The Social Security Act provides benefits to disabled persons
under two programs administered by the Social Security
Administration (SSA): the Social Security Disability Insurance
Program (SSD) and the Supplemental Security Income Program (SSI).
Regulations for both programs establish a five-step "sequential
evaluation" process for determining eligibility for benefits. The
initial determination of whether an individual is disabled is made
by a state agency under the authority and control of the Secretary
of Health and Human Services (Secretary). This determination is
subject to review by the SSA. The disappointed claimant is then
afforded a three-stage administrative review process. Proceeding
through these three stages exhausts the claimant's administrative
remedies. Thereafter, he may seek judicial review in Federal
District Court, but must do so within 60 days of the Secretary's
final decision as required by 42 U.S.C. § 405(g). Respondents
brought a class action against the Secretary and the Commissioner
of the SSA, seeking relief on behalf of all individuals residing in
New York who had, within a specified time period, been denied
disability benefits or whose benefits were terminated pursuant to
an allegedly illegal internal policy of the Secretary. The District
Court certified the class as including claimants who had not
complied with the 60-day requirement for seeking judicial review
and other claimants who had not exhausted their administrative
remedies and obtained a final decision of the Secretary as required
by § 405(g). Holding that the policy in question was illegal,
the District Court ordered the Secretary to reopen the decisions
denying or terminating benefits, and to redetermine eligibility.
The Court of Appeals affirmed.
Held:
1. The District Court properly included in the class claimants
who had received a final decision from the Secretary but did not
seek judicial review within the statutory 60-day period. The 60-day
requirement is not jurisdictional, but rather constitutes a statute
of limitations. Equitable tolling of that requirement is consistent
with Congress' intent in enacting § 405(g), and, on the facts
of this case, the equities are in favor of tolling. Tolling serves
the Act's purpose where the internal policy
Page 476 U. S. 468
prevented the claimants from knowing of a violation of their
rights. Pp.
476 U. S.
478-482.
2. The District Court also properly included in the class
claimants who failed to exhaust their administrative remedies. The
court did not err in waiving exhaustion not only as to those
claimants whose time to pursue further administrative appeals had
lapsed, but also as to those who still had time to pursue
administrative remedies at the time the suit was filed. For
claimants whose time to pursue further remedies had lapsed,
exhaustion is excused for the same reasons requiring tolling of the
60-day statute of limitations. Since the claimants could not attack
a policy of which they were unaware, it would be unfair to penalize
them for not exhausting under such circumstances. It was also
proper to waive the exhaustion requirement with respect to those
claimants who still had time to file suit. The claims in the suit
are collateral to the claims for benefits that class members had
presented administratively. The class members neither sought nor
were awarded benefits in the District Court, but rather challenged
the Secretary's failure to follow the regulations. Moreover, the
claimants would be irreparably injured if the exhaustion
requirement were now enforced against them. The relief afforded by
the District Court was fully consistent with the policies
underlying exhaustion. Pp.
476 U. S. 482-486.
742 F.2d 729 and 755 F.2d 31, affirmed.
POWELL, J., delivered the opinion for a unanimous Court.
Page 476 U. S. 469
JUSTICE POWELL delivered the opinion of the Court.
This class action was brought pursuant to 42 U.S.C. §
405(g) challenging an internal policy of the Secretary of Health
and Human Services that had the effect of denying disability
benefits to numerous claimants who may have been entitled to them.
The issues presented are whether the District Court correctly
included within the class (i) claimants who had received a final
decision on their individual claims for benefits more than 60 days
prior to the filing of this action, and (ii) other claimants who
had not exhausted their administrative remedies.
I
The Federal Government provides benefits to disabled persons
under two distinct programs administered by the Social Security
Administration (SSA). The Social Security
Page 476 U. S. 470
Disability Insurance Program (SSD) established by Title II of
the Social Security Act, 49 Stat. 622, as amended, 42 U.S.C. §
401
et seq., pays benefits to disabled persons who have
contributed to the program and who suffer from a mental or physical
disability. The Supplemental Security Income Program (SSI)
established by Title XVI of the Act, 86 Stat. 1465, as amended, 42
U.S.C. § 1381, provides benefits to indigent disabled persons.
Both statutes define "disability" as the "inability to engage in
any substantial gainful activity. . . ." §§ 423(d)(1)(A),
1382c(a)(3)(A). An individual is found to be under a disability
only if
"his physical or mental impairment or impairments are of such
severity that he is not only unable to do his previous work but
cannot, considering his age, education, and work experience, engage
in any other kind of substantial gainful work which exists in the
national economy."
§§ 423(d)(2)(A), 1382c(a)(3)(B).
