When a disability claim is denied, a claimant typically has 60 days to request review of the unfavorable decision. This rule applies at all levels of adjudication, whether it be the initial level, reconsideration, request for administrative law judge hearing, request for review by the Appeals Council, or federal court review.

There are certain circumstances in which the 60 day appeal period may be extended for good cause. One of these circumstances is where the claimant lacked the mental capacity to understand the process and time constraints for a timely request for review. This circumstance may constitute good cause for a late filing if the claimant did not have a responsible adult assisting on his or her case (such as a parent, legal guardian, or attorney).

Some of the criteria for determining good cause based on mental incapacity are:

Inability to read and write
Limited ability with the English language
Lack of education
Any physical or mental impairment that prevents the claimant from caring for himself or herself

If good cause based on mental incapacity is found, the case may be reopened, regardless of how long it has been since the denial. This means the rules on res judicata (a legal doctrine precluding continued pursuit of a matter already decided) and administrative finality will not apply.

The principles on establishing good cause for a late request for review in the case of mental incapacity are set out in Social Security Ruling (SSR) 91-5p.

It often helps to consult an experienced attorney to determine whether or not good cause might exist to make a belated request review, particularly in the case of a claimant’s mental incapacity.

 This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.