Persons claiming retirement, disability or survivor as well as unemployment or sickness benefits from the Railroad Retirement Board have the right to appeal unfavorable determinations on their claim. The following questions and answers describe the appeals processes for persons whose claims under the Railroad Retirement Act or Railroad Unemployment Insurance Act are denied, or who are dissatisfied with decisions on their claims.
1. How does a person initiate a review of an unfavorable decision on a claim and what are the time limits?
For retirement, disability or survivor as well as unemployment or sickness benefit claims, there is a three-stage review and appeals process within the Railroad Retirement Board.
Persons dissatisfied with the initial decision on their claims may first request reconsideration from the Board unit which denied their claims. An individual has 60 days, from the date of the initial denial notice, to file a written statement requesting reconsideration.
In decisions involving retirement, disability or survivor overpayments, requests for waiver of the overpayment must be filed within 30 days of the date of the overpayment notice. In such cases, recovery of the overpayment will be deferred and an oral hearing may be held, if requested. A request for waiver received after 30 days will be considered but will not defer collection of the overpayment.
If the case involves an unemployment or sickness benefit overpayment, claimants may request a waiver of repayment. A request for waiver filed within 30 days will, in certain cases, defer recovery of the overpayment from subsequent benefit payments.
2. What are the second and third stages of the appeals process and their time limits?
If dissatisfied with the reconsideration or waiver decision on a retirement, disability, survivor or unemployment-sickness claim, a person may appeal to the Railroad Retirement Board's Bureau of Hearings and Appeals, which is independent of those units responsible for reconsideration decisions. An appellant has 60 days from the date of the reconsideration decision notice to file this appeal. An oral hearing may be held under certain circumstances. This hearing may be in person or conducted by telephone.
If not satisfied with the Bureau of Hearings and Appeals' decision, an appellant may further appeal to the three-member Board. Sixty days from the date of the notice of the Bureau of Hearings and Appeals' decision are allowed for filing this appeal. The three-member Board will base its decision on the evidence before the hearings officer. The three-member Board ordinarily will not accept additional evidence or conduct a hearing.
3. What are the criteria applied to requests for waivers of retirement, disability or survivor benefit overpayments, and unemployment or sickness benefit overpayments?
A person's obligation to repay any erroneous benefit payments may be waived only if the following conditions are met:
(1) The person was not at fault in causing the overpayment; and (2) recovery of the overpayment would cause financial hardship to the extent that he or she would not be able to meet ordinary and necessary living expenses, or recovery would be against equity or good conscience. "Against equity or good conscience" is defined in the regulations of the Board as meaning that the claimant has, by reason of the erroneous payment, changed his or her position in such a manner as to make recovery a severe hardship.
In cases involving unemployment or sickness benefits, there is an additional requirement that the overpayment must be more than 10 times the current maximum daily benefit rate.
Persons requesting waiver may be asked to complete a financial statement on a form provided by the Railroad Retirement Board.
4. What happens if a person's appeal is not filed within the prescribed time limit?
Failure to request reconsideration or to file an appeal within the allocated time period will result in forfeiture of further appeal rights, unless there is good cause for the delay. Some examples of good cause include: serious illness; a death or serious illness in the appellant's immediate family; destruction of important or relevant records; failure to be notified of a decision: or an unusual or unavoidable circumstance which demonstrated that the appellant could not have known of the need for timely filing or which prevented the appellant from filing in a timely manner. If good cause is not established, further appeal is forfeited, except that the appellant may contest the determination that the request for reconsideration or the appeal was not filed timely.
5. Are there avenues of appeal beyond the Railroad Retirement Board?
Appellants not satisfied with the Board's final decision may then apply for a review by a U.S. Court of Appeals. In cases involving retirement, disability or survivor claims, the petition for review must be filed within one year of the date of the three-member Board's decision notice. In cases involving claims for unemployment or sickness benefits, the petition for review must be filed within 90 days of the Board's decision notice.
6. Can employers contest the claims of their employees for unemployment and sickness benefits?
Employers are provided the right to appeal claims of their employees, but such appeals do not prevent timely payment of benefits. However, employees may be required to repay benefits if their employers' appeals are successful.
7. Where can a person obtain retirement, disability or survivor as well as unemployment or sickness benefit appeals forms and assistance in completing the forms?
The appropriate appeals forms and assistance in completing them can be obtained from any Railroad Retirement Board field office. Most field offices are open to the public from 9:00 a.m. to 3:30 p.m., Monday through Friday. Appeal forms can also be obtained from the Board's Bureau of Hearings and Appeals, 844 North Rush Street, Chicago, Illinois 60611-2092.