Pursuant to statutory authority, the Secretary of Health and
Human Services (Secretary) has adopted complex regulations
governing eligibility for SSD and SSI payments. 20 CFR pt. 404,
subpart P (1985) (SSD); 20 CFR pt. 404, pt. 416, subpart I (1985)
(SSI). The regulations for both programs are essentially the same,
and establish a five-step "sequential evaluation" process. The
first step determines whether the claimant is engaged in
"substantial gainful activity." If he is, benefits are denied. 20
CFR §§ 404.1520(a),(b), 416.920(a),(b) (1985). If he is
not engaged in such activity, the process moves to the second step,
which decides whether the claimant's condition or impairment is
"severe" --
i.e., one that significantly limits his
physical or mental ability to do basic work activities. If the
impairment is not severe, benefits are denied. §§
404.1520(c), 416.920(c). If the impairment is severe, the third
step determines whether the claimant's impairments meet or equal
those set forth in the "Listing of Impairments" (listings)
contained in subpart P, appendix 1, of the regulations, 20 CFR
§§ 404.1520(d), 416.920(d). The listings consist of
specified
Page 476 U. S. 471
impairments acknowledged by the Secretary to be of sufficient
severity to preclude gainful employment. If a claimant's condition
meets or equals the listed impairments, he is conclusively presumed
to be disabled and entitled to benefits. If the claimant's
impairments are not listed, the process moves to the fourth step,
which assesses the individual's "residual functional capacity"
(RFC); this assessment measures the claimant's capacity to engage
in basic work activities. If the claimant's RFC permits him to
perform his prior work, benefits are denied. §§
404.1520(e), 416.920(e). [
Footnote
1] If the claimant is not capable of doing his past work, a
decision is made under the fifth and final step whether, in light
of his RFC, age, education, and work experience, he has the
capacity to perform other work. §§ 404.1520(f),
416.920(f). If he does not, benefits are awarded.
The determination whether an individual is disabled is made
initially by a state agency acting under the authority and control
of the Secretary. 42 U.S.C. §§ 421(a), 1383b(a); 20 CFR
§§ 404.1503, 416.903 (1985);
see Heckler v. Day,
467 U. S. 104,
467 U. S. 106,
and n. 4 (1984). All decisions by the state agency are subject to
Quality Assurance Reviews by the Regional Office and by the Central
Baltimore Offices of SSA. If the responsible SSA officials
determine during either review that a state agency erred, the case
is "returned" to the State for correction.
The disappointed claimant is afforded a three-stage
administrative review process beginning with
de novo
reconsideration by the State of the initial determination. 20
CFR
Page 476 U. S. 472
§§ 404.909(a)(1), 416.1409(a) (1985). If a claimant is
dissatisfied with the state agency's decision on reconsideration,
he is entitled to a hearing by an administrative law judge (ALJ)
within SSA's Office of Hearings and Appeals. 42 U.S.C. §
405(b)(1) (1982 ed., Supp. II), 42 U.S.C. § 1383(c)(1); 20 CFR
§§ 404.929, 416.1429, 422.201
et seq. (1985).
[
Footnote 2]
If the ALJ's decision is adverse to the claimant, the claimant
may then seek review by the Appeals Council. 20 CFR §§
404.967-404.983, 416.1467-416.1483 (1985). Proceeding through these
three stages exhausts the claimant's administrative remedies.
Following the determination at each stage, a disappointed claimant
is notified that he must proceed to the next stage within 60 days
of notice of the action taken or the decision will be considered
binding.
E.g., 20 CFR §§ 404.905, 404.909(a)(1),
416.1405, 416.1409(a), 404.955(a), 404.968(a)(1), 416.1455(a),
416.1468(a) (1985). Thereafter, he may seek judicial review in
federal district court, pursuant to 42 U.S.C. § 405(g).
See 42 U.S.C. §§ 421(d), 1383(c)(3); 20 CFR
§§ 404.900(a)(5), 404.981, 416.1400(a)(5), 416.1481,
422.210 (1985). [
Footnote
3]
Page 476 U. S. 473
II
On February 8, 1983, respondents the City of New York, the New
York City Health and Hospitals Corporation, and two state
officials, suing on their own behalf and as
parens
patriae, together with eight named individuals, brought this
class action against the Secretary and the Commissioner of SSA.
They sought relief on behalf of all individuals residing in the
State who had applied for or received SSD or SSI benefits on or
after April 1, 1980, who had been found by petitioners to have a
severe mental impairment, and whose applications for benefits
either had been or were to be denied, or whose benefits had been or
were to be terminated, based on petitioners' determination that the
claimants were capable of substantial gainful employment.
