Change in Reconsideration Policy

Policy Change:

Starting March 1, 2024, the Social Security Administration (SSA) will differentiate filing limitations for earnings and non-earnings related reconsideration requests.

For the past three years, as a pandemic-era accommodation, SSA has not been enforcing filing limits for reconsiderations. SSA recently evaluated reconsideration requests received during this period and determined that while the 60-day filing limit is sufficient time for Vocational Rehabilitation (VR) agencies to submit reconsideration requests for non-earnings related denials, on average, VR agencies need more time for earnings-related denials. 

SSA recognizes that earnings-related denials are usually due to a lag in the earnings data available to SSA at the time of claim adjudication. While VR agencies submit claims based on a client attaining nine months of Substantial Gainful Activity (SGA) based on their records, it may take almost a year before SSA can see the same earnings information. In response to this lag, SSA will now recognize two distinct types of reconsiderations: earnings reconsiderations and non-earnings reconsiderations. Refer to the chart below for a list of earnings-related denials.

Earnings-related Denials:

Denial Code	Denial Reason
200	WORK ACTIVITY COULD NOT BE ESTABLISHED (NO EARNINGS OR NOT VERIFIED)
210	EARNINGS BELOW SGA
215	EARNINGS BELOW BLIND SGA
220	8 MONTHS OR LESS OF SGA
225	8 MONTHS OR LESS OF BLIND SGA
320	9 MONTHS OF SGA BUT NOT WITHIN 12-MONTH PERIOD
325	9 MONTHS OF BLIND SGA BUT NOT WITHIN 12-MONTH PERIOD

Going forward, VR agencies will be limited to one reconsideration for an initial claim, no matter the denial reason.

Per the current VR Provider Handbook (page 34), SSA will strictly enforce the 60-day filing restriction for reconsiderations if the initial claim was denied for reasons other than earnings. If the non-earnings reconsideration request is not received within 60 calendar days from the date on the initial claim denial notice, the reconsideration will be denied due to untimely filing. 

For claims denied due to insufficient earnings, SSA will allow up to 365 calendar days to file a reconsideration. If the earnings reconsideration is not received within 365 calendar days from the date on the initial claim denial notice, the reconsideration will be denied due to untimely filing. 

SSA will update the VR Provider Handbook to reflect this policy change.

Finally, as a reminder, a claim is ready for payment when there are proven earnings for nine out of 12 continuous months at or above SGA level (or Blind SGA if applicable). Per our earnings policy effective November 1, 2019, all VR agencies must submit proof of earnings documentation with every claim. Acceptable earnings documentation include, but are not limited to:

• The Work Number
• Pay Stubs
• Employer Signed Statement with FICA withholdings
• SSA-supplied Quarterly VR Client Earnings Report (VRCER)
• Quarterly Office of Child Support and Enforcement (OCSE) National Directory of New Hire (NDNH) data
• VR remarks with applicable quarters and earnings

Please contact the VR Help Desk (VR.Helpdesk@ssa.gov) with any questions on this policy change.