| [1] | SUPREME COURT OF THE UNITED STATES |
| [2] | No. 74-204 |
| [3] | 1976.SCT.40691 <http://www.versuslaw.com>; 424
U.S. 319, 96 S. Ct. 893, 47 L. Ed. 2d 18 |
| [4] | February 24, 1976 |
| [5] | MATHEWS, SECRETARY OF HEALTH, EDUCATION, AND
WELFARE v. ELDRIDGE |
| [6] | CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE FOURTH
CIRCUIT |
| [7] | Solicitor General Bork argued the cause for petitioner. With him on
the briefs were Deputy Solicitor General Jones, Acting Assistant Attorney
General Jaffe, Gerald P. Norton, William Kanter, and David M.
Cohen. |
| [8] | Donald E. Earls argued the cause for respondent. With him on the
briefs was Carl E. McAfee.*fn* |
| [9] | Burger, Brennan, Stewart, White, Marshall, Blackmun, Powell,
Rehnquist, Stevens |
| [10] | Author: Powell |
| [11] | MR. JUSTICE POWELL delivered the opinion of the Court. |
| [12] | The issue in this case is whether the Due Process Clause of the Fifth
Amendment requires that prior to the termination of Social Security
disability benefit payments the recipient be afforded an opportunity for
an evidentiary hearing. |
| [13] | I |
| [14] | Cash benefits are provided to workers during periods in which they are
completely disabled under the disability insurance benefits program
created by the 1956 amendments to Title II of the Social Security Act. 70
Stat. 815, 42 U.S.C. § 423.*fn1
Respondent Eldridge was first awarded benefits in June 1968.
In March 1972, he received a questionnaire from the state agency charged
with monitoring his medical condition. Eldridge completed the
questionnaire, indicating that his condition had not improved and
identifying the medical sources, including physicians, from whom he had
received treatment recently. The state agency then obtained reports from
his physician and a psychiatric consultant. After considering these
reports and other information in his file the agency informed
Eldridge by letter that it had made a tentative
determination that his disability had ceased in May 1972. The letter
included a statement of reasons for the proposed termination of benefits,
and advised Eldridge that he might request reasonable time in which to
obtain and submit additional information pertaining to his
condition. |
| [15] | In his written response, Eldridge disputed one
characterization of his medical condition and indicated that the agency
already had enough evidence to establish his disability.*fn2
The state agency then made its final determination that he had ceased to
be disabled in May 1972. This determination was accepted by the Social
Security Administration (SSA), which notified Eldridge in
July that his benefits would terminate after that month. The notification
also advised him of his right to seek reconsideration by the state agency
of this initial determination within six months. |
| [16] | Instead of requesting reconsideration Eldridge commenced
this action challenging the constitutional validity of
the administrative procedures established by the Secretary of Health,
Education, and Welfare for assessing whether there exists a continuing
disability. He sought an immediate reinstatement of benefits pending a
hearing on the issue of his disability.*fn3
361 F. Supp. 520 (WD Va. 1973). The Secretary moved
to dismiss on the grounds that Eldridge's benefits had been
terminated in accordance with valid administrative regulations and
procedures and that he had failed to exhaust available remedies. In
support of his contention that due process requires a pretermination
hearing, Eldridge relied exclusively upon this Court's
decision in Goldberg v. Kelly, 397 U.S. 254 (1970),
which established a right to an "evidentiary hearing" prior to termination
of welfare benefits.*fn4
The Secretary contended that Goldberg was not controlling since
eligibility for disability benefits, unlike eligibility for welfare
benefits, is not based on financial need and since issues of credibility
and veracity do not play a significant role in the disability entitlement
decision, which turns primarily on medical evidence. |
| [17] | The District Court concluded that the administrative procedures
pursuant to which the Secretary had terminated Eldridge's
benefits abridged his right to procedural due
process. The court viewed the interest of the disability recipient in
uninterrupted benefits as indistinguishable from that of the welfare
recipient in Goldberg. It further noted that decisions subsequent to
Goldberg demonstrated that the due process requirement of pretermination
hearings is not limited to situations involving the deprivation of vital
necessities. See Fuentes v. Shevin, 407 U.S. 67,
88-89 (1972); Bell v. Burson, 402 U.S. 535, 539
(1971). Reasoning that disability determinations may involve subjective
judgments based on conflicting medical and non-medical evidence, the
District Court held that prior to termination of benefits
Eldridge had to be afforded an evidentiary hearing of the
type required for welfare beneficiaries under Title IV of the Social
Security Act. 361 F. Supp., at 528.*fn5
Relying entirely upon the District Court's opinion, the Court of Appeals
for the Fourth Circuit affirmed the injunction barring termination of
Eldridge's benefits prior to an evidentiary hearing. 493 F.2d 1230 (1974).*fn6
We reverse. |
| [18] | II |
| [19] | At the outset we are confronted by a question as to whether the
District Court had jurisdiction over this suit. The Secretary contends
that our decision last Term in Weinberger v. Salfi, 422 U.S. 749 (1975), bars the District Court from considering
Eldridge's action. Salfi was an action challenging the
Social Security Act's duration-of-relationship
eligibility requirements for surviving wives and stepchildren of deceased
wage earners. We there held that 42 U.S.C. § 405(h)*fn7
precludes federal-question jurisdiction in an action challenging denial of
claimed benefits. The only avenue for judicial review is 42 U.S.C. §
405(g), which requires exhaustion of the administrative remedies provided
under the Act as a jurisdictional prerequisite. |
| [20] | Section 405(g) in part provides: S |
| [21] | "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."*fn8
On
its face § 405(g) thus bars judicial review of any denial of a claim of
disability benefits until after a "final decision" by the Secretary after
a "hearing." It is uncontested that Eldridge could have
obtained full administrative review of the termination of his benefits,
yet failed even to seek reconsideration of the initial determination.