The gravamen of respondents' complaint was that petitioners had
adopted an unlawful, unpublished policy under which countless
deserving claimants were denied benefits. They contended that the
policy mandated a presumption -- applicable at the level of the
initial state psychiatric assessment -- that a failure to meet or
equal the listings was tantamount to a finding of ability to do at
least unskilled work; that the presumption led to routine denials
of benefits to eligible claimants; and that such a presumption was
arbitrary, capricious, and violative of the Constitution, the
Social Security Act, and the applicable regulations. Respondents
claimed that this internal policy had the effect of eliminating
steps four and five from the sequential evaluation process, and
thus ignored the requirement for an individualized RFC assessment
to determine whether a claimant with a severe condition is
nonetheless able to work. They alleged that the policy was never
published in the Federal Register, as required by the
Administrative Procedure Act, but was nonetheless implemented
Page 476 U. S. 474
through various internal memoranda and the "returns" process by
which SSA sends cases back to the States for correction.
Respondents contended that failure to make the policy known to
claimants denied the individual plaintiffs and class members due
process of law.
A
Following a 7-day trial, the District Court held that, from 1978
until at least the early months of 1983, [
Footnote 4] SSA followed the covert policy alleged by
respondents, and that the policy was illegal.
City of New York
v. Heckler, 578 F.
Supp. 1109, 1115 (EDNY 1984). The court noted that the
"Act and its regulations require the Secretary to make a
realistic, individual assessment of each claimant's ability to
engage in substantial gainful activity.
See Heckler v.
Campbell, [
461 U.S.
458] (1983). The class plaintiffs did not receive that
assessment."
Id. at 1124. [
Footnote
5] Rather, as respondents alleged,
Page 476 U. S. 475
SSA had consistently
"followed a policy which presumes that mentally disabled
claimants who do not meet or equal the listings necessarily retain
sufficient residual functional capacity to do at least 'unskilled
work.'"
Id. at 1115. The District Court further found that
these tainted RFC assessments by state review physicians were
subsequently given "great weight" by ALJ's in the administrative
appeal process.
Id. at 1125. Moreover,
"[t]he means of enforcement of the policy, through internal
memoranda, returns, and reviews, has meant that the affected SSD or
SSI applicant, as well as counsel, social workers and advisers, for
a long time were unaware of its existence."
Id. at 1115. The court stated that evidence of the
"fixed clandestine policy against those with mental illness" was
overwhelming.
Ibid.
The District Court certified a class, [
Footnote 6] and decided that the class properly
included claimants who had not exhausted administrative remedies.
Relying on
Mathews v.
Eldridge,
Page 476 U. S. 476
424 U. S. 319
(1976), the court concluded that this was an appropriate case in
which to waive the statutory exhaustion requirement. In the court's
view, both parts of the
Eldridge test were satisfied here:
the claims were collateral to any claim for benefits, and the harm
imposed by exhaustion would be irreparable.
Similarly, the District Court decided that the class properly
included those who had not complied with the requirement that a
claimant seek judicial review within 60 days of the Secretary's
final decision or "within such further time as the Secretary may
allow." 42 U.S.C. § 405(g). The court noted that the 60-day
requirement is not jurisdictional, but rather is a statute of
limitations waivable by the parties.
Mathews v. Eldridge,
supra, at
424 U. S. 328,
n. 9;
Weinberger v. Salfi, 422 U.
S. 749,
422 U. S.
763-764 (1975). Observing that petitioners had made no
argument concerning this requirement until their post-trial brief,
the court found that
"the same reasons which justify implying waiver of the
exhaustion requirement are stronger for the sixty-day requirement,
because the statute of limitations is not, as is the exhaustion
requirement, 'central to the requisite grant of subject matter
jurisdiction.'
Weinberger v. Salfi, 422 U. S.
749,
422 U. S. 764 . . .
(1975)."
578 F. Supp. at 1124.
As a remedy, the District Court ordered the Secretary to reopen
the decisions denying or terminating benefits, and to redetermine
eligibility. As interim relief, the court directed the Secretary to
reinstate benefits of all class members who had previously been
entitled to benefits but who were subsequently terminated, until
the claimant's eligibility was properly determined. [
Footnote 7]
Page 476 U. S. 477
B
The Court of Appeals for the Second Circuit affirmed.
City
of New York v. Heckler, 742 F.2d 729 (1984). On appeal,
petitioners did not challenge the District Court's findings of fact
or ruling on the merits, but only raised contentions respecting the
District Court's definition of the appropriate class, and the
interim relief awarded. [
Footnote
8] With respect to the composition of the class, petitioners
asserted that the District Court lacked jurisdiction under §
405(g) over most class members, including (i) claimants who failed
to exhaust administrative remedies, and (ii) claimants whose right
to pursue administrative or judicial review had lapsed by the time
this action was commenced.
Id. at 734.
