Medicare Part D Subsidy Rules - Section 20 CFR 418.3645

Social Security Administration

§ 418.3650

(b) Where to file your request. You can
request administrative review by mailing or faxing a request or calling or
visiting any Social Security office.
(c) When we will extend the time period
to request administrative review. If you
want a review of the initial determination but do not request one within 60
days after the date you receive notice
of the initial determination, you may
ask us for more time to request a review. Your request for an extension
must explain why it was not filed within the stated time period. If you show
us that you had good cause for missing
the deadline, we will extend the time
period. To determine whether good
cause exists, we use the standards explained in § 418.3640.
§ 418.3635 Can anyone request administrative review on your behalf?
Your personal representative (as defined in 42 CFR 423.772) may request administrative review on your behalf.
That person can send additional information to us on your behalf and participate in the hearing.

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§ 418.3640 How do we determine if you
had good cause for missing the
deadline to request administrative
review?
(a) In determining whether you have
shown that you have good cause for
missing a deadline to request review we
consider:
(1) What circumstances kept you
from making the request on time;
(2) Whether our action misled you;
(3) Whether you did not understand
the requirements of the Act resulting
from amendments to the Act, other
legislation, or court decisions; and
(4) Whether you had any physical,
mental, educational, or linguistic limitations (including any lack of facility
with the English language) which prevented you from filing a timely request
or from understanding or knowing
about the need to file a timely request
for review.
(b) Examples of circumstances where
good cause may exist include, but are
not limited to, the following situations:
(1) You were seriously ill and were
prevented from contacting us in per-

son, in writing, or through a friend,
relative, or other person.
(2) There was a death or serious illness in your immediate family.
(3) Important records were destroyed
or damaged by fire or other accidental
cause.
(4) You were trying very hard to find
necessary information to support your
claim but did not find the information
within the stated time periods.
(5) You asked us for additional information explaining our action within
the time limit, and within 60 days of
receiving the explanation you requested a review.
(6) We gave you incorrect or incomplete information about when and how
to request administrative review.
(7) You did not receive notice of the
initial determination.
(8) You sent the request to another
Government agency in good faith within the time limit and the request did
not reach us until after the time period
had expired.
(9) Unusual or unavoidable circumstances exist, including the circumstances described in paragraph
(a)(4) of this section, which show that
you could not have known the need to
file timely, or which prevented you
from filing timely.
§ 418.3645 Can you request that the decision-maker be disqualified?
The person designated to conduct
your hearing will not conduct the hearing if he or she is prejudiced or partial
with respect to any party or has any
interest in the matter pending for decision. If you object to the person who
will be conducting your hearing, you
must notify us at your earliest opportunity. The Commissioner or the Commissioner’s designee will decide whether to appoint another person to conduct your hearing.
§ 418.3650 How do we make our decision upon review?
After you request review of our initial determination, we will review the
information that we considered in
making the initial determination and
any other information we receive. We
will make our decision based on this

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