Since the Secretary has not "waived" the finality requirement as he had in
Salfi, supra, at 767, he concludes that Eldridge cannot
properly invoke § 405(g) as a basis for jurisdiction. We
disagree. |
| [22] | Salfi identified several conditions which must be satisfied in order
to obtain judicial review under § 405(g). Of these, the requirement that
there be a final decision by the Secretary after a hearing was regarded as
"central to the requisite grant of subject-matter jurisdiction...." 422 U.S., at 764.*fn9
Implicit in Salfi, however, is the principle that this condition 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 non-waivable element is the
requirement that a claim for benefits shall have been presented to the
Secretary. Absent such a claim there can be no "decision" of any type. And
some decision by the Secretary is clearly required by the statute. That
this second requirement is an essential and distinct precondition for §
405 (g) jurisdiction is evident from the different conclusions that we
reached in Salfi with respect to the named appellees and the unnamed
members of the class. As to the latter the complaint was found to be
jurisdictionally deficient since it "[c]ontained no allegations that they
have even filed an application with the Secretary...." 422 U.S.,
at 764. With respect to the named appellees, however, we
concluded that the complaint was sufficient since it alleged that they had
"fully presented their claims for benefits 'to their district Social
Security Office and, upon denial, to the Regional Office for
reconsideration.'" Id., at 764-765. Eldridge has fulfilled
this crucial prerequisite. Through his answers to the state agency
questionnaire, and his letter in response to the tentative determination
that his disability had ceased, he specifically presented the claim that
his benefits should not be terminated because he was still disabled. This
claim was denied by the state agency and its decision was accepted by the
SSA. |
| [23] | The fact that Eldridge failed to raise with the
Secretary his constitutional claim to a pretermination hearing is not
controlling.*fn10
As construed in Salfi, § 405 (g) requires only that there be a "final
decision" by the Secretary with respect to the claim of entitlement to
benefits. Indeed, the named appellees in Salfi did not present their
constitutional claim to the Secretary. Weinberger v. Salfi, O.T. 1974, No.
74-214, App. 11, 17-21. The situation here is not identical to Salfi, for,
while the Secretary
had no power to amend the statute alleged to be unconstitutional in that
case, he does have authority to determine the timing and content of the
procedures challenged here. 42 U.S.C.§ 405 (a). We do not, however, regard
this difference as significant. It is unrealistic to expect that the
Secretary would consider substantial changes in the current administrative
review system at the behest of a single aid recipient raising a
constitutional challenge in an adjudicatory context. The Secretary would
not be required even to consider such a challenge. |
| [24] | As the non-waivable jurisdictional element was satisfied, we next
consider the waivable element. The question is whether the denial of
Eldridge's claim to continued benefits was a sufficiently
"final" decision with respect to his constitutional claim to satisfy the
statutory exhaustion requirement. Eldridge concedes that he
did not exhaust the full set of internal-review procedures provided by the
Secretary. See 20 CFR §§ 404.910, 404.916, 404.940 (1975). As Salfi
recognized, the Secretary may waive the exhaustion requirement if he
satisfies himself, at any stage of the administrative process, that no
further review is warranted either because the internal needs of the
agency are fulfilled or because the relief that is sought is beyond his
power to confer. Salfi suggested that under § 405 (g) the power to
determine when finality has occurred ordinarily rests with the Secretary
since ultimate responsibility for the integrity of the administrative
program is his. But 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. This is such a case. |
| [25] | Eldridge's constitutional challenge is entirely
collateral to his substantive claim of entitlement. Moreover, there is
a crucial distinction between the nature of the constitutional claim
asserted here and that raised in Salfi. A claim to a predeprivation
hearing as a matter of constitutional right rests on the proposition that
full relief cannot be obtained at a post-deprivation hearing. See Regional
Rail Reorganization Act Cases, 419 U.S. 102, 156
(1974). In light of the Court's prior decisions, see, e.g., Goldberg v.
Kelly, 397 U.S. 254 (1970); Fuentes v. Shevin, 407 U.S. 67 (1972), Eldridge has 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.*fn11
Thus, unlike the situation in Salfi, denying Eldridge's
substantive claim
"for other reasons" or upholding it "under other provisions" at the
post-termination stage, 422 U.S., at 762, would not
answer his constitutional challenge. |
| [26] | We conclude that the denial of Eldridge's request for
benefits constitutes a final decision for purposes of § 405 (g)
jurisdiction over his constitutional claim. We now proceed to the merits
of that claim.*fn12 |
| [27] | III |
| [28] | A |
| [29] | Procedural due process imposes constraints on governmental decisions
which deprive individuals of "liberty" or "property" interests within the
meaning of the Due Process Clause of the Fifth or Fourteenth Amendment.
The Secretary does not contend that procedural due process is inapplicable
to terminations of Social Security disability benefits. He recognizes, as
has been implicit in our prior decisions, e.g., Richardson v. Belcher, 404 U.S. 78, 80-81 (1971); Richardson v. Perales, 402 U.S. 389, 401-402 (1971); Flemming v. Nestor, 363 U.S. 603, 611 (1960), that the interest of an
individual in continued receipt of these benefits is a statutorily created
"property" interest protected by the Fifth Amendment. Cf. Arnett v.
Kennedy, 416 U.S. 134, 166 (POWELL, J., concurring in
part) (1974); Board of Regents v. Roth, 408 U.S. 564,
576-578 (1972); Bell v. Burson, 402 U.S., at 539;
Goldberg v. Kelly, 397 U.S., at 261-262. Rather, the
Secretary contends that the existing administrative procedures, detailed
below, provide all the process that
is constitutionally due before a recipient can be deprived of that
interest. |
| [30] | This Court consistently has held that some form of hearing is required
before an individual is finally deprived of a property interest. Wolff v.
McDonnell, 418 U.S. 539, 557-558 (1974). See, e.g.,
Phillips v. Commissioner, 283 U.S. 589, 596-597
(1931). See also Dent v. West Virginia, 129 U.S. 114,
124-125 (1889). The "right to be heard before being condemned to suffer
grievous loss of any kind, even though it may not involve the stigma and
hardships of a criminal conviction, is a principle basic to our society."