The Court of Appeals rejected petitioners' argument that the
District Court lacked jurisdiction over the claims of class members
who had failed to exhaust their administrative remedies. It upheld
the District Court's finding that the harm caused by the wrongful
denials was irreparable. While the court did not believe that the
claims were "wholly" collateral to claims for benefits, it was
satisfied that the class was complaining "fundamentally of a
procedural irregularity, and not of the Secretary's substantive
standards of eligibility."
Id. at 737. Moreover, the Court
of Appeals believed it was significant that the District Court was
not asked to, and did not, rule on the merits of the underlying
benefit claims.
The court then rejected petitioners' contention that the
District Court should not have included within the class those
claimants who failed to seek judicial review within 60 days of an
adverse decision by the Secretary. The court agreed with the
District Court that the 60-day limitation is not a jurisdictional
requirement, but rather is a statute of limitations.
Id.
at 738, citing
Eldridge, supra, at
424 U. S. 328,
n. 9;
Salfi, supra, at
422 U. S.
763-764. The Secretary's secretive conduct justified
Page 476 U. S. 478
tolling the period
"during the time that SSA's policy of applying the challenged
presumption concerning residual functional capacity remained
operative but undisclosed."
742 F.2d at 738. [
Footnote
9]
On petition for rehearing, the same panel of the Court of
Appeals, per Judge Newman, denied rehearing, and in so doing
rejected petitioners' argument that passage of the Social Security
Disability Benefits Reform Act of 1984, Pub.L. 98-460, 98 Stat.
1794, required the court to alter its holding with respect to the
effect of class members' failure to comply with § 405(g).
City of New York v. Heckler, 755 F.2d 31 (1985). The
Secretary sought a writ of certiorari from this Court. We granted
certiorari, 474 U.S. 815 (1985), and now affirm.
III
Petitioners renew here arguments rejected by the Court of
Appeals. They challenge on jurisdictional grounds inclusion in the
class of two groups of claimants: those who failed to bring a court
action within 60 days of a final decision of the Secretary, and
those who failed to exhaust administrative remedies. We first
consider the requirement embodied in § 405(g) that claims must
be presented in the District Court within 60 days of a final
decision of the Secretary. Petitioners contend that the provision
sets the bounds of the District Court's jurisdiction. This argument
is foreclosed by two of our prior decisions that have declared that
the 60-day requirement is not jurisdictional, but rather
constitutes a period of limitations.
Eldridge, supra, at
424 U. S. 328,
n. 9;
Salfi, supra, at
422 U. S. 764.
[
Footnote 10]
Page 476 U. S. 479
Petitioners next contend that, if the 60-day limit is a statute
of limitations, it is a condition on the waiver of sovereign
immunity, and thus must be strictly construed. We have no
difficulty agreeing with that statement.
See Block v. North
Dakota, 461 U. S. 273,
461 U. S. 287
(1983). Accepting this proposition, however, does not answer the
question whether equitable tolling can be applied to this statute
of limitations, for in construing the statute, we must be careful
not to "assume the authority to narrow the waiver that Congress
intended,"
United States v. Kubrick, 444 U.
S. 111,
444 U. S. 118
(1979), or construe the waiver "unduly restrictively."
Block,
supra, at
461 U. S. 287.
In
Honda v. Clark, 386 U. S. 484
(1967), the Court held that, where consistent with congressional
intent and called for by the facts of the case, it would "apply a
traditional equitable tolling principle. . . ."
Id. at
386 U. S. 501.
[
Footnote 11] Petitioners
argue that
Honda stands for the proposition that equitable
tolling is permissible only in cases in which the public treasury
is not directly affected. We decline to hold that the doctrine of
equitable tolling is so limited. When application of the doctrine
is consistent with Congress' intent in enacting a particular
statutory scheme, there is no justification for limiting the
doctrine to cases that do not involve monetary relief.
Page 476 U. S. 480
We must determine, therefore, whether equitable tolling is
consistent with Congress' intent in enacting § 405(g), and
whether tolling is appropriate on these facts. The statute of
limitations we construe in this case is contained in a statute that
Congress designed to be "unusually protective" of claimants.
Heckler v. Day, 467 U.S. at
467 U. S. 106.
Moreover, Congress has authorized the Secretary to toll the 60-day
limit, [
Footnote 12] thus
expressing its clear intention to allow tolling in some cases.
While in most cases the Secretary will make the determination
whether it is proper to extend the period within which review must
be sought, cases may arise where the equities in favor of tolling
the limitations period are "so great that deference to the agency's
judgment is inappropriate."
Eldridge, 424 U.S. at
424 U. S. 330.
As in
Honda v. Clark, we conclude that application of a
"traditional equitable tolling principle" to the 60-day requirement
of § 405(g) is fully "consistent with the overall
congressional purpose," and is "nowhere eschewed by Congress." 386
U.S. at
386 U. S.
501.
