Exception to SSR 11-1p

SSR 11-1p general precludes the filing of a new disability application if there is a prior application pending at the Appeals Council. However, revisions in POMS DI 51501.001 provided an exception – new critical condition exception – which allows a claimant with an appeal pending at the Appeals Council to file a new application.

Example:
Claimant alleged lumbar spine impairment. ALJ published the denial on May 1, 2014. Claimant timely appealed the denial to the Appeals Council. On July 20, 2014, claimant suffered repeated seizure episodes after a vehicle accident on July 15, 2014. Since the new critical on-set condition is after the ALJ’s decision, the claimant can file a request to the Field Office for an exception to file a new application.

To request for a new application under the critical condition exception rule, the claimant must file the request at the Field Office, not at the Appeals Council. The Field Office will forward the request to the Appeals Council. The Field Office cannot process the new application until the Appeals Council approves the request.