ISSUED: July 9, 1993
I. Purpose
This Temporary Instruction (TI) provides guidance for OHA processing of
Tennessee Disability Determination Section (TDDS)
Samuels “pipeline” cases that
proceeded on appeal to OHA and that OHA adjudicated prior to August 24,
1987, the effective date of the OHA Samuels
instructions issued in HALLEX
HA 01540.018.
Although the TI affects only decision makers processing
Samuels pipeline cases, decision makers throughout
the country must be familiar with the TI because of potential case
transfers or a claimant's change of State residence.
II. Background
The Program Operations Manual System instructions for TDDS processing of
Samuels cases became effective on November 17,
1986. However, the TDDS did not achieve full implementation of the
instructions until February 1, 1987. Accordingly, the TDDS listed cases
that it adjudicated on or after November 17, 1986, but before February 1,
1987 (determined by the date the SSA-831 was signed), for subsequent
review under the Samuels instructions. These cases
are known as “pipeline” cases or “Code 167”
cases (see item 26 of the SSA-831-U3), because they were adjudicated
subsequent to the issuance of the Samuels POMS
instructions and prior to February 1, 1987, the date the POMS were fully
implemented in the TDDS.
Some cases alerted as pipeline cases may already have been alerted,
screened and processed as OHA-jurisdiction Samuels
class members, because those cases that proceeded on appeal to OHA may
have been adjudicated prior to the August 24, 1987 date of issuance of the
OHA Samuels instructions
(HA 01540.018). Prior
processing as an OHA-jurisdiction Samuels class
member depends on whether the claimant: 1) received a notice of potential
class membership and 2) responded to that notice.
III. Identification and Routing of Pipeline Cases
Unlike the processing of Samuels class member
claims, SSA will not send advance notice of the possibility of review in
pipeline cases. However, SSA will release alerts for all listed pipeline
cases. The alert will identify the case as a pipeline case by the notation
“Code 167” on the face of the alert and will identify the
TDDS as the reviewing office.
At the request of the Office of the Deputy Commissioner for Programs'
Litigation Staff, the Office of Information Management will prepare a tape
from the Civil Action Tracking System of cases to be alerted. The Office
of Disability and International Operations (ODIO) will directly receive
and print the tape, which will produce an alert and folder location
information for each case. ODIO will associate the alerts with claim
folders in its possession and forward those cases directly to the TDDS for
processing. ODIO will forward alerts for cases not in its possession
directly to the folder location for association and, unless the case is
pending or associated with a pending claim, for forwarding to the TDDS
(see Parts V.C. and D. for OHA actions on receipt of an alert for a
pending case or for a case associated with a pending claim).
IV. TDDS Processing of Pipeline Cases
The TDDS must review all alerted cases to determine if they were fully
processed under the Samuels criteria. Although
pipeline cases are not eligible for Samuels class
membership (unless, as indicated above, the claimant responded to a notice
of potential class membership at the OHA level), they are entitled to
adjudication under the Samuels criteria (see the
TDDS Samuels checklist at Attachment G in
HALLEX
HA 01540.018-A, issued
May 30, 1989).
For cases that did not proceed to the OHA level, the TDDS will determine
if further action under Samuels is necessary and,
if so, will notify the claimant and proceed with a redetermination. If no
action under Samuels is necessary, the TDDS will
not prepare a notice to the claimant (because the claimant has not been
notified of the possibility of review). Rather, the TDDS will prepare a
statement (similar to Attachment 1) and return the case to its storage
location.
Because pipeline cases are not eligible for class membership (except as
indicated above), the TDDS will not
complete a class membership screening sheet and the notice of review will
not refer to class membership.
The TDDS will notify claimants who receive unfavorable redeterminations of
their right to request a hearing before an Administrative Law Judge (ALJ).
The TDDS will prepare a statement (similar to Attachment 1) and return to
the storage location, the following pipeline cases that proceeded to the
OHA level:
•
cases that received fully favorable ALJ or Appeals Council
decisions;
•
cases that received either any TDDS reconsideration action on or after
February 1, 1987, or any OHA action on or after August 24, 1987, the
effective date of OHA's Samuels instructions;
and
•
cases that have already been redetermined as
Samuels class members.
Additionally, the TDDS will prepare a statement similar to Attachment 1
for pipeline cases in which the adjudication of a subsequent claim, at any
administrative level, considered, using the Samuels
criteria, the complete time period at issue in the pipeline case.
The TDDS will forward all other OHA cases, except for ALJ dismissals, to
OHA's Office of Civil Actions (OCA), Division III, for the actions stated
below. The TDDS will review ALJ dismissals (processed prior to August 24,
1987) to determine if further TDDS action under
Samuels is necessary.
V. OHA Processing of Pipeline Cases
OCA Division III personnel will take the following actions on
cases forwarded by the TDDS (see Parts V.
C. and D. for OHA processing of alerts only):
•
Review the case for compliance with the substantive, medical development
and procedural (including documentation and special decisional language)
requirements of HALLEX
HA 01540.018-A, issued
May 30, 1989 (see the TDDS Samuels checklist at
Attachment G of that instruction).
