Opinion ID: 8414595
Heading Depth: 2
Heading Rank: 2

Heading: The Waiver Claim

Text: We close by briefly addressing Casey’s waiver claim. Because the Appeals Council granted Casey’s good cause request but then arbitrarily dismissed his administrative appeal, there is no “final decision” on the underlying merits within the meaning of 42 U.S.C. § 405(g). It is therefore inappropriate for us to decide whether Casey is entitled to a waiver of the $334,000 overpayment: that is a question for the agency to consider on remand. The bar to prevail on such a claim is rather high. The claimant must show both that he was without fault with respect to the overpayment and that recovery by the agency would either defeat the purpose of the Social Security Act or violate equity and good eonseiénee. 42 U.S.C. § 404(b)(1); 20 C.F.R. § 404.506. Given those hurdles, Casey may have a rocky road ahead. That said, we think Casey’s waiver claim is at least plausible. Casey alleged in his complaint that a local office of the Social Security Administration reviewed his case “at least five (5) times over the previous ten (10) years” and that the international office interceded on his behalf to forestall action by the local office. On appeal, Casey has presented an assortment of documents showing that the agency was aware of earnings posted to his account between 1968 and 2004 and that Casey had submitted income information to the agency upon request. 4 While the fact of Casey’s overpayment is res judicata given that Casey did not request reconsideration of the agency’s initial determination, see 20 C.F.R. § 404.905, the agency’s knowledge of his income and continued payment of benefits over a period of many years— coupled with the Marshals Service’s alleged assurance that Casey was entitled to benefits for life — may be relevant to a' finding whether Casey was without fault. See § 404.507 (“In determining whether an individual is at fault, the Social Security Administration will consider all pertinent circumstances.... ”); see also §§ 404.510(b), 404.510a (individual is without fault where individual relied on erroneous information from government agency that individual reasonably believed was involved with benefits administration); § 404.510(g) (individual is without fault with regard to deduction overpayment where individual continued receiving benefits after notifying Social Security Administration of event that should have caused deductions, provided that individual believed in good faith he was entitled to benefits). 5 In any event, Casey’s uncertain prospects of success on the merits do not excuse the Appeals Council’s arbitrary dismissal of his request for review. We reverse the judgment of the district court and remand with orders to remand this matter to the Social Security Administration for further proceedings. On remand, the Appeals Council shall render a final decision on the merits of Casey’s waiver claim or shall remand for further consideration by an ALJ pursuant to 20 C.F.R. § 404.983, without revisiting the timeliness of Casey’s request for review. REVERSED and REMANDED.