We conclude, moreover, that, on these facts, the equities in
favor of tolling are compelling. As the Court of Appeals
explained:
"All of the class members who permitted their administrative or
judicial remedies to expire were entitled to believe that their
Government's determination of ineligibility was the considered
judgment of an agency faithfully executing the laws of the United
States. Though they knew of the denial or loss of benefits, they
did not and could not know that those adverse decisions had
Page 476 U. S. 481
been made on the basis of a systematic procedural irregularity
that rendered them subject to court challenge. Where the
Government's secretive conduct prevents plaintiffs from knowing of
a violation of rights, statutes of limitations have been tolled
until such time as plaintiffs had a reasonable opportunity to learn
the facts concerning the cause of action. Since, in this case, the
full extent of the Government's clandestine policy was uncovered
only in the course of this litigation, all class members may pursue
this action notwithstanding the 60-day requirement."
742 F.2d at 738 (citations omitted).
In addition to serving its customary purpose, [
Footnote 13] the statute of limitations
embodied in § 405(g) is a mechanism by which Congress was able
to move cases to speedy resolution in a bureaucracy that processes
millions of claims annually. Thus, the limitation serves both the
interest of the claimant and the interest of the Government.
Tolling, in the rare case such as this, does not undermine the
purpose of the 60-day limitations period when viewed in connection
with the underlying statute. Rather, it serves the purpose of the
Act where, as the Court of Appeals stated, "the Government's
secretive conduct prevents plaintiffs from knowing of a violation
of rights. . . ."
Ibid. See also Heckler v. Day,
supra, at
467 U. S. 106.
Tolling of the 60-day limitations period was appropriate in this
case, and the District Court properly included in the
Page 476 U. S. 482
class claimants who had received a final decision from the
Secretary, but who did not seek judicial review within the
statutory 60-day time period.
IV
Petitioners also contend that the District Court erred in
including in the class those members who failed to obtain a "final
decision" from the Secretary as required by § 405(g). To
obtain a final decision from the Secretary, a claimant is required
to exhaust his administrative remedies by proceeding through all
three stages of the administrative appeals process. Only a claimant
who proceeds through all three stages receives a final decision
from the Secretary. At the outset, we note that, by the time this
lawsuit was filed, it was too late for a large number of class
members to exhaust their claims, since expiration of the 60-day
time limits for administrative appeals barred further access to the
administrative appeals process.
See 20 CFR §§
404.905, 404.909(a)(1), 416.1405, 416.1409(a), 404.955(a),
404.968(a)(1), 416.1455(a), 416.1468(a) (1985). For these
claimants, we conclude that exhaustion is excused for the same
reasons requiring tolling of the statute of limitations. Since
"[m]embers of the class could not attack a policy they could not be
aware existed," 578 F. Supp. at 1118;
see 476 U.
S. supra, it would be unfair to penalize these
claimants for not exhausting under these circumstances.
At the time the suit was filed, however, some claimants may
still have had time to exhaust their administrative remedies. The
question remains whether it was permissible to include these
claimants in the class. Resolution of this question is aided by
cases in which we have been called upon to consider issues of
exhaustion under § 405(g).
See Weinberger v. Salfi,
422 U. S. 749
(1975);
Mathews v. Eldridge, supra; Heckler v. Ringer,
466 U. S. 602
(1984). Our decisions teach that the "final decision" requirement
embodied in that section
Page 476 U. S. 483
consists of two elements, only one of which is purely
"jurisdictional" in the sense that it cannot be waived by the
Secretary in a particular case. The waivable element is the
requirement that the administrative remedies prescribed by the
Secretary be exhausted. The nonwaivable element is the requirement
that a claim for benefits shall have been presented to the
Secretary.
Mathews v. Eldridge, 424 U.S. at
424 U. S. 328.
Ordinarily, the Secretary has discretion to decide when to waive
the exhaustion requirement. But as we held in
Eldridge,
"cases may arise where a claimant's interest in having a
particular issue resolved promptly is so great that deference to
the agency's judgment is inappropriate."
424 U.S. at
424 U. S.
330.
Two factors influenced the Court's judgment that
Eldridge was a case in which deference to the agency's
determination of finality was not necessary. First, the
constitutional challenge brought there was "entirely collateral to
[a] substantive claim of entitlement."
Ibid. Second, the
claim rested "on the proposition that full relief cannot be
obtained at a postdeprivation hearing."
Id. at
424 U. S. 331.
The petitioner had raised
"at least a colorable claim that, because of his physical
condition and dependency upon the disability benefits, an erroneous
termination would damage him in a way not recompensable through
retroactive payments."
Ibid.
The claims in this lawsuit are collateral to the claims for
benefits that class members had presented administratively. The
class members neither sought nor were awarded benefits in the
District Court, but rather challenged the Secretary's failure to
follow the applicable regulations.