•
If the case is in compliance, complete the statement in Attachment 1,
checking item 4. Place the original in the claim folder and forward one
copy to the Division of Litigation Analysis and Implementation (DLAI),
Suite 702, Attn: Samuels coordinator. Forward
another copy to plaintiffs' counsel at the address on the statement.
Return the folder to its storage location.
•
If the case is not in compliance, send the notice in Attachment 2 or 3, as
appropriate, to the claimant and the representative of record, if any
(follow HALLEX
HA 01540.018, A, Part
VI. B., concerning representation). Also send a copy of the notice to the
Samuels coordinator in DLAI. Because the benefit of
a protective filing date for new claims was negotiated only for
Samuels class members, the protective filing date
instructions in Parts VI. B. and VII. A. of
HALLEX
HA 01540.018, A, are
not applicable in pipeline cases.
Forward the case to the servicing hearing office (HO). On the covering
route slip, annotate “Samuels Pipeline
Case” and indicate the area(s) deficient with respect to the
Samuels requirements. Also annotate the route slip
if a subsequent claim (which did not form a basis for non-review), or a
class member claim, is pending at any administrative level or in
court.
Pipeline cases are subject to the substantive, medical development and
procedural (including documentation and special decisional language)
requirements of HALLEX
HA 01540.018-A (see the
TDDS Samuels checklist at Attachment G of that
instruction). However, because the benefit of a protective filing date for
new claims was negotiated only for Samuels class
members, the protective filing date instructions in Parts VI. B. and VII.
A. of HALLEX
HA 01540.018-A are not
applicable in pipeline cases.
Consistent with Samuels practice, ALJs will issue
redetermination decisions in initial entitlement pipeline cases. However,
ALJs will follow Acquiescence
Ruling 92-2(6), published March 17, 1992, concerning the scope of
review for the medical cessation cases of all Sixth Circuit
residents.
On release of a decision or dismissal, HO personnel will forward a copy
to:
Division of Litigation Analysis and Implementation
5107 Leesburg
Pike
Suite 702
Falls Church, VA 22041-3200
ATTN:
Samuels Coordinator
C. OHA Processing — Alerts for OHA-Jurisdiction Pipeline
Cases
OCA will directly receive alerts for any pipeline cases that may be
currently located in OHA. Pipeline cases that are pending in OHA or stored
in OHA pending appeal are under OHA's jurisdiction and must continue to be
processed under Samuels. Therefore, OCA will
forward alerts to the components (inside or outside of OHA) having current
possession of the folder. OHA components receiving these alerts will flag
the pipeline case for continued Samuels processing
by attaching the alert to the outside of the claim folder.
The alerted pending or stored pipeline cases should have already received
an ALJ decision under Samuels and should require no
further review. However, the OHA component having possession of the folder
will also forward a copy of the ALJ (or Appeals Council) decision (or
dismissal order) to DLAI (at the address indicated in A. and B.) for
reporting purposes. The appropriate personnel will also annotate the face
of the alert with the fact and date of forwarding a copy of the decision
or dismissal order to DLAI.
If the case alerted as a pipeline case is pending screening in OCA
Division III because it was previously alerted as a potential
Samuels class member case, Division III personnel
will first screen for Samuels class membership. If
the claimant is a class member, Division III personnel will continue with
Samuels class member processing. Division III
personnel will also prepare the statement in Attachment 1, checking item
5. and taking the related actions in section V. A. above, except for
forwarding the folder to the storage location. If the claimant is not a
Samuels class member, Division III personnel will
send the notice of non-class membership and take related actions except
for forwarding the folder to the TDDS (for potential review by plaintiffs'
counsel of the class membership issue). Division III personnel will then
review the case for any necessary processing as a pipeline case, following
the procedures in V. A. above. Additionally, if no processing is
necessary, Division III personnel will forward the case to the TDDS to
await potential review by plaintiffs' counsel of the class membership
issue.
D. OHA Processing — Alerts for TDDS-Jurisdiction Pipeline
Cases
OHA may receive alerts for pipeline cases that did not proceed on appeal
to OHA but are in OHA's possession for other reasons, e.g., the case is
associated with a subsequent claim.
If the pipeline case is associated with a claim pending at the hearing
level, the HO will review the pipeline case and 1) complete the statement
in Attachment 1 and follow the related procedures in Part V. A. above;
or 2) follow the
Samuels consolidation procedures in
HALLEX
HA 01540.018-A.
If the pipeline case is associated with a claim stored in the Office of
Appellate Operations (OAO), OAO personnel will forward all folders to OCA
Division III for review and appropriate action, usually the completion of
the statement in Attachment 1 and related actions (see Part V. A.). If
further action under Samuels is necessary, Division
III personnel will forward it to the TDDS (using the address on the alert)
unless it appears that the folder may be needed for appeal purposes.