Joint Anti-Fascist Comm. v. McGrath, 341 U.S. 123,
168 (1951) (Frankfurter, J., concurring). The fundamental requirement of
due process is the opportunity to be heard "at a meaningful time and in a
meaningful manner." Armstrong v. Manzo, 380 U.S. 545,
552 (1965). See Grannis v. Ordean, 234 U.S. 385, 394
(1914). Eldridge agrees that the review procedures available to a claimant
before the initial determination of ineligibility becomes final would be
adequate if disability benefits were not terminated until after the
evidentiary hearing stage of the administrative process. The dispute
centers upon what process is due prior to the initial termination of
benefits, pending review. |
| [31] | In recent years this Court increasingly has had occasion to consider
the extent to which due process requires an evidentiary hearing prior to
the deprivation of some type of property interest even if such a hearing
is provided thereafter. In only one case, Goldberg v. Kelly, 397
U.S., at 266-271, has the Court held that a hearing closely
approximating a judicial trial is necessary. In other cases requiring some
type of pretermination hearing as a matter of constitutional right the
Court has spoken sparingly about the requisite procedures. Sniadach v.
Family Finance Corp., 395 U.S. 337 (1969), involving
garnishment of wages, was entirely silent on the matter. In Fuentes v.
Shevin, 407 U.S., at 96-97, the Court said only that
in a replevin suit between two private parties the initial determination
required something more than an ex parte proceeding before a court clerk.
Similarly, Bell v. Burson, supra, at 540, held, in the context of the
revocation of a state-granted driver's license, that due process required
only that the prerevocation hearing involve a probable-cause determination
as to the fault of the licensee, noting that the hearing "need not take
the form of a full adjudication of the question of liability." See also
North Georgia Finishing, Inc. v. Di-Chem, Inc., 419 U.S. 601, 607 (1975). More recently, in Arnett v. Kennedy, supra, we
sustained the validity of procedures by which a federal employee could be
dismissed for cause. They included notice of the action sought, a copy of
the charge, reasonable time for filing a written response, and an
opportunity for an oral appearance. Following dismissal, an evidentiary
hearing was provided. 416 U.S. at
142-146. |
| [32] | These decisions underscore the truism that "'[d]ue process,' unlike
some legal rules, is not a technical conception with a fixed content
unrelated to time, place and circumstances." Cafeteria Workers v. McElroy,
367 U.S. 886, 895 (1961). "[D]ue process is flexible
and calls for such procedural protections as the particular situation
demands." Morrissey v. Brewer, 408 U.S. 471, 481
(1972). Accordingly, resolution of the issue whether the administrative
procedures provided here are constitutionally sufficient requires analysis
of the governmental and private interests that are affected. Arnett v.
Kennedy, supra, at 167-168 (POWELL, J., concurring in part); Goldberg v.
Kelly, supra, at 263-266; Cafeteria Workers v. McElroy, supra, at 895.
More precisely, our prior decisions indicate
that identification of the specific dictates of due process generally
requires consideration of three distinct factors: First, the private
interest that will be affected by the official action; second, the risk of
an erroneous deprivation of such interest through the procedures used, and
the probable value, if any, of additional or substitute procedural
safeguards; and finally, the Government's interest, including the function
involved and the fiscal and administrative burdens that the additional or
substitute procedural requirement would entail. See, e.g., Goldberg v.
Kelly, supra, at 263-271. |
| [33] | We turn first to a description of the procedures for the termination
of Social Security disability benefits, and thereafter consider the
factors bearing upon the constitutional adequacy of these
procedures. |
| [34] | B |
| [35] | The disability insurance program is administered jointly by state and
federal agencies. State agencies make the initial determination whether a
disability exists, when it began, and when it ceased. 42 U.S.C. § 421
(a).*fn13
The standards applied and the procedures followed are prescribed by the
Secretary, see § 421 (b), who has delegated his responsibilities and
powers under the Act to the SSA. See 40 Fed. Reg. 4473 (1975). In
order to establish initial and continued entitlement to disability
benefits a worker must demonstrate that he is unable S |
| [36] | "to engage in any substantial gainful activity by reason of any
medically determinable physical or mental impairment which can be expected
to result in death or which has lasted or can be expected to last for a
continuous period of not less than 12 months...." 42 U.S.C. § 423
(d)(1)(A).I |
| [37] | To satisfy this test the worker bears a continuing burden of showing,
by means of "medically acceptable clinical and laboratory diagnostic
techniques," § 423 (d)(3), that he has a physical or mental impairment of
such severity that S |
| [38] | "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, regardless
of whether such work exists in the immediate area in which he lives, or
whether a specific job vacancy exists for him, or whether he would be
hired if he applied for work." § 423 (d)(2)(A).*fn14 |
| [39] | The principal reasons for benefits terminations are that the worker is
no longer disabled or has returned to work. As Eldridge's
benefits were terminated because he was determined to be no longer
disabled, we consider only the sufficiency of the procedures involved in
such cases.*fn15
The
continuing-eligibility investigation is made by a state agency acting
through a "team" consisting of a physician and a non-medical person
trained in disability evaluation. The agency periodically communicates
with the disabled worker, usually by mail -- in which case he is sent a
detailed questionnaire -- or by telephone, and requests information
concerning his present condition, including current medical restrictions
and sources of treatment, and any additional information that he considers
relevant to his continued entitlement to benefits. CM § 6705.1; Disability
Insurance State Manual (DISM) § 353.3 (TL No. 137, Mar. 5, 1975).*fn16 |
| [40] | Information regarding the recipient's current condition is also
obtained from his sources of medical treatment. DISM § 353.4. If there is
a conflict between the information provided by the beneficiary and that
obtained from medical sources such as his physician, or between two
sources of treatment, the agency may arrange for an examination by an
independent consulting physician.*fn17
Ibid. Whenever the agency's tentative assessment of the beneficiary's
condition differs from his own
assessment, the beneficiary is informed that benefits may be terminated,
provided a summary of the evidence upon which the proposed determination
to terminate is based, and afforded an opportunity to review the medical
reports and other evidence in his case file.*fn18
