Hiciano v. Commissioner of Social Security

Background

After M.O.G.H.’s father died in 2018, the Social Security Administration awarded M.O.G.H., who was then a minor, a survivor benefit. Before M.O.G.H. turned 18 in 2022, Hiciano was told that the benefit would end unless she provided documentation showing that M.O.G.H. had an intellectual disability or was still in school. Hiciano alleged that she attempted to submit documentation in 2022 and 2023.

Hiciano filed the complaint on August 26, 2024, alleging that the Commissioner improperly terminated M.O.G.H.’s benefits. The Commissioner moved to dismiss under Federal Rule of Civil Procedure 12(b)(6), which permits dismissal when a complaint does not state a legally sufficient claim. The Commissioner also alternatively requested summary judgment under Rule 56, which can resolve a case when there is no genuine dispute requiring a trial. Hiciano did not oppose the motion.

Exhaustion of administrative remedies

Federal law permits judicial review of a Social Security decision only after a final decision by the Commissioner following a hearing. The court explained that this generally requires a claimant to complete four stages: receiving an initial determination, seeking reconsideration, requesting a hearing before an administrative law judge, and requesting review by the Appeals Council.

The court held that Hiciano’s complaint did not allege that she completed this process. In the parts of the complaint asking for the dates of an administrative law judge’s decision and an Appeals Council decision, Hiciano wrote “n/a.” The complaint also did not allege that she received a final agency decision denying benefits. A letter included with the complaint stated only that there was an issue with the payment and that a payment processing center had to resolve it.

The court also found no basis to excuse exhaustion. It said the claim was directly about benefits rather than a separate issue, the complaint did not show that completing the administrative process would be futile, and the complaint did not allege that requiring exhaustion would cause irreparable harm. Because the complaint itself lacked the necessary allegations, the court did not convert the motion to dismiss into the alternative motion for summary judgment.

Leave to amend and disposition

The court noted that self-represented plaintiffs ordinarily should receive at least one opportunity to amend when a generous reading of the complaint suggests that a valid claim might be stated. Although the court suspected that Hiciano might be unable to correct the problem, it granted leave to amend so she could show that she had exhausted administrative remedies or should be excused from doing so.

The court granted the Commissioner’s motion to dismiss the complaint for failure to state a claim. It dismissed the complaint with leave to amend within 30 days. The court did not address the Commissioner’s alternative motion for summary judgment.