Division III personnel will annotate the covering route slip concerning
the area(s) deficient with respect to the Samuels
requirements. If the folder cannot be released pending potential appeal,
Division III personnel will: 1) place the annotated route slip in the
folder; and 2) attach the flag at Attachment 4 to the outside of the
folder, for forwarding the folder to the TDDS at the close of the OHA
retention period.
If the pipeline case is associated with a claim pending in OAO, OAO
personnel will: 1) review the pipeline case; 2) complete the statement in
Attachment 1 if appropriate and take related actions (see Part V. A.); or
3) if further action under Samuels is necessary,
forward the case to the TDDS (using the address on the alert) unless the
folder is needed for adjudication purposes. OAO personnel will annotate
the covering route slip concerning the area(s) deficient with respect to
the Samuels requirements. If the folder is needed
for adjudication purposes, OAO personnel will: 1) place the annotated
route slip in the folder; and 2) attach the flag at Attachment 4 to the
outside of the folder, for forwarding the folder to the TDDS at the close
of the OHA retention period.
VI. Inquiries
HO personnel should direct any questions to their Regional Office (RO). RO
personnel should contact the Division of Field Practices and Procedures in
the Office of the Chief Administrative Law Judge at (703) 305-0022.
Attachment 1. Samuels Code 167 Case Reason for Non-Review
|
TO : |
ODCP Litigation Staff
3-K-26
Operations Building
640l Security Boulevard
Baltimore, MD 21235
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|
FROM: |
_______________
Contact person: _______________
Telephone: _______________
|
|
RE : |
_______________
Claimant's Name
|
_______________
SSN
|
|
This Code 167 case will not receive a Samuels review because:
|
|
______ 1. |
Claim received Samuels development on appeal. (NOTE: OHA began applying the Samuels criteria on August 24, 1987.)
Date of appeal decision: ____________
Check one: TDDS ______ ALJ ______ Appeals Council ______
|
|
______ 2. |
Claim received fully favorable decision. ____________ (NOTE: Do not check this block if the TDDS or OHA issued only a partially favorable determination or decision.)
Date of favorable determination/decision: ____________
(TDDS (or OHA) will forward case to FO if full retroactive benefits, based on administrative finality, have not been paid.)
|
|
______ 3. |
Subsequent claim provided Samuels development for entire period covered by Code 167 case.
Enter dates:
|
|
|
AOD on Code 167 case
|
__________________
|
|
|
AOD on subsequent claim
|
__________________
|
|
|
Date of decision on subsequent claim
|
__________________
|
|
______ 4. |
TDDS applied Samuels criteria to pipeline case.
Date criteria applied: __________________
|
|
______ 5. |
Claimant is a Samuels class member.
|
cc:
Legal Services of Middle Tennessee,
Inc.
211 Union Street
800 Stahlman Building
Nashville, TN 32701
Attachment 2. Notice of Review (Initial Entitlement Cases)
Notice of Review — Initial Entitlement Cases
(use Office of
Civil Actions letterhead)
Claimant's Name and Address
We are writing to let you know that we are going to review your claim that
we previously decided on
(insert date of decision), and apply
the court order in Samuels v. Bowen. Our review
will cover only the time period through
(insert previous date). We will
consider any new evidence you submit, but only if it applies to this
period. This review will not affect any benefits you may now be
receiving.
We are sending your claim to the
(insert name of servicing hearing office)
Hearing Office to schedule a hearing. The Hearing Office will contact you
concerning the time and place of the hearing and any new evidence you may
wish to submit.
As always, you may file a new application at any time. It is especially
important to file a new application if you have a new health problem(s)
that occurred after the above date. Please remember that if you want us to
consider evidence of your health problem(s) for the period after the above
date, you must file a new application. If you have already filed a new
claim, please notify the Hearing Office.
If you have any questions, you may call, write, or visit any Social
Security office. If you do call or visit an office, please have this
notice with you. It will help us to answer your questions. If you plan to
visit an office, you may wish to call ahead to schedule an appointment.
This will help us to serve you more quickly and efficiently.
Attachment 3. Notice of Review (Cessation Cases)
Notice of Review — Initial Entitlement Cases
(use Office of
Civil Actions letterhead)
Claimant's Name and Address
We are writing to let you know that we are going to review your claim that
we previously decided on
(insert date of decision), and apply
the court order in Samuels v. Bowen. This review
will not affect any benefits you may now be receiving.
We are sending your claim to the
(insert name of servicing hearing office)
Hearing Office to schedule a hearing. The Hearing Office will contact you
concerning the time and place of the hearing and any new evidence you may
wish to submit.
If you have any questions, you may call, write, or visit any Social
Security office. If you do call or visit an office, please have this
notice with you. It will help us to answer your questions. If you plan to
visit an office, you may wish to call ahead to schedule an appointment.
This will help us to serve you more quickly and efficiently.
SAMUELS Pipeline Case
REVIEW NECESSARY
Claimant:
SSN :
Upon expiration of the retention period, forward this case for review to:
Disability Determination Section
P.O. Box 775Nashville,
TN 37202
Case locator code 1440.