He also may respond in writing and submit additional evidence. Id., §
353.6. |
| [41] | The state agency then makes its final determination, which is reviewed
by an examiner in the SSA Bureau of Disability Insurance. 42 U.S.C. § 421
(c); CM §§ 6701 (b), (c).*fn19
If, as is usually the case, the SSA accepts the agency determination it
notifies the recipient in writing, informing him of the reasons for the
decision, and of his right to seek de novo reconsideration by the state
agency. 20 CFR §§ 404.907, 404.909 (1975).*fn20
Upon acceptance by the SSA, benefits are terminated effective two months
after the month in which medical recovery is found to have occurred. 42
U.S.C.§ 423 (a) (1970 ed., Supp. III). If
the recipient seeks reconsideration by the state agency and the
determination is adverse, the SSA reviews the reconsideration
determination and notifies the recipient of the decision. He then has a
right to an evidentiary hearing before an SSA administrative law judge. 20
CFR §§ 404.917, 404.927 (1975). The hearing is non-adversary, and the SSA
is not represented by counsel. As at all prior and subsequent stages of
the administrative process, however, the claimant may be represented by
counsel or other spokesmen. § 404.934. If this hearing results in an
adverse decision, the claimant is entitled to request discretionary review
by the SSA Appeals Council, § 404.945, and finally may obtain judicial
review. 42 U.S.C. § 405(g); 20 CFR § 404.951 (1975).*fn21 |
| [42] | Should it be determined at any point after termination of benefits,
that the claimant's disability extended beyond the date of cessation
initially established, the worker is entitled to retroactive payments. 42
U.S.C. § 404. Cf. § 423(b); 20 CFR §§ 404.501, 404.503, 404.504 (1975).
If, on the other hand, a beneficiary receives any payments to which he is
later determined not to be entitled, the statute authorizes the Secretary
to attempt to recoup these funds in specified circumstances. 42 U.S.C. §
404.*fn22 |
| [43] | C |
| [44] | Despite the elaborate character of the administrative procedures
provided by the Secretary, the courts below
held them to be constitutionally inadequate, concluding that due process
requires an evidentiary hearing prior to termination. In light of the
private and governmental interests at stake here and the nature of the
existing procedures, we think this was error. |
| [45] | Since a recipient whose benefits are terminated is awarded full
retroactive relief if he ultimately prevails, his sole interest is in the
uninterrupted receipt of this source of income pending final
administrative decision on his claim. His potential injury is thus similar
in nature to that of the welfare recipient in Goldberg, see 397
U.S., at 263-264, the nonprobationary federal employee in
Arnett, see 416 U.S., at 146, and the wage earner in
Sniadach. See 395 U.S., at 341-342.*fn23 |
| [46] | Only in Goldberg has the Court held that due process requires an
evidentiary hearing prior to a temporary deprivation. It was emphasized
there that welfare assistance is given to persons on the very margin of
subsistence: S |
| [47] | "The crucial factor in this context -- a factor not present in the
case of... virtually anyone else whose governmental entitlements are ended
-- is that termination of aid pending resolution of a controversy over
eligibility may deprive an eligible recipient of the very means by which
to live while he waits." 397 U.S., at 264 (emphasis
in original).I |
| [48] | Eligibility for disability benefits, in contrast, is not based upon
financial need.*fn24
Indeed, it is wholly unrelated to the
worker's income or support from many other sources, such as earnings of
other family members, workmen's compensation awards,*fn25
tort claims awards, savings, private insurance, public or private
pensions, veterans' benefits, food stamps, public assistance, or the "many
other important programs, both public and private, which contain
provisions for disability payments affecting a substantial portion of the
work force...." Richardson v. Belcher, 404 U.S., at 85-87 (Douglas, J., dissenting). See Staff of the House
Committee on Ways and Means, Report on the Disability Insurance Program,
93d Cong., 2d Sess., 9-10, 419-429 (1974) (hereinafter Staff
Report). |
| [49] | As Goldberg illustrates, the degree of potential deprivation that may
be created by a particular decision is a factor to be considered in
assessing the validity of any administrative decisionmaking process. Cf.
Morrissey v. Brewer, 408 U.S. 471 (1972). The
potential deprivation here is generally likely to be less than in
Goldberg, although the degree of difference can be overstated. As the
District Court emphasized, to remain eligible for benefits a recipient
must be "unable to engage in substantial gainful activity." 42 U.S.C. §
423; 361 F. Supp., at 523. Thus, in contrast to the
discharged federal employee in Arnett, there is little possibility that
the terminated recipient will be able to find even temporary employment to
ameliorate the interim loss. |
| [50] | As we recognized last Term in Fusari v. Steinberg, 419 U.S.
379, 389 (1975), "the possible length of wrongful deprivation
of... benefits [also] is an important factor in assessing the impact of
official action on the private interests." The Secretary concedes that the
delay between a
request for a hearing before an administrative law judge and a decision on
the claim is currently between 10 and 11 months. Since a terminated
recipient must first obtain a reconsideration decision as a prerequisite
to invoking his right to an evidentiary hearing, the delay between the
actual cutoff of benefits and final decision after a hearing exceeds one
year. |
| [51] | In view of the torpidity of this administrative review process, cf.
id., at 383-384, 386, and the typically modest resources of the family
unit of the physically disabled worker,*fn26
the hardship imposed upon the erroneously terminated disability recipient
may be significant. Still, the disabled worker's need is likely to be less
than that of a welfare recipient. In addition to the possibility of access
to private resources, other forms of government assistance will become
available where the termination of disability benefits places a worker or
his family below the subsistence level.*fn27
See Arnett v. Kennedy, 416 U.S., at
169 (POWELL, J., concurring in part); id., at 201-202 (WHITE, J.,
concurring in part and dissenting in part). In view of these potential
sources of temporary income, there is less reason here than in Goldberg to
depart from the ordinary principle, established by our decisions, that
something less than an evidentiary hearing is sufficient prior to adverse
administrative action. |
| [52] | D |
| [53] | An additional factor to be considered here is the fairness and
reliability of the existing pretermination procedures, and the probable
value, if any, of additional procedural safeguards. Central to the
evaluation of any administrative process is the nature of the relevant
inquiry. See Mitchell v. W. T. Grant Co., 416 U.S. 600, 617 (1974); Friendly, Some Kind of Hearing, 123 U. Pa. L.
