Opinion ID: 4875
Heading Depth: 2
Heading Rank: 2

Heading: Final Decision Under Section 405(g)

Text: The Supreme Co urt has stated that section 405(g) clearly limits judicial review to a particular type of agency action, a final decision of the Secretary made after a hearing.'  Califano v. Sanders, 430 U.S. 99, 97 S.Ct. 980, 986, 51 L.Ed.2d 192 (1977). Accordingly, the Court held that a decision not to reopen a prior final determination, since the decision could be made without a hearing, was not reviewable by the federal courts unless the claimant challenged the Secretary's action on constitutional grounds. Id. This Circuit has applied Sanders to hold that a denial of a claimant's request for an extension of time to seek judicial review was not reviewable, McCall v. Bowen, 832 F.2d 862, 863 (5th Cir.1987), and likewise that a denial of an extension of time to seek Appeals Council review of an ALJ decision was not reviewable, Harper v. Bowen, 813 F.2d 737, 743 (5th Cir.), cert. denied, 484 U.S. 969, 108 S.Ct. 466, 98 L.Ed.2d 405 (1987). This appeal presents the quest ion, apparently one of first impression in this Circuit,1 of 1 To our knowledge, the only case in which a court of appeals has addressed this question is Doe v. Secretary of Health and Human Services, 744 F.2d 3 (1st Cir.1984) (per curiam), where whether the same result applies when an ALJ dismisses a request for a hearing based on the claimant's failure to appear. Although we are not convinced, as the Secretary argues, that Sanders, McCall, and Harper are completely dispositive of the question, we agree that those cases provide the starting point. The Sanders Court was driven, at least in part, by a recognition that permitting judicial review of a request for reopening a case would create a simple path for evading section 405(g)'s sixty-day limitation on judicial review of the Secretary's decisions. Sanders, 97 S.Ct. at 986. The Court decided that because the district court's jurisdiction is invoked only after a claimant has complied with all of the requirements of the administrative review process, including the sixty-day period for filing a civil action at the conclusion of the process, decisions such as whether to reopen a case—thus effectively waiving the sixty-day limitations period—are antecedent to the court's involvement and are committed to the discretion of the Secretary. McCall, Harper, and other cases to which the Secretary refers us extend this principle to the limitation periods prescribed by regulation for the four-stage appeals process for SSI claims and for old-age, survivors', or disability insurance claims.2 The regulations impose sixty-day limitation periods on each stage: on seeking reconsideration (20 C.F.R. § 416.1409(a)), on requesting a hearing before an ALJ (id. § 416.1433(b)), on requesting Appeals Council review (id. § 416.1468(a)), and on bringing suit (id. § 416.1481).3 Furthermore, each limitation period may be extended if good cause is shown, see id. §§ 416.1409(b), 416.1433(c), the First Circuit held that a dismissal for failure to appear is unreviewable. Among the district courts, some have agreed with this conclusion, see, e.g., Bush v. Bowen, 690 F.Supp. 417, 418 (W.D.Pa.1988); Plagianos v. Schweiker, 571 F.Supp. 495, 497 (S.D.N.Y.1983); cf. Hines v. Bowen, 671 F.Supp. 10, 11 (D.N.J.1987) (finding a colorable constitutional claim that preserved jurisdiction under Sanders, but apparently assuming that the dismissal would otherwise be unreviewable), but others have not, see, e.g., Crumble v. Secretary of Health and Human Servs., 586 F.Supp. 57, 58–60 (E.D.N.Y.1984); Beckham v. Schweiker, 557 F.Supp. 137, 139–40 (S.D.Ohio 1982). 2 Old-age, survivors, or disability insurance claims are governed by 20 C.F.R. pt. 404, rather than part 416, which applies to requests for SSI. Part 404 has the same four-stage appeals process, however, and the counterparts to the provisions relevant here are essentially identical. 3 The counterpart provisions in Part 404 are 20 C.F.R. §§ 404.909(a), 404.933(b), 404.968(a), 404.981. 416.1468(b), 416.1482, with the standards for determining whether good cause exists set forth in 20 C.F.R. § 416.1411. Courts have been virtually unanimous in holding, as we did in McCall and Harper, that these determinations of whether to extend for cause the limitation periods prescribed by regulation are not final decisions wit hin the meaning of section 405(g) and are hence unreviewable.4 The Secretary here urges us to put a dismissal by an ALJ for failure to appear at a scheduled hearing on the same footing. Bearing in mind that administrative exhaustion should be applied with a regard for the particular administrative scheme at issue and that final decision is not defined in the Social Security Act but its meaning is left to the Secretary to flesh out by regulation, Weinberger v. Salfi, 422 U.S. 749, 95 S.Ct. 2457, 2467, 45 L.Ed.2d 522 (1975), we initially note that the regulations offer less direct support for the step urged by the Secretary here than they did for our holdings in McCall and Harper. 