Claimant filed a claim for social security disability benefits in April, 1981. His claim was denied. The decision became a final administrative decision when he failed to appeal it within the 60-day time limit.

In October, 1981 claimant sent a letter to his local social security office seeking to reopen the prior claim. His request was denied.

In 1984 claimant filed suit in federal district court, arguing that the Secretary of Health and Human Services was required under the applicable regulations to reopen the case. The District Court agreed, and issued a writ of mandamus compelling the Secretary to reopen the case. The Secretary appealed, arguing that the district court did not have jurisdiction to issue a writ of mandamus in the case, and that reopening the case was discretionary, not mandatory.

The 4th Circuit Court of Appeals stayed the writ of mandamus pending the appeal. The Court ultimately held that it did not need to decide the issue of the district court’s authority to issue a writ of mandamus, because the regulations were clear that reopening was discretionary and not mandatory.

There are two basic situations in which a claim for disability benefits may be reopened. The first is the twelve-month rule stating that a claim may be reopened within 12 months of the date of the notice of the initial determination for any reason. The second is the four-year rule stating that a case may be reopened within 4 years of the date of the initial determination if the agency finds good cause to reopen the case.

The Court’s ruling turned on the regulation’s use of the terms “will” (mandatory language) and “may” (discretionary language). The Court also noted the well-established principle that an agency’s interpretation of its own regulations is entitled to great deference.

See Monger v. Bowen, 817 F.2d 15, (4th Cir. 1987). See also Social Security Ruling (SSR) 88-1c.

Note: Although reopening of a case is discretionary, in my experience, requests to reopen within 12 months of an initial determination are usually readily granted. On the other hand, requests to reopen a claim for cause after the twelve-month period are much more difficult. Moral of the story for disability claimants: don’t sit on your rights.

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.