Rev. 1267, 1281 (1975). In order to remain eligible for benefits the
disabled worker must demonstrate by means of "medically acceptable
clinical and laboratory diagnostic techniques," 42 U.S.C. § 423(d)(3),
that he is unable "to engage in any substantial gainful activity by reason
of any medically determinable physical or mental impairment...." §
423(d)(1)(A) (emphasis supplied). In short, a medical assessment of the
worker's physical or mental condition is required. This is a more sharply
focused and easily documented decision than the typical determination of
welfare entitlement. In the latter case, a wide variety of information may
be deemed relevant, and issues of witness credibility and veracity
often are critical to the decisionmaking process. Goldberg noted that in
such circumstances "written submissions are a wholly unsatisfactory basis
for decision." 397 U.S., at 269. |
| [54] | By contrast, the decision whether to discontinue disability benefits
will turn, in most cases, upon "routine, standard, and unbiased medical
reports by physician specialists," Richardson v. Perales, 402
U.S., at 404, concerning a subject whom they have personally
examined.*fn28
In Richardson the Court recognized the "reliability and probative worth of
written medical reports," emphasizing that while there may be
"professional disagreement with the medical conclusions" the "specter of
questionable credibility and veracity is not present." Id., at 405, 407.
To be sure, credibility and veracity may be a factor in the ultimate
disability assessment in some cases. But procedural due process rules are
shaped by the risk of error inherent in the truthfinding process as
applied to the generality of cases, not the rare exceptions. The potential
value of an evidentiary hearing, or even oral presentation to the
decisionmaker, is
substantially less in this context than in Goldberg. |
| [55] | The decision in Goldberg also was based on the Court's conclusion that
written submissions were an inadequate substitute for oral presentation
because they did not provide an effective means for the recipient to
communicate his case to the decisionmaker. Written submissions were viewed
as an unrealistic option, for most recipients lacked the "educational
attainment necessary to write effectively" and could not afford
professional assistance. In addition, such submissions would not provide
the "flexibility of oral presentations" or "permit the recipient to mold
his argument to the issues the decision maker appears to regard as
important." 397 U.S., at 269. In the context of the
disability-benefits-entitlement assessment the administrative procedures
under review here fully answer these objections. |
| [56] | The detailed questionnaire which the state agency periodically sends
the recipient identifies with particularity the information relevant to
the entitlement decision, and the recipient is invited to obtain
assistance from the local SSA office in completing the questionnaire. More
important, the information critical to the entitlement decision usually is
derived from medical sources, such as the treating physician. Such sources
are likely to be able to communicate more effectively through written
documents than are welfare recipients or the lay witnesses supporting
their cause. The conclusions of physicians often are supported by X-rays
and the results of clinical or laboratory tests, information typically
more amenable to written than to oral presentation. Cf. W. Gellhorn &
C. Byse, Administrative Law -- Cases and Comments 860-863 (6th ed.
1974). |
| [57] | A further safeguard against mistake is the policy of allowing the
disability recipient's representative full access to
all information relied upon by the state agency. In addition, prior to the
cutoff of benefits the agency informs the recipient of its tentative
assessment, the reasons therefor, and provides a summary of the evidence
that it considers most relevant. Opportunity is then afforded the
recipient to submit additional evidence or arguments, enabling him to
challenge directly the accuracy of information in his file as well as the
correctness of the agency's tentative conclusions. These procedures, again
as contrasted with those before the Court in Goldberg, enable the
recipient to "mold" his argument to respond to the precise issues which
the decisionmaker regards as crucial. |
| [58] | Despite these carefully structured procedures, amici point to the
significant reversal rate for appealed cases as clear evidence that the
current process is inadequate. Depending upon the base selected and the
line of analysis followed, the relevant reversal rates urged by the
contending parties vary from a high of 58.6% for appealed reconsideration
decisions to an overall reversal rate of only 3.3%.*fn29
Bare statistics rarely provide a satisfactory measure of the fairness of a
decisionmaking process. Their adequacy is especially suspect here since the
administrative review system is operated on an open file basis. A
recipient may always submit new evidence, and such submissions may result
in additional medical examinations. Such fresh examinations were held in
approximately 30% to 40% of the appealed cases in fiscal 1973, either at
the reconsideration or evidentiary hearing stage of the administrative
process. Staff Report 238. In this context, the value of reversal rate
statistics as one means of evaluating the adequacy of the pretermination
process is diminished. Thus, although we view such information as
relevant, it is certainly not controlling in this case. |
| [59] | E |
| [60] | In striking the appropriate due process balance the final factor to be
assessed is the public interest. This includes the administrative burden
and other societal costs that would be associated with requiring, as a
matter of constitutional right, an evidentiary hearing upon demand in all
cases prior to the termination of disability benefits. The most visible
burden would be the incremental cost resulting from the increased number
of hearings and the expense of providing benefits to ineligible recipients
pending decision. No one can predict the extent of the increase, but the
fact that full benefits would continue until after such hearings would
assure the exhaustion in most cases of this attractive option. Nor would
the theoretical right of the Secretary to recover undeserved benefits
result, as a practical matter, in any substantial offset to the added
outlay of public funds. The parties submit widely varying estimates of the
probable additional financial cost. We only need say that experience with
the constitutionalizing of government procedures suggests that the
ultimate additional cost in terms of money and administrative burden would
not be insubstantial. Financial
cost alone is not a controlling weight in determining whether due process
requires a particular procedural safeguard prior to some administrative
decision. But the Government's interest, and hence that of the public, in
conserving scarce fiscal and administrative resources is a factor that
must be weighed. At some point the benefit of an additional safeguard to
the individual affected by the administrative action and to society in
terms of increased assurance that the action is just, may be outweighed by
the cost. Significantly, the cost of protecting those whom the preliminary
administrative process has identified as likely to be found undeserving
may in the end come out of the pockets of the deserving since resources
available for any particular program of social welfare are not unlimited.
