Reconsideration of Denials

Requirement

When an application has been denied due to lack of information or verification, the EW must establish whether there was good cause for failure to submit the required information when the applicant:

Later provides the necessary verification within three months of the denial, or
Requests an appeal.

Decision Chart

The chart below shows the required actions which must be taken:

If the applicant...	And...	Then the EW must...
Later provides the necessary verification within three months of the denial,	Good cause does exist (and the applicant provides evidence of good cause),	Rescind the denial and approve MC back to the date of application (if client is otherwise eligible).
Requests an appeal and submits the missing verification,	Good cause does exist (and the applicant provides evidence of good cause),	Rescind the denial and approve MC back to the date of application (if client is otherwise eligible). Note: Follow Appeals’ instructions regarding the withdrawal of the hearing request.
Later provides the necessary verification within three months of the denial,	Good cause does not exist,	Document on the Journal Detail page why good cause did not exist for the applicant's failure to submit needed information. The case remains denied.
Requests an appeal and submits the missing verification,	Good cause does not exist,	Document on the Journal Detail page why good cause did not exist for the applicant's failure to submit needed information. The case remains denied, unless it is later rescinded through an appeal. Important: Make sure there is case documentation of EW attempts to assist the applicant in providing essential information.

Reconsideration of Denials

Requirement

Decision Chart

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