Conditions and Examples That May Establish Good Cause for Late Filing by

240.2 - Conditions and Examples That May Establish Good Cause for Late Filing by Beneficiaries (Rev. 4278, Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19) A. Conditions Good cause may be found when the record clearly shows, or the beneficiary alleges, that the delay in filing was due to one of the following: • Circumstances beyond the beneficiary’s control, including mental or physical impairment (e.g., disability, extended illness) or significant communication difficulties; • Incorrect or incomplete information about the subject claim and/or appeal was furnished by official sources (CMS, the contractor, or the Social Security Administration) to the beneficiary (e.g., a party is not notified of her appeal rights or a party receives inaccurate information regarding a filing deadline); NOTE: Whenever a beneficiary is not notified of his/her appeal rights or of the time limits for filing, good cause must be found. • Delay resulting from efforts by the beneficiary to secure supporting evidence, where the beneficiary did not realize that the evidence could be submitted after filing the request; • When destruction of or other damage to the beneficiary’s records was responsible for the delay in filing (e.g., a fire, natural disaster); • Unusual or unavoidable circumstances, the nature of which demonstrates that the beneficiary could not reasonably be expected to have been aware of the need to file timely; • Serious illness which prevented the party from contacting the contractor in person, in writing, or through a friend, relative, or other person; • A death or serious illness in his or her immediate family; • A request was sent to a Government agency in good faith within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired; or • Delay due to additional time required to produce the beneficiary’s Medicare documents (such as an MSN) in an accessible format (e.g., large print, Braille, etc.); • Delay as the result of an individual having sought and received help from an auxiliary resource (such as a SHIP or senior center), due to his or her disability, in order to be able to file the appeal. B. Examples Following are examples of cases where good cause for late filing is found. This list is illustrative only and not all-inclusive: • Beneficiary was hospitalized and extremely ill, causing a delay in filing; • Beneficiary is deceased. Her husband, as representative of the beneficiary’s estate, died during the appeals filing period. Request was then filed late by the deceased husband’s executor; • The denial notice sent to the beneficiary did not specify the time limit for filing for the redetermination; and • The request was received after, but close to, the last day to file, and the beneficiary claims that the request was submitted timely.