See Friendly, supra, 123 U. Pa. L. Rev., at 1276, 1303. |
| [61] | But more is implicated in cases of this type than ad hoc weighing of
fiscal and administrative burdens against the interests of a particular
category of claimants. The ultimate balance involves a determination as to
when, under our constitutional system, judicial-type procedures must be
imposed upon administrative action to assure fairness. We reiterate the
wise admonishment of Mr. Justice Frankfurter that differences in the
origin and function of administrative agencies "preclude wholesale
transplantation of the rules of procedure, trial, and review which have
evolved from the history and experience of courts." FCC v. Pottsville
Broadcasting Co., 309 U.S. 134, 143 (1940). The
judicial model of an evidentiary hearing is neither a required, nor even
the most effective, method of decisionmaking in all circumstances. The
essence of due process is the requirement that "a person in jeopardy of
serious loss [be given] notice of the case against him and opportunity to
meet it." Joint Anti-Fascist Comm. v. McGrath, 341 U.S., at
171-172 (Frankfurter,
J., concurring). All that is necessary is that the procedures be tailored,
in light of the decision to be made, to "the capacities and circumstances
of those who are to be heard," Goldberg v. Kelly, 397 U.S., at
268-269 (footnote omitted), to insure that they are given a
meaningful opportunity to present their case. In assessing what process is
due in this case, substantial weight must be given to the good-faith
judgments of the individuals charged by Congress with the administration
of social welfare programs that the procedures they have provided assure
fair consideration of the entitlement claims of individuals. See Arnett v.
Kennedy, 416 U.S., at 202 (WHITE, J., concurring in
part and dissenting in part). This is especially so where, as here, the
prescribed procedures not only provide the claimant with an effective
process for asserting his claim prior to any administrative action, but
also assure a right to an evidentiary hearing, as well as to subsequent
judicial review, before the denial of his claim becomes final. Cf. Boddie
v. Connecticut, 401 U.S. 371, 378
(1971). |
| [62] | We conclude that an evidentiary hearing is not required prior to the
termination of disability benefits and that the present administrative
procedures fully comport with due process. |
| [63] | The judgment of the Court of Appeals is |
| [64] | Reversed. |
| [65] | MR. JUSTICE STEVENS took no part in the consideration or decision of
this case. |
| [66] | MR. JUSTICE BRENNAN, with whom MR. JUSTICE MARSHALL concurs,
dissenting. |
| [67] | For the reasons stated in my dissenting opinion in Richardson v.
Wright, 405 U.S. 208, 212 (1972), I agree with the
District Court and the Court of Appeals that, prior to termination of
benefits, Eldridge must be afforded an
evidentiary hearing of the type required for welfare beneficiaries under
Title IV of the Social Security Act, 42 U.S.C. § 601 et seq. See Goldberg
v. Kelly, 397 U.S. 254 (1970). I would add that the
Court's consideration that a discontinuance of disability benefits may
cause the recipient to suffer only a limited deprivation is no argument.
It is speculative. Moreover, the very legislative determination to provide
disability benefits, without any prerequisite determination of need in
fact, presumes a need by the recipient which is not this Court's function
to denigrate. Indeed, in the present case, it is indicated that because
disability benefits were terminated there was a foreclosure upon the
Eldridge home and the family's furniture was repossessed,
forcing Eldridge, his wife, and their children to sleep in
one bed. Tr. of Oral Arg. 39, 47-48. Finally, it is also no argument that
a worker, who has been placed in the untenable position of having been
denied disability benefits, may still seek other forms of public
assistance. |
| [68] | Counsel FOOTNOTES |
| [69] | * J. Albert Wall, Laurence Gold, and Stephen P. Berzon filed a brief
for the American Federation of Labor and Congress of Industrial
Organizations et al. as amici curiae urging affirmance. |
| [70] | David A. Webster filed a brief for Caroline Williams as amicus
curiae. |
|
| |
| Opinion Footnotes | |
|
| |
| [71] | *fn1
The program is financed by revenues derived from employee and employer
payroll taxes. 26 U.S.C. §§ 3101(a), 3111(a); 42 U.S.C. § 401(b). It
provides monthly benefits to disabled persons who have worked sufficiently
long to have an insured status, and who have had substantial work
experience in a specified interval directly preceding the onset of
disability. 42 U.S.C. §§ 423(c)(1)(A) and (B). Benefits also are provided
to the worker's dependents under specified circumstances. §§ 402(b) (d).
When the recipient reaches age 65 his disability benefits are
automatically converted to retirement benefits. §§ 416(i)(2)(D),
423(a)(1). In fiscal 1974 approximately 3,700,000 persons received
assistance under the program. Social Security Administration, The Year in
Review 21 (1974). |
| [72] | *fn2
Eldridge originally was disabled due to chronic anxiety and
back strain. He subsequently was found to have diabetes. The tentative
determination letter indicated that aid would be terminated because
available medical evidence indicated that his diabetes was under control,
that there existed no limitations on his back movements which would impose
severe functional restrictions, and that he no longer suffered emotional
problems that would preclude him from all work for which he was qualified.