Moreover, as in
Eldridge, the claimants in this case
would be irreparably injured were the exhaustion requirement now
enforced against them. The District Court found that class members
not only were denied the benefits they were seeking, but
"[t]he ordeal of having to go through the administrative appeal
process may trigger a severe medical setback.
Page 476 U. S. 484
Many persons have been hospitalized due to the trauma of having
disability benefits cut off. Interim benefits will not adequately
protect plaintiffs from this harm. Nor will ultimate success if
they manage to pursue their appeals."
578 F. Supp. at 1118. Petitioners do not challenge this finding
here, and therefore, like the Court of Appeals, "[w]e have no
reason to disturb Chief Judge Weinstein's conclusion that the harm
caused by wrongful denials was irreparable." 742 F.2d at 736. We
should be especially sensitive to this kind of harm where the
Government seeks to require claimants to exhaust administrative
remedies merely to enable them to receive the procedure they should
have been afforded in the first place.
Finally, application of the exhaustion doctrine is "intensely
practical."
Eldridge, supra, at
424 U. S. 331,
n. 11. In
Salfi, we explained:
"Exhaustion is generally required as a matter of preventing
premature interference with agency processes, so that the agency
may function efficiently and so that it may have an opportunity to
correct its own errors, to afford the parties and the courts the
benefit of its experience and expertise, and to compile a record
which is adequate for judicial review."
422 U.S. at
422 U. S. 765.
The ultimate decision of whether to waive exhaustion should not be
made solely by mechanical application of the
Eldridge
factors, but should also be guided by the policies underlying the
exhaustion requirement. The purposes of exhaustion would not be
served by requiring these class members to exhaust administrative
remedies. This case is materially distinguishable from one in which
a claimant sues in district court, alleging mere deviation from the
applicable regulations in his particular administrative proceeding.
In the normal course, such individual errors are fully correctable
upon subsequent administrative review, since the claimant, on
appeal,
Page 476 U. S. 485
will alert the agency to the alleged deviation. Because of the
agency's expertise in administering its own regulations, the agency
ordinarily should be given the opportunity to review application of
those regulations to a particular factual context. Thus, our
holding today does not suggest that exhaustion is to be excused
whenever a claimant alleges an irregularity in the agency
proceedings.
These claimants stand on a different footing from one arguing
merely that an agency incorrectly applied its regulation. Rather,
the District Court found a system-wide, unrevealed policy that was
inconsistent in critically important ways with established
regulations. Nor did this policy depend on the particular facts of
the case before it; rather, the policy was illegal precisely
because it ignored those facts. The District Court found that the
policy was being adhered to by state agencies due to pressure from
SSA, and that therefore exhaustion would have been futile. Under
these unique circumstances, there was nothing to be gained from
permitting the compilation of a detailed factual record, or from
agency expertise.
Cf. McKart v. United States,
395 U. S. 185,
395 U. S. 200
(1969).
In addition, the relief afforded by the District Court is fully
consistent with the policies underlying exhaustion. The court did
not order that class members be paid benefits. Nor does its
decision in any way interfere with the agency's role as the
ultimate determiner of eligibility under the relevant statutes and
regulations. Indeed, by ordering simply that the claims be reopened
at the administrative level, the District Court showed proper
respect for the administrative process. It did no more than the
agency would have been called upon to do had it, instead of the
District Court, been alerted to the charge that an undisclosed
procedure was illegal, and had improperly resolved innumerable
claims.
Petitioners correctly assert that, had class members exhausted
administrative remedies, some might have received benefits despite
the illegal policy. It also is likely that many
Page 476 U. S. 486
may have been disqualified for reasons having nothing to do with
the illegal policy. Such observations, however, merely serve to
remind us why exhaustion is the rule in the vast majority of cases;
they do not aid the Court in deciding when exhaustion should be
excused. [
Footnote 14] We
hold that the District Court did not err in waiving exhaustion in
this case either with respect to those claimants whose time to
pursue further administrative appeals had lapsed or with respect to
those claimants who still had time to pursue administrative
remedies.
Page 476 U. S. 487
V
Government agencies administering complex programs that bridge
both state and federal bureaucracies necessarily will take certain
actions pursuant to policies unknown to the public. We do not
suggest that every internal policy that is found to be inconsistent
with legal requirements, and arguably touches upon the outcome of a
class of cases, will justify tolling the statute of limitations or
excusing exhaustion. But, whatever the outer bounds of our holding
today, this case falls well within them. While "hard" cases may
arise, this is not one of them.
Moreover, we are aware that administrative inconvenience may
result from our decision today. But the Secretary had the
capability and the duty to prevent the illegal policy found to
exist by the District Court. The claimants here were denied the
fair and neutral procedure required by the statute and regulations,
and they are now entitled to pursue that procedure. The judgment of
the Court of Appeals is affirmed.