20 C.F.R. § 416.1403 lists a number of agency actions that are not initial determinations and thus are not subject to the administrative review process described above or to judicial review. Among those actions is [d]enying your request to extend the time period for requesting review of a determination or a decision. Id. § 416.1403(a)(8).5 In Harper we relied upon that provision, concluding that it brought the case within the Sanders principle that where the regulations prohibit it, there is no judicial review. Harper, 813 F.2d at 743. There is no comparable regulation expressly reserving the challenged action here—dismissal 4 As to the time limit for seeking reconsideration, see Giacone v. Schweiker, 656 F.2d 1238, 1241–43 (7th Cir.1981). As to the time limit for seeking an ALJ hearing, see, e.g., Penner v. Schweiker, 701 F.2d 256, 260 (3d Cir.1983); Watters v. Harris, 656 F.2d 234, 238–39 (7th Cir.1980); White v. Schweiker, 725 F.2d 91, 93–94 (10th Cir.1984). As to the time limit for seeking Appeals Council review, see, e.g., Dietsch v. Schweiker, 700 F.2d 865, 867 (2d Cir.1983); Adams v. Heckler, 799 F.2d 131, 133 (4th Cir.1986); Smith v. Heckler, 761 F.2d 516, 518–19 (8th Cir.1985); Matlock v. Sullivan, 908 F.2d 492, 493 (9th Cir.1990). But see Bloodsworth v. Heckler, 703 F.2d 1233, 1237 (11th Cir.1983). As to the time limit for filing suit, see, e.g., Turner v. Bowen, 862 F.2d 708, 710 (8th Cir.1988) (per curiam); Peterson v. Califano, 631 F.2d 628, 629–31 (9th Cir.1980); Dozier v. Bowen, 891 F.2d 769, 771 (10th Cir.1989); Stone v. Heckler, 778 F.2d 645, 648–49 (11th Cir.1985). 5 The counterpart provision in Part 404 is 20 C.F.R. § 404.903(j). of a hearing request by an ALJ for failure to appear—to the Secretary's discretion. Indeed, dismissals by an ALJ are specifically made subject to review by the Appeals Council, 20 C.F.R. §§ 416.1459, 416.1467, and in the normal case denials of review by the Appeals Council make the underlying decision of the ALJ final and subject to judicial review, id. § 416.1481.6 Nevertheless, we are persuaded that under Sanders the Secretary's construction of section 405(g) is the correct one, and that the regulations taken as a whole support that result. The Sanders Court relied upon the literal wording of the statute, which limits reviewable agency action to final decision[s] of the Secretary made after a hearing, and upon the absence in the Social Security Act of any guarantee of a hearing on a petition to reopen a prior final decision. Sanders, 97 S.Ct. at 986. The Court noted that the opportunity to reopen cases and any hearing convened pursuant to such a request were afforded by the Secretary's regulations, not the Social Security Act. Id. We have stated the holding of Sanders to be that section 405(g) referred to decisions where a hearing was mandatory, not discretionary. Harper, 813 F.2d at 741; see also Watters v. Harris, 656 F.2d 234, 239 n. 10 (7th Cir.1980). It is clear that the Social Security Act does not mandate a hearing to consider the appropriateness of dismissal prior to a hearing on the merits of an individual's disability claim—indeed, such a requirement would essentially make dismissal pointless. However, this cannot end application of the Sanders test here. Unlike a request to reopen a prior final decision, where both the relief sought by the claimant and the grant of a hearing were discretionary, here the claimant's request is to have his hearing before the ALJ, and that right is conferred by statute. See 42 U.S.C. § 405(b)(1). Therefore we must also inquire whether the practice of pre-hearing dismissals violates the statute. Section 405(b)(1) guarantees any individual against whom an unfavorable determination 6 By contrast, the proper response by the Appeals Council to an untimely request for review is dismissal rather than denial, 20 C.F.R. § 416.1471; the dismissal of a request for Appeals Council review is binding and not subject to further review, id. § 416.1472. See also Matlock v. Sullivan, 908 F.2d 492, 494 (9th Cir.1990) (distinguishing between dismissals and denials). of disability has been made reasonable notice and opportunity for a hearing. (emphasis added) The SSA must, like any agency, adopt procedures for fairly accommodating each claimant's desire for detailed review of his case with all claimants' and society's interest in an efficient system. Section 405 recognizes that necessity and gives the Secretary discretion to do so by guaranteeing a reasonable opportunity for a hearing, rather than guaranteeing a hearing absolutely. We are also cognizant, though, of the danger that holding pre-hearing dismissals to be unreviewable might create a situation in which an ALJ could insulate his own arbitrary denials of hearings from scrutiny and thus undermine even the statutory right to a reasonable opportunity for a hearing. Here we are not presented with such a case, however. For SSI claims (and for old-age, survivors', and disability insurance claims under 20 C.F.R. pt. 404), the Secretary has explicitly defined the range of the ALJ's discretion in dismissing cases. The regulations provide that an ALJ may dismiss a hearing request in certain specified circumstances. 