App. 12-13. In his reply letter he claimed to have arthritis of the spine
rather than a strained back. |
| [73] | *fn3
The District Court ordered reinstatement of Eldridge's
benefits pending its final disposition on the merits. |
| [74] | *fn4
In Goldberg the Court held that the pretermination hearing must include
the following elements: (1) "timely and adequate notice detailing the
reasons for a proposed termination"; (2) "an effective opportunity [for
the recipient] to defend by confronting any adverse witnesses and by
presenting his own arguments and evidence orally"; (3) retained counsel,
if desired; (4) an "impartial" decisionmaker; (5) a decision resting
"solely on the legal rules and evidence adduced at the hearing"; (6) a
statement of reasons for the decision and the evidence relied on. 397 U.S., at 266-271. In this opinion the term
"evidentiary hearing" refers to a hearing generally of the type required
in Goldberg. |
| [75] | *fn5
The HEW regulations direct that each state plan under the federal
categorical assistance programs must provide for pretermination hearings
containing specified procedural safeguards, which include all of the
Goldberg requirements. See 45 CFR § 205.10(a) (1975); n. 4,
supra. |
| [76] | *fn6
The Court of Appeals for the Fifth Circuit, simply noting that the issue
had been correctly decided by the District Court in this case, reached the
same conclusion in Williams v. Weinberger, 494 F.2d 1191 (1974), cert. pending, No. 74-205. |
| [77] | *fn7
Title 42 U.S.C. § 405(h) provides in full:
"(h) Finality of Secretary's decision. "The findings and decisions of
the Secretary after a hearing shall be binding upon all individuals who
were parties to such hearing. No findings of fact or decision of the
Secretary shall be reviewed by any person, tribunal, or governmental
agency except as herein provided. No action against the United States, the
Secretary, or any officer or employee thereof shall be brought under
section 41 of Title 28 to recover on any claim arising under this
subchapter." |
| [78] | *fn8
Section 405(g) further provides:
"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.... 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...." |
| [79] | *fn9
The other two conditions are (1) that the civil action be commenced within
60 days after the mailing of notice of such decision, or within such
additional time as the Secretary may permit, and (2) that the action be
filed in an appropriate district court. These two requirements specify a
statute of limitations and appropriate venue, and are waivable by the
parties. Salfi, 422 U.S. at 763-764. As in Salfi no
question as to whether Eldridge satisfied these requirements
was timely raised below, see Fed. Rules Civ. Proc. 8(c), 12(h)(1), and
they need not be considered here. |
| [80] | *fn10
If Eldridge had exhausted the full set of available
administrative review procedures, failure to have raised his
constitutional claim would not bar him from asserting it later in a
district court. Cf. Flemming v. Nestor, 363 U.S. 603,
607 (1960). |
| [81] | *fn11
Decisions in different contexts have emphasized that the nature of the
claim being asserted and the consequences of deferment of judicial review
are important factors in determining whether a statutory requirement of
finality has been satisfied. The role these factors may play is
illustrated by the intensely "practical" approach which the Court has
adopted, Cohen v. Beneficial Ind. Loan Corp., 337 U.S. 541, 546 (1949), when applying the finality requirements of 28
U.S.C. § 1291, which grants jurisdiction to courts of appeals to review
all "final decisions" of the district courts, and 28 U.S.C. § 1257, which
empowers this Court to review only "final judgments" of state courts. See,
e.g., Harris v. Washington, 404 U.S. 55 (1971);
Construction Laborers v. Curry, 371 U.S. 542, 549-550
(1963); Mercantile Nat. Bank v. Langdeau, 371 U.S. 555, 557-558 (1963); Cohen v. Beneficial Ind. Loan Corp.,
supra, at 545-546. To be sure, certain of the policy considerations
implicated in §§ 1257 and 1291 cases are different from those that are
relevant here. Compare Construction Laborers, supra, at 550; Mercantile
Nat. Bank, supra, at 558, with McKart v. United States, 395 U.S.
185, 193-195 (1969); L. Jaffe, Judicial Control of
Administrative Action 424-426 (1965). But the core principle that
statutorily created finality requirements should, if possible, be
construed so as not to cause crucial collateral claims to be lost and
potentially irreparable injuries to be suffered remains
applicable. |
| [82] | *fn12
Given our conclusion that jurisdiction in the District Court was proper
under § 405 (g), we find it unnecessary to consider
Eldridge's contention that notwithstanding § 405 (h) there
was jurisdiction over his claim under the mandamus statute, 28 U.S.C. §
1361, or the Administrative Procedure Act, 5 U.S.C. § 701 et
seq. |
| [83] | *fn13
In all but six States the state vocational rehabilitation agency charged
with administering the state plan under the Vocational Rehabilitation Act
of 1920, 41 Stat. 735, as amended, 29 U.S.C. § 701 et seq. (1970 ed.,
Supp. III), acts as the "state agency" for purposes of the disability
insurance program. Staff of the House Committee on Ways and Means, Report
on the Disability Insurance Program, 93d Cong., 2d Sess., 148 (1974). This
assignment of responsibility was intended to encourage rehabilitation
contacts for disabled workers and to utilize the well-established
relationships of the local rehabilitation agencies with the medical
profession. H.R. Rep. No. 1698, 83d Cong., 2d Sess., 23-24
(1954). |
| [84] | *fn14
Work which "exists in the national economy" is in turn defined as "work
which exists in significant numbers either in the region where such
individual lives or in several regions of the country." § 423
(d)(2)(A). |
| [85] | *fn15
Because the continuing-disability investigation concerning whether a
claimant has returned to work is usually done directly by the SSA Bureau
of Disability Insurance, without any state agency involvement, the
administrative procedures prior to the post-termination evidentiary
hearing differ from those involved in cases of possible medical recovery.
