Within the context of Social Security Administration regulations, a claimant may be required, in certain circumstances, to show good cause for missing a deadline, reopening a claim, or otherwise failing to comply with procedures.
If a claimant fails to file a timely report or appeal, or fails to appear at a scheduled appointment, the regulations allow for dismissal of a claim, unless the claimant can demonstrate that there was a reasonable explanation for non-compliance.
Generally, a good reason is a matter of common sense. Serious illness or death in the immediate family is always good cause for failure to miss a scheduled appointment.
When it comes to failure to make required reports, consideration is given to whether the failure is the result of “untoward circumstances” misleading action of the SSA, confusion as to requirements as a result of amendments to legislation, or any physical, mental, educational or linguistic limitations (including lack of facility with the English language) an individual may have.
Inability to obtain information due to destruction by fire or other damage to records is enumerated as good cause, as is timely transmittal of a document, in good faith, to another government agency. Also, SSA must provide a claimant sufficient time to complete and return forms and submit documents.
Typically, SSA will only allow a single instance of substantial failure where circumstances are similar. So, for example, good cause may not be found for failure to timely submit a report on the second or subsequent violation.
Similarly, SSA enumerates good reasons for missing filing deadlines. SSA considers the circumstances, whether you understood the requirements or were misled by the Administration, and physical, mental and linguistic limitations. For example, a claimant with mental limitations may allege inability to understand the requirements of timely filing, or a non-English speaking claimant may be excused for failure to follow instructions provided in English.
Appeal deadlines are normally 60 days from the date on the last notice of denial. SSA presumes that a claimant received the notice within 5 days, effectively allowing 65 days to file an appeal. But if a claimant can show they did not receive the notice within 5 days, or at all, that may prove to be good cause.
SSA will consider reopening a previously closed claim for good cause, stated to be provision of new and material evidence, proof that a clerical error was made by the Administration, or if the evidence used in deciding your claim clearly shows on its face that an error was made. SSA will not reopen a case based upon a change of legal interpretation upon which the determination was made.
While SSA does list the above situations in which good cause may be found, good cause is not limited to the enumerated items. The rule of thumb is one of reasonableness. SSA understands that its claimants are disabled, and will generally find good cause where a reasonable explanation for the failure is provided.