Gray v. Commissioner of Social Security

Background

Tijuana N. Gray brought an action under 42 U.S.C. § 405(g), which allows federal-court review of a final decision by the Social Security Commissioner. Gray was representing herself. The court had previously allowed her to proceed without paying filing fees upfront.

Gray used the court’s form for Social Security review but left most responses blank. In response to the question asking when she received notice of the Appeals Council’s action, she wrote: “I never received paperwork for this case.”

Administrative Exhaustion and Jurisdiction

The court explained that a federal court generally may review a Social Security matter only after the claimant has received a final administrative decision. The administrative process ordinarily includes an initial benefits determination, reconsideration, a hearing before an administrative law judge, and review by the Appeals Council. The Appeals Council’s final action, or its denial of review in circumstances described by the court, permits judicial review.

The court stated that Gray’s complaint did not allege facts showing that this process had been completed. Her statement suggested that she might not have received a final decision, an administrative law judge’s unfavorable decision and appeal information, or a final Appeals Council decision. Gray also did not allege facts that might justify excusing the exhaustion requirement. Because the complaint did not show that the court had jurisdiction under Section 405(g), the complaint could not proceed at that time.

Order

The court granted Gray leave to amend rather than dismissing the action immediately. The amended complaint must provide the date of the administrative law judge’s decision, the date of the Appeals Council notice, and the date Gray received that notice. If possible, Gray must attach the Appeals Council notice. If she did not complete the administrative process, she must allege facts explaining why the failure should be excused.

The court stated that the amended complaint would replace the original complaint entirely, so any facts or claims Gray wants to retain must appear in the amended version. It granted 60 days to file the amended complaint with the court’s Pro Se Intake Unit and stated that no summons would issue at that time. If Gray failed to comply and could not show good cause, the court said it would dismiss the action for failure to exhaust administrative remedies, without prejudice to filing a new action after she receives the relevant final decision.

The court also certified that an appeal from the order would not be taken in good faith and denied Gray permission to proceed without prepaying fees for an appeal. The Clerk was directed to mail Gray a copy of the order and record service on the docket.