They are similar, however, in the important respect that the process
relies principally on written communications and there is no provision for
an evidentiary hearing prior to the cutoff of benefits. Due to the nature
of the relevant inquiry in certain types of cases, such as those involving
self-employment and agricultural employment, the SSA office nearest the
beneficiary conducts an oral interview of the beneficiary as part of the
pretermination process. SSA Claims Manual (CM) § 6705.2 (c). |
| [86] | *fn16
Information is also requested concerning the recipient's belief as to
whether he can return to work, the nature and extent of his employment
during the past year, and any vocational services he is
receiving. |
| [87] | *fn17
All medical-source evidence used to establish the absence of continuing
disability must be in writing, with the source properly identified. DISM §
353.4C. |
| [88] | *fn18
The disability recipient is not permitted personally to examine the
medical reports contained in his file. This restriction is not significant
since he is entitled to have any representative of his choice, including a
lay friend or family member, examine all medical evidence. CM § 7314. See
also 20 CFR § 401.3 (a)(2) (1975). The Secretary informs us that this
curious limitation is currently under review. |
| [89] | *fn19
The SSA may not itself revise the state agency's determination in a manner
more favorable to the beneficiary. If, however, it believes that the
worker is still disabled, or that the disability lasted longer than
determined by the state agency, it may return the file to the agency for
further consideration in light of the SSA's views. The agency is free to
reaffirm its original assessment. |
| [90] | *fn20
The reconsideration assessment is initially made by the state agency, but
usually not by the same persons who considered the case originally. R.
Dixon, Social Security Disability and Mass Justice 32 (1973). Both the
recipient and the agency may adduce new evidence. |
| [91] | *fn21
Unlike all prior levels of review, which are de novo, the district court
is required to treat findings of fact as conclusive if supported by
substantial evidence. 42 U.S.C. § 405 (g). |
| [92] | *fn22
The Secretary may reduce other payments to which the beneficiary is
entitled, or seek the payment of a refund, unless the beneficiary is
"without fault" and such adjustment or recovery would defeat the purposes
of the Act or be "against equity and good conscience." 42 U.S.C. § 404(b).
See generally 20 CFR §§ 404.501-404.515 (1975). |
| [93] | *fn23
This, of course, assumes that an employee whose wages are garnisheed
erroneously is subsequently able to recover his back wages. |
| [94] | *fn24
The level of benefits is determined by the worker's average monthly
earnings during the period prior to disability, his age, and other factors
not directly related to financial need, specified in 42 U.S.C. § 415 (1970
ed., Supp. III). See § 423(a)(2). |
| [95] | *fn25
Workmen's compensation benefits are deducted in part in accordance with a
statutory formula. 42 U.S.C. § 424a (1970 ed., Supp. III); 20 CFR §
404.408 (1975); see Richardson v. Belcher, 404 U.S. 78 (1971). |
| [96] | *fn26
Amici cite statistics compiled by the Secretary which indicate that in
1965 the mean income of the family unit of a disabled worker was $3,803,
while the median income for the unit was $2,836. The mean liquid assets --
i.e., cash, stocks, bonds -- of these family units was $4,862; the median
was $940. These statistics do not take into account the family unit's
nonliquid assets -- i.e., automobile, real estate, and the like. Brief for
AFL-CIO et al. as Amici Curiae App. 4a. See n. 29, infra. |
| [97] | *fn27
Amici emphasize that because an identical definition of disability is
employed in both the Title II Social Security Program and in the
compensation welfare system for the disabled, Supplemental Security Income
(SSI), compare 42 U.S.C. § 423(d)(1) with § 1382c(a)(3) (1970 ed., Supp.
III), the terminated disability-benefits recipient will be ineligible for
the SSI Program. There exist, however, state and local welfare programs
which may supplement the worker's income. In addition, the worker's
household unit can qualify for food stamps if it meets the financial need
requirements. See 7 U.S.C. §§ 2013(c), 2014(b); 7 CFR § 271 (1975).
Finally, in 1974 480,000 of the approximately 2,000,000 disabled workers
receiving Social Security benefits also received SSI benefits. Since
financial need is a criterion for eligibility under the SSI program, those
disabled workers who are most in need will in the majority of cases be
receiving SSI benefits when disability insurance aid is terminated. And,
under the SSI program, a pretermination evidentiary hearing is provided,
if requested. 42 U.S.C. § 1383(c) (1970 ed., Supp. III); 20 CFR §
416.1336(c) (1975); 40 Fed. Reg. 1512 (1975); see Staff Report
346. |
| [98] | *fn28
The decision is not purely a question of the accuracy of a medical
diagnosis since the ultimate issue which the state agency must resolve is
whether in light of the particular worker's "age, education, and work
experience" he cannot "engage in any... substantial gainful work which
exists in the national economy...." 42 U.S.C. § 423(d)(2)(A). Yet
information concerning each of these worker characteristics is amenable to
effective written presentation. The value of an evidentiary hearing, or
even a limited oral presentation, to an accurate presentation of those
factors to the decisionmaker does not appear substantial. Similarly,
resolution of the inquiry as to the types of employment opportunities that
exist in the national economy for a physically impaired worker with a
particular set of skills would not necessarily be advanced by an
evidentiary hearing. Cf. 1 K. Davis, Administrative Law Treatise § 7.06,
p. 429 (1958). The statistical information relevant to this judgment is
more amenable to written than to oral presentation. |
| [99] | *fn29
By focusing solely on the reversal rate for appealed reconsideration
determinations amici overstate the relevant reversal rate. As we indicated
last Term in Fusari v. Steinberg, 419 U.S. 379, 383
n. 6 (1975), in order fully to assess the reliability and fairness of a
system of procedure, one must also consider the overall rate of error for
all denials of benefits. Here that overall rate is 12.2%. Moreover, about
75% of these reversals occur at the reconsideration stage of the
administrative process. Since the median period between a request for
reconsideration review and decision is only two months, Brief for AFL-CIO
et al. as Amici Curiae App. 4a, the deprivation is significantly less than
that concomitant to the lengthier delay before an evidentiary hearing.
Netting out these reconsideration reversals, the overall reversal rate
falls to 3.3%. See Supplemental and Reply Brief for Petitioner
14. |