Social Security Ruling 91-5p pertains if the claimant had good cause for missing the deadline to request review. This Ruling provides that if a claimant presents evidence that mental incapacity prevented her from requesting timely review of an administrative action, and the claimant had no one legally responsible for prosecuting the claim on her behalf at the time of the prior adverse action, SSA “will determine whether or not good cause exists for extending the time to request review.” SSR 91-5p. “The claimant will have established mental incapacity for the purpose of establishing good cause when the evidence establishes that he or she lacked the mental capacity to understand the procedures for requesting review.” In making the 91-5p determination, the following four factors must be considered: (1) inability to read or write; (2) lack of facility with the English language; (3) limited education; and (4) any mental or physical condition which limits the claimant’s ability to do things for him/herself. In all cases, “[t]he adjudicator will resolve any reasonable doubt in favor of the claimant.” If it is determined, applying the proper criteria, that the claimant lacked the mental capacity to understand the procedures for requesting review, time limits are tolled “regardless of how much time has passed since the prior administrative action.” In such cases, the adjudicator must “take the action which would have been appropriate had the claimant filed a timely request for review.”
