[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: 20CFR422.210]

[Page 1082-1083]
 
                      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. 422.210  Judicial review.

    (a) General. A claimant may obtain judicial review of a decision by 
an administrative law judge if the Appeals Council has denied the 
claimant's request for review, or of a decision by the Appeals Council 
when that is the final decision of the Commissioner. A claimant may also 
obtain judicial review of a reconsidered determination, or of a decision 
of an administrative law judge, where, under the expedited appeals 
procedure, further administrative review is waived by agreement under 
Sec. Sec. 404.926, 410.629d, or 416.1426 of this chapter or 42 CFR 
405.718a-e as appropriate. For judicial review as to the amount of 
benefits under part A or part B of title XVIII of the Social Security 
Act, or of health services to be provided by a health maintenance 
organization without additional cost, the amount in controversy must be 
$1,000 or more as provided under section 1869(b) and section 
1876(c)(5)(B) of the Act. For judicial review of a determination by a 
PRO, the amount in controversy must be $2,000 or more. An institution or 
agency may obtain judical review of a decision by the Appeals Council 
that it is not a provider of services, or of a decision by the Appeals 
Council terminating an agreement entered into by the institution or 
agency with the Commissioner (see section 1866(b)(2) of the Act). The 
Social Security Act does not provide for a right to judicial review of a 
final decision of the Commissioner regarding the status of an entity 
which is not a ``provider of services'', such as an independent 
laboratory. Providers of services or other persons may seek judicial 
review of a final administrative determination made pursuant to section 
1128(b)(6) of the Act. There are no amount-in-controversy limitations on 
these rights of appeal.
    (b) Court in which to institute civil action. Any civil action 
described in paragraph (a) of this section must be instituted in the 
district court of the United States for the judicial district in which 
the claimant resides or where such individual or institution or agency 
has his principal place of business. If the individual does not reside 
within any such judicial district, or if such individual or institution 
or agency does not have his principal place of business within any such 
judicial district, the civil action must be instituted in the District 
Court of the United States for the District of Columbia.
    (c) Time for instituting civil action. Any civil action described in 
paragraph (a) of this section must be instituted within 60 days after 
the Appeals Council's notice of denial of request for review of the 
administrative law judge's decision or notice of the decision by the 
Appeals Council is received by the individual, institution, or agency, 
except that this time may be extended by the Appeals Council upon a 
showing of good cause. For purposes of this section, the date of receipt 
of notice of denial of request for review of the presiding officer's 
decision or notice of the decision by the Appeals Council shall be 
presumed to be 5 days after the date of such notice, unless there is a 
reasonable showing to the contrary. Where pursuant to the expedited 
appeals procedures an agreement has been entered into under 42 CFR 
405.718c, a civil action under section 205(g) of the Act must be 
commenced within 60 days from the date of the signing of such agreement 
by, or on behalf of, the Commissioner, except where the time described 
in the first sentence of this paragraph (c) has been extended by the 
Commissioner upon a showing of good cause. Where pursuant to the 
expedited appeals procedures an agreement has been entered into under 
Sec. Sec. 404.926, 410.629d, or 416.1426 of this chapter, a civil 
action under section 205(g) of the Act must be commenced within 60 days 
after the date the individual receives notice (a signed copy of the 
agreement will be mailed to the individual and will constitute notice) 
of the signing of such agreement by, or on behalf of, the Commissioner, 
except where the time described in this paragraph (c) has been extended 
by the Commissioner upon a showing of good cause.
    (d) Proper defendant. Where any civil action described in paragraph 
(a) of this section is instituted, the person

[[Page 1083]]

holding the Office of the Commissioner shall, in his official capacity, 
be the proper defendant. Any such civil action properly instituted shall 
survive notwithstanding any change of the person holding the Office of 
the Commissioner or any vacancy in such office. If the complaint is 
erroneously filed against the United States or against any agency, 
officer, or employee of the United States other than the Commissioner, 
the plaintiff will be notified that he has named an incorrect defendant 
and will be granted 60 days from the date of receipt of such notice in 
which to commence the action against the correct defendant, the 
Commissioner.

[41 FR 53792, Dec. 9, 1976, as amended at 44 FR 34942, June 18, 1979; 49 
FR 46370, Nov. 26, 1984; 49 FR 48036, Dec. 10, 1984; 54 FR 4268, Jan. 
30, 1989; 62 FR 38456, July 18, 1997]