[Code of Federal Regulations]
[Title 20, Volume 2]
[Revised as of April 1, 2004]
From the U.S. Government Printing Office via GPO Access
[CITE: 20CFR422.205]

[Page 1080-1082]
 
                      TITLE 20--EMPLOYEES' BENEFITS
 
               CHAPTER III--SOCIAL SECURITY ADMINISTRATION
 
PART 422_ORGANIZATION AND PROCEDURES--Table of Contents
 
       Subpart C_Procedures of the Office of Hearings and Appeals
 
Sec. 422.205  Review by Appeals Council.

    (a) Any party to a hearing decision or dismissal may request a 
review of such action by the Appeals Council. The Health Care Financing 
Administration or, as appropriate, the Office of the Inspector General 
is a party to a hearing on a determination under Sec. 422.203 (a)(2) 
and (a)(3) and to administrative appeals involving matters under section 
1128(b)(6) of the Act (see 42 CFR 498.42). This request may be made on 
Form

[[Page 1081]]

HA-520, ``Request for Review of Hearing Decision/Order,'' or by any 
other writing specifically requesting review. Form HA-520 may be 
obtained from any social security district office or branch office, from 
the Office of Hearings and Appeals Social Security Administration, P.O. 
Box 3200, Arlington, VA 22203, or at any other office where a request 
for a hearing may be filed. (For time and place of filing, see 
Sec. Sec. 404.968, 410.661, and 416.1468 of this chapter, and 42 CFR 
405.724, 498.82 and 417.261.)
    (b) Whenever the Appeals Council reviews a hearing decision under 
Sec. Sec. 404.967 or 404.969, 410.662, 416.1467, or 416.1469 of this 
chapter, or 42 CFR 405.724 or 417.261 or 473.46 and the claimant does 
not appear personally or through representation before the Council to 
present oral argument, such review will be conducted by a panel of not 
less than two members of the Council designated in the manner prescribed 
by the Chairman or Deputy Chairman of the Council. In the event of 
disagreement between a panel composed of only two members, the Chairman 
or Deputy Chairman, or his delegate, who must be a member of the 
Council, shall participate as a third member of the panel. When the 
claimant appears in person or through representation before the Council 
in the location designated by the Council, the review will be conducted 
by a panel of not less than three members of the Council designated in 
the manner prescribed by the Chairman or Deputy Chairman. Concurrence of 
a majority of a panel shall constitute the decision of the Appeals 
Council unless the case is considered as provided under paragraph (e) of 
this section.
    (c) The denial of a request for review of a hearing decision 
concerning a determination under Sec. 422.203(a)(1) shall be by such 
appeals officer or appeals officers or by such member or members of the 
Appeals Council as may be designated in the manner prescribed by the 
Chair or Deputy Chair. The denial of a request for review of a hearing 
dismissal, the dismissal of a request for review, the denial of a 
request for review of a hearing decision whenever such hearing decision 
after such denial would not be subject to judicial review as explained 
in Sec. 422.210(a), or the refusal of a request to reopen a hearing or 
Appeals Council decision concerning a determination under Sec. 
422.203(a)(1) shall be by such member or members of the Appeals Council 
as may be designated in the manner prescribed by the Chair or Deputy 
Chair.
    (d) A review or a denial of review of a hearing decision or a 
dismissal of a request for review with respect to requests by parties 
under 42 CFR 498.82 or 1001.128 in accordance with Sec. 498.83 will be 
conducted by a panel of at least two members of the Appeals Council 
designated by the Chairman or Deputy Chairman and one person from the 
U.S. Public Health Service designated by the Surgeon General, Public 
Health Service, Department of Health and Human Services, or his 
delegate. This person shall serve on an ad hoc basis and shall be 
considered for this purpose as a member of the Appeals Council. 
Concurrence of a majority of the panel shall constitute the decision of 
the Appeals Council unless the case is considered as provided under 
paragraph (e) of this section.
    (e) On call of the Chairman, the Appeals Council may meet en banc or 
a representative body of Appeals Council members may be convened to 
consider any case arising under paragraph (b), (c), or (d) of this 
section. Such representative body shall be comprised of a panel of not 
less than five members designated by the Chairman as deemed appropriate 
for the matter to be considered, including a person from the U.S. Public 
Health Service in a matter under paragraph (d) of this section. The 
Chairman or Deputy Chairman shall preside, or in his absence, the 
Chairman shall designate a member of the Appeals Council to preside. A 
majority vote of the designated panel, or of the members present and 
voting shall constitute the decision of the Appeals Council.
    (f) The Chairman may designate an administrative law judge to serve 
as a member of the Appeals Council for temporary assignments. An 
administrative law judge shall not be designated to serve as a member on 
any panel where such panel is conducting

[[Page 1082]]

review on a case in which such individual has been previously involved.

[41 FR 53792, Dec. 9, 1976, as amended at 44 FR 34942, June 18, 1979; 54 
FR 4268, Jan. 30, 1989; 60 FR 7120, Feb. 7, 1995]