It is so ordered.
[
Footnote 1]
The RFC assessment is made by a review physician employed by the
state agency under contract with SSA. His written conclusion
becomes part of the administrative record of the claim.
See,
e.g., Plaintiffs' Ex. 50, p. 10; App. 148, 158; Record Doc.
No. 73; Tr. 27. The District Court found that this assessment is
generally given great weight by the administrative law judge on
later review.
City of New York v. Heckler, 578 F.
Supp. 1109, 1125 (EDNY 1984).
[
Footnote 2]
The Secretary has not provided for a separate reconsideration
stage in disability cessation cases under Title XVI. An SSI
recipient whose benefits are terminated, therefore, is entitled to
proceed directly to an ALJ hearing if he requests one within 60
days of the initial determination. 20 CFR §§ 416.1407,
416.1415 (1985).
[
Footnote 3]
Title 42 U.S.C. § 405(g), provides in part:
"Any individual, after any final decision of the Secretary made
after a hearing to which he was a party, irrespective of the amount
in controversy, may obtain a review of such decision by a civil
action commenced within sixty days after the mailing to him of
notice of such decision or within such further time as the
Secretary may allow. Such action shall be brought in the district
court of the United States for the judicial district in which the
plaintiff resides, or has his principal place of business, or, if
he does not reside or have his principal place of business within
any such judicial district, in the United States District Court for
the District of Columbia. As part of his answer the Secretary shall
file a certified copy of the transcript of the record including the
evidence upon which the findings and decision complained of are
based. The court shall have power to enter, upon the pleadings and
transcript of the record, a judgment affirming, modifying, or
reversing the decision of the Secretary, with or without remanding
the cause for a rehearing. The findings of the Secretary as to any
fact, if supported by substantial evidence, shall be conclusive. .
. ."
[
Footnote 4]
The District Court noted that in 1983 SSA
"yielded to pressure to allow medical vocational allowances for
those with mental disabilities. The change was precipitated only
after the filing of this lawsuit, and after a preliminary
injunction was issued on December 22, 1982, in the case of
Mental Health Association of Minnesota v.
Schweiker, 554 F.
Supp. 157 (D. Minn.1982),
aff'd, 720 F.2d 965 (8th
Cir.1983)."
578 F. Supp. at 1115.
[
Footnote 5]
The District Court added:
On the contrary, SSA relied on bureaucratic instructions, rather
than individual assessments, and overruled the medical opinions of
its own consulting physicians that many of those whose claims they
were instructed to deny could not, in fact, work. Physicians were
pressured to reach "conclusions" contrary to their own professional
beliefs in cases where they felt, at the very least, that
additional evidence needed to be gathered in the form of a
realistic work assessment. The resulting supremacy of bureaucracy
over professional medical judgments and the flaunting of published,
objective standards is contrary to the spirit and letter of the
Social Security Act.
"The Secretary's practices have violated the requirements of her
own regulations. Defendants have ignored the five-step sequential
evaluation process by presuming that the failure to meet listings
at step three or four of the process automatically translates into
a residual functional capacity to do unskilled work at steps four
and five. The bureaucratic assessment of residual functional
capacity, if it was done at all, was reduced to a paper charade
where the SSA physician completed a cursory report or checked off a
form knowing the conclusion had to be that the claimant had the
capacity for unskilled work. Medical experts demonstrated to the
court that the symptoms and restrictions of the listings of
impairments do not measure an individual's capacity for work or his
or her ability to withstand the stress of even the least demanding
work."
Id. at 1124.
[
Footnote 6]
The class was ultimately defined by the District Court after
trial as consisting of:
"All individuals residing in the State of New York who have
applied for or received Title II and/or Title XVI benefits and who,
between April 1, 1980, and May 15, 1983, were found by the New York
Office of Disability Determinations to have a functional psychotic
or functional nonpsychotic mental impairment which is severe
(
i.e., determined under 20 CFR § 404.1520(c) or
§ 416.930(c) to require evaluation under Appendix I of that
Regulation), and whose applications for benefits have been denied
or whose benefits have been or will be terminated, on the basis of
defendants' determination that such persons are capable of
substantial gainful activity."
App. to Pet. for Cert. 65a. The class is estimated to include
more than 50,000 New York residents.
City of New York v.
Heckler, 742 F.2d 729, 731 (CA2 1984).
[
Footnote 7]
The District Court also ordered SSA to notify class members that
their claims had been reopened, and to inform class members with an
appeal pending before an ALJ that such claimants had the option of
proceeding with their appeals upon the existing record, rather than
with the administrative reopening of their case. App. to Pet. for
Cert. 65a-66a.
[
Footnote 8]
The Court of Appeals affirmed the District Court's award of
interim relief, and petitioners have raised in this Court no issue
respecting that portion of the Court of Appeals' decision.