20 C.F.R. § 416.1457. Before the ALJ can even make a determination whether to dismiss a hearing request, one of a limited number of situations listed in section 416.1457 must exist. As noted above, these include the failure of a party or his representative to appear at a hearing after having been notified that their failure to do so would subject them to dismissal without further notice. Id. § 416.1457(b)(1). And, in such an instance the ALJ must also find (as he did here) there was not good cause for the failure to appear. Id. Dismissal is also authorized if cause is found because a previous determination on the same facts has become final, barring the present claim under the doctrine of res judicata, id. § 416.1457(c)(1), or if the claimant has not gone through the required prior steps in the review process, namely the request and receipt of a reconsidered determination, id. § 416.1457(c)(2), or if the claimant did not request a hearing within sixty days of his notice of the previous determination, and no good cause was found for extending the period, id. § 416.1457(c)(3). Secti on 416.1457(b)(1) does not give rise to the danger of a completely arbitrary dismissal that is beyond the power of the courts to correct. Brandyburg, for instance, could have removed himself from the reach of section 416.1457(b)(1) simply by appearing at his hearing. If the ALJ had proceeded to make a benefits determination adverse to Brandyburg and he felt that he was prejudiced by lack of time to prepare or lack of assistance of counsel, he would have had standing to make these arguments to the Appeals Council and, if the Appeals Council disagreed, to a federal court. The authorization of dismissals in section 416.1457(b)(1) is therefore not inconsistent with the statute's guarantee of an opportunity for a hearing. And at least where, as here, the claimant does not allege any facts showing a violation of the regulation's requirements (e.g., that the ALJ dismissed in a situation not authorized by the regulations or that he failed to give the claimant the required notice7), but merely objects to the ALJ's determination to dismiss the request for hearing, a district court's refusal to accept jurisdiction also does not undermine the statutory guarantee.8 We now return to the provision of the regulations indicating that upon denials of review by the Appeals Council the underlying ALJ decision may be challenged by filing an action in district court. 20 C.F.R. § 416.1481. Although our holding here requires us to read if otherwise reviewable into this provision, that construction is warranted by Sanders and by prior decisions of this Circuit. Sanders was explicit in holding that section 405(g) only authorizes judicial review when there is a hearing, so we must read section 416.1481 in light of section 405(g) as construed in Sanders. Moreover, we and other circuits have held that district courts lack jurisdiction to review other types of dismissals under section 416.1457. For example, an ALJ's dismissal of a claimant's case on res judicata grounds (see 20 C.F.R. § 416.1457(c)(1)) is unreviewable absent a colorable constitutional claim. Hensley v. Califano, 601 F.2d 216 (5th Cir.1979) (per curiam); accord Matos 7 See Howard v. Heckler, 661 F.Supp. 654, 656–57 (N.D.Ill.1986). 8 Brandyburg does not claim, and nothing in the record suggests, either that he was not able (for any reason) to appear at the hearing, or that he had not actually received adequate notice of it (and that failure to appear could result in dismissal without further notice), or that his failure to appear was other than knowing and voluntary. Thus, we do not address a situation where, for example, a claimant does not appear because he suffered a heart attack on the way to the hearing or was unaware of the hearing date (as when a properly sent notice was, due to no fault of the claimant, never received). Indeed, Brandyburg does not claim that he had good cause for failing to appear, as such, at the hearing; rather, his claim is that it was arbitrary and capricious of the ALJ to have denied his request for a postponement and to have dismissed his request for a hearing because he thereafter failed to appear. v. Secretary of Health, Education and Welfare, 581 F.2d 282, 285–86 (1st Cir.1978); Stauffer v. Califano, 693 F.2d 306, 307 (3d Cir.1982); Brown v. Harris, 669 F.2d 911, 912–13 (4th Cir.1981); Holland v. Heckler, 764 F.2d 1560, 1561 (11th Cir.1985) (per curiam). Likewise, the cases holding that denials of requests for extensions of time in which to request an ALJ hearing are unreviewable also hold, a fortiori, that the ALJ's pre-hearing dismissal for untimeliness (see 20 C.F.R. § 416.1457(c)(3)) is unreviewable. See Penner v. Schweiker, 701 F.2d 256, 260 (3d Cir.1983); White v. Schweiker, 725 F.2d 91, 93 (10th Cir.1984). Denials of review by the Appeals Council of these decisions do not create federal jurisdiction, and it is sensible that the various forms of dismissal in section 416.1457 be treated similarly. Indeed, even if the ALJ makes a determination on the merits, and the Appeals Council grants review and decides that the request for hearing should have been dismissed, either on res judicata grounds or for lack of good cause for untimeliness of the hearing request, federal courts lack jurisdiction to review the dismissal. Ellis v. Schweiker, 662 F.2d 419, 419–20 (5th Cir.1981) (res judicata ); White, 725 F.2d at 93–94 (failure to show good cause for delay in requesting ALJ hearing). These cases show that it is the fact of dismissal on procedural grounds at the administrative stage, not the form of the Appeals Council's decision, that deprives the district court of jurisdiction under section 405(g). For these reasons, we conclude that the district court was correct in its holding that the ALJ's dismissal of Brandyburg's request was not a final decision subject to judicial review under section 405(g). We therefore do not reach Brandyburg's contention that the ALJ's dismissal was arbitrary and capricious.