whether completion of or continuation for a specified period of time in an appropriate vocational rehabilitation program will significantly increase the likelihood that the claimant will not have to return to the disability benefit rolls and thus, whether the claimant’s benefits may be continued even though the claimant is not disabled;
  19. Nonpayment of benefits because of  claimant’s confinement for more than 30 continuous days in a jail, prison, or other correctional institution for conviction of a criminal offense;
  20. Nonpayment of benefits because of claimant’s confinement for more than 30 continuous days in a mental health institution or other medical facility because a court found the individual was not guilty for reason of insanity; a court found that he/she was incompetent to stand trial or was unable to stand trial for some other similar mental defect; or, a court found that he/she was sexually dangerous.

Title XVI:

  1. Eligibility for, or the amount of, Supplemental Security Income benefits;
  2. Suspension, reduction, or termination of Supplemental Security Income benefits;
  3. Whether an overpayment of benefits must be repaid;
  4. Whether payments will be made, on claimant’s behalf to a representative payee, unless the claimant is under age 18, legally incompetent, or determined to be a drug addict or alcoholic;
  5. Who will act as payee if the SSA determines that representative payment will be made;
  6. Imposing penalties for failing to report important information;
  7. Drug addiction or alcoholism;
  8. Whether claimant is eligible for special SSI cash benefits;
  9. Whether claimant is eligible for special SSI eligibility status;
  10. Claimant’s disability; and
  11. Whether completion of or continuation for a specified period of time in an appropriate vocational rehabilitation program will significantly increase the likelihood that claimant will not have to return to the disability benefit rolls and thus, whether claimant’s benefits may be continue even though he or she is not disabled. 

    12. Note:         Every redetermination which gives an individual the right of further review constitutes an initial determination.

Title VIII (See VB 02501.035)

  1. Meeting or failing to meet the qualifying and/or entitlement factors for special veterans benefits (SVB);
  2. Reduction, suspension, or termination of SVB payments;
  3. Applicability of a disqualifying event prior to SVB entitlement;
  4. Administrative actions in SVB cases similar to those listed under Title II—items 3, 4, 10, 11, & 16.

Title XVIII (SSI)

  1. Entitlement to hospital insurance benefits and to enrollment for supplementary medical insurance benefits;
  2. Disallowance (including denial of application for HIB and denial of application for enrollment for SMIB);
  3. Termination of benefits (including termination of entitlement to HI and SMI).
  4. Initial determinations regarding Medicare Part B income-related premium subsidy reductions.