[
Footnote 9]
As an alternative basis for jurisdiction, the Court of Appeals
relied on 28 U.S.C. § 1361 "in the event that, upon further
review, it is determined that section 405(g) jurisdiction is
unavailable to some of the class members." 742 F.2d at 739. Because
we conclude that jurisdiction under § 405(g) is available, we
do not reach the issue whether mandamus jurisdiction would have
been proper in this context.
[
Footnote 10]
We reject petitioners' contention that
Salfi and
Eldridge do not stand for the proposition that the 60-day
requirement is not jurisdictional. In both cases, jurisdiction was
premised on § 405(g), and we noted that we did not have to
consider whether the 60-day requirement had been satisfied, because
the issue had not been timely raised below.
Eldridge, 424
U.S. at
424 U. S. 328,
n. 9;
Salfi, 422 U.S. at
422 U. S. 764.
Were the requirement jurisdictional, of course, the Court could not
have declined to consider whether it had been satisfied in those
cases.
[
Footnote 11]
In
Honda v. Clark, United States citizens or residents
of Japanese descent sought to recover funds vested under the
Trading with the Enemy Act, 40 Stat. 411, 60 U.S.C.App. § 1
et seq. Under that Act, the United States seized the
American assets of businesses owned by Japanese nationals. After
the war, a mechanism was established to return the assets to their
rightful owners or the owners' creditors. The central problem in
that case revolved around the fact that the petitioners failed to
file a lawsuit challenging a schedule of payments within the
applicable 60-day time period. This Court allowed the limitations
period to be tolled during the pendency of related litigation
because it was consistent with the statutory scheme and equitable
principles to do so. 386 U.S. at
386 U. S.
501.
[
Footnote 12]
SSA's regulations governing extensions of time for filing are
based on considerations of fairness to claimants. Thus, the
Secretary may grant an extension where a suit was not timely filed
because of illness, accident, destruction of records, or mistake.
Similarly, an extension may be granted where the claimant
misunderstands the appeal process or is unable timely to collect
necessary information, or where the Secretary undertook action that
"misled" the claimant concerning his right to review. 20 CFR
§§ 404.911, 416.1411 (1985). The fairness concerns
underlying the regulations support our application of equitable
tolling in this case.
[
Footnote 13]
As we explained in
American Pipe & Construction Co. v.
Utah, 414 U. S. 538,
414 U. S. 554
(1974), statutory limitation periods are
"'designed to promote justice by preventing surprises through
the revival of claims that have been allowed to slumber until
evidence has been lost, memories have faded, and witnesses have
disappeared. The theory is that, even if one has a just claim, it
is unjust not to put the adversary on notice to defend within the
period of limitation, and that the right to be free of stale claims
in time comes to prevail over the right to prosecute them.'"
(Quoting
Railroad Telegraphers v. Railway Express Agency,
Inc., 321 U. S. 342,
321 U. S.
348-349 (1944)).
[
Footnote 14]
Petitioners argue that, when Congress in 1984 made comprehensive
revisions in the disability program in the Social Security
Disability Benefits Reform Act of 1984, Pub.L. 98-460, 98 Stat.
1794, it reaffirmed the finality requirement of § 405(g). In
§ 2(d) of the 1984 Act (98 Stat. 1797), Congress provided for
remand to the Secretary, for redetermination under the new
statutory medical improvement standard, of the claims of any
individuals who were included in a class that had been certified in
a case involving medical improvement, whether or not each
individual class member had personally satisfied the jurisdictional
requirements of § 405(g).
Congress took a different approach in cases involving
individuals who have mental impairments. In § 5(a) of the 1984
Act, 98 Stat. 1801, Congress directed the Secretary to develop new
standards for the evaluation of mental impairments. It then
provided in § 5(c) (98 Stat. 1802) that any person who had
sought benefits based on a mental impairment and who was found to
be not disabled on or after March 1, 1981, could reapply to the
Secretary and be reevaluated under these new standards.
Thus, petitioners argue that these provisions demonstrate that
Congress knew how to grant relief to disability claimants who have
not satisfied the exhaustion requirement. We agree with the Court
of Appeals' observation in its decision denying the petition for
rehearing:
"The Reform Act is remedial legislation, enacted principally to
be of assistance to large numbers of persons whose disability
benefits have been terminated. It would be a perverse view of
Congressional intent if we were to infer from this beneficial
legislation a determination on the part of Congress to deny other
disability claimants the fruits of a judgment entered in their
favor after a ruling that their claims had been unlawfully
processed by the Secretary. What the Secretary is urging us to hold
is that the Reform Act renders the finality and exhaustion
requirements of section 405(g) more stringent than they were before
the passage of the Act."
City of New York v. Heckler, 755 F.2d 31, 33
(1985).