McCuin v. Bowen
Decision Date | 23 April 1985 |
Docket Number | No. 84-675-L.,84-675-L. |
Citation | 634 F. Supp. 431 |
Court | U.S. District Court — District of New Hampshire |
Parties | Gaynell McCUIN v. Otis R. BOWEN, Secretary Health & Human Services. |
Alan Linder and Mitchell M. Simon, Concord, N.H., John E. Tobin, Jr., N.H. Legal Aid, Berlin, N.H., for plaintiff.
Susan Howard, U.S. Atty.'s Office, Concord, N.H., for defendant.
The plaintiff is challenging an agency's interpretation of its own regulation.
Cheshire Hospital v. N.H.—Vt. Hospitalization Service, Inc., 689 F.2d 1112, 1117-18 (1st Cir.1982).
The hearing decision of July 18, 1983 which was partially favorable to plaintiff, was reopened by the Appeals Council by letter dated March 22, 1984. See Transcript at 143. The letter clearly states that the Appeals Council was acting pursuant to 20 C.F.R. § 404.988. Id. Plaintiff contends that the Appeals Council must review the ALJ's decision within 60 days of the hearing decision or dismissal, or not at all under 20 CFR § 404.969. Plaintiff asserts that the reopening provisions of 20 CFR § 404.988 must be read in conjunction with the preceding section, 20 C.F.R. § 404.987, and applies only to a claimant initiated review.
404.987 (emphasis added).
The conditions enunciated in § 404.988 include:
1. Within 12 months of the date of notice of the initial determination, for any reason;
2. within four years of the notice of the initial determination if the agency finds "good cause" to reopen the case;
3. if the determination was obtained by fraud or similar fault;
4. if the determination was wholly or partially unfavorable to the claimant, to correct clerical error or an error that appears on the face of the evidence that was considered when the determination was made.
"Good cause" to reopen a case is defined in 20 CFR § 404.989:
Defendant asserts that the reopening provisions of 20 CFR § 404.988 do not apply only to a claimant initiated review, but also to the Appeals Council on their own motion. In effect, this extends the Council's sixty day review period enunciated in 20 CFR § 404.969 to twelve months, for any reason, or within four years for "good cause", as defined in § 404.989.
This interpretation of the regulation in question is inconsistent with the clear language of § 404.987. Section 404.987(b) states that § 404.988 explains the conditions that must be met before the agency will reopen a previous determination. Section 404.987(b) is the procedure for reopening and revision initiated by the claimant. Although this section does not specifically prohibit agency initiated review pursuant to 20 CFR § 404.988, such an interpretation would render meaningless 20 CFR § 404.969, which provides for Appeals Council initiated review of an action only within sixty days of a hearing decision of dismissal.
In Dion v. Secretary of Health and Human Services, Civil No. 83-442-D, dated April 25, 1984, this court considered a similar issue. Plaintiff had been awarded disability and SSI benefits after a hearing before an Administrative Law Judge in February, 1982. Nearly a year later, the Appeals Council reopened the ALJ's decision allegedly pursuant to 20 C.F.R. § 416.1488. The Appeals Council was authorized to review plaintiff's SSI determination within sixty days of the ALJ's determination.
20 CFR § 416.1469 (1983). This provision is identical to 20 CFR § 404.969.
Final determination of SSI claims may be reopened under 20 CFR § 416.1488 (1983). Dion at 4.
Except for the two years limitation to reopen for "good cause", instead of a four year period, § 416.1488 is virtually identical to 20 CFR § 404.988.
In Dion this court found that "the Appeals Council had no authority to reopen under 20 CFR § 416.1488, which regulates reopening by claimants. Id.
The Appeals Council on its own motion must reopen within sixty days of a hearing decision. 20 C.F.R. § 416.1469. The Appeals Council on its own motion may reopen within sixty days under 20 C.F.R. § 416.1469, but may not reopen under the lengthier timelines of 20 C.F.R. § 416.1488. Silvis v. Heckler, 578 F.Supp. 1401 (W.D.Pa.1984). The reopening by the Appeals Council on its own motion nearly one year after the ALJ's hearing decision exceeded its authority granted by the regulations, deprived Dion of fair notice of the Secretary's intentions, stripped away the protective cloak of due process, and destroyed the surety which a final, binding decision should guarantee. See United States v. Larionoff, 431 U.S. 864 97 S.Ct. 2150, 53 L.Ed.2d 48 (1977); Mathews v. Eldridge, 424 U.S. 319 96 S.Ct. 893, 47 L.Ed.2d 18 (1976).
The court's rationale in Dion applies with equal force to 20 CFR § 404.988.
The court in Silvis v. Heckler, 578 F.Supp. 1401 (W.D.Pa.1984) faced the same issue as presented in Dion; whether 20 CFR § 416.1488 permits the Secretary, as well as the claimant, to reopen a decision of an ALJ after the sixty day period for review under 20 CFR § 416.1469 has elapsed. Silvis, 578 F.Supp. at 1402. The Silvis court believed that the reopening regulations must be read together to obtain a fair interpretation. Preceding § 416.1488 on the subject of reopening and revising decisions, § 20 CFR § 416.1487 provides:
§ 416.1487 is identical to 20 CFR § 404.987. Reading § 416.1487 in conjunction with § 416.1488, the court held "that the regulations provide a method by which a claimant who has been denied benefits may seek to have that adverse decision reopened by the Secretary." Silvis, 578 F.Supp. at 1404. The court...
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McCuin v. Secretary of Health and Human Services, 86-1732
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