ISSUED: June 29, 1994; REVISED: October 4, 1996
I. Purpose
This Temporary Instruction (TI) sets forth procedures for implementing the
parties' joint Stipulation and Order in the Prue/Weathers, et
al. v. Sullivan class action involving the “not
severe” impairment issue. The Stipulation and Order was approved by
the United States District Court for the District of Columbia on July 23,
1993.
Adjudicators throughout the country must be familiar with this TI because
Prue/Weathers class members who now reside outside
of the District of Columbia must have their cases processed in accordance
with the requirements of the Stipulation and Order.
II. Background
On March 10, 1986, the United States District Court for the District of
Columbia granted plaintiffs' motion for partial summary judgment, denied
the Secretary's cross-motion for summary judgment and certified a class
challenging the Secretary's regulations, policies and practices for
evaluating disability claims at step two of the sequential evaluation. In
addition, the court held that the Secretary's pre-1984 policy of not
considering the combined effect of an individual's multiple “not
severe” impairments violated the Social Security Act. Accordingly,
the court enjoined the Secretary from denying or terminating disability
benefits at step two and ordered the Secretary to readjudicate all pending
class member claims.
On August 22, 1986, the district court denied the Secretary's motion to
alter or amend the judgment to the extent that the Secretary requested the
court to: 1) eliminate the requirement that the Secretary reinstate
benefits previously terminated; 2) exclude from the class individuals
whose benefits were terminated, as distinguished from denied, on the
ground that the sole party seeking class relief had her benefits denied,
not terminated; and 3) exclude from the class those individuals who had
failed to exhaust their administrative remedies. However, the court
granted the Secretary a partial stay concerning the reinstatement of
benefits pending the Secretary's appeal.
On October 30, 1986, the United States Court of Appeals for the District
of Columbia agreed to stay the briefing schedule and hold the merits of
the case in abeyance pending the Supreme Court's decision in
Bowen v. Yuckert, 482 U.S. 137 (1987). Furthermore,
the court of appeals denied the Secretary's motion for a partial stay with
respect to the process of identifying the closed claims referred to in the
Secretary's motion and with respect to locating the Agency's files for
those claims. However, the court of appeals granted the stay with respect
to payment of interim benefits and the further processing and
readjudication of previous closed claims.
On September 16, 1987, in response to the Secretary's motion following the
Supreme Court's decision in Bowen v. Yuckert, the
court of appeals remanded this case to the district court for further
consideration in light of Yuckert, but refused to
vacate the district court's injunction.
On February 24, 1992, the district court lifted the injunction and
dismissed plaintiffs' class action complaint. On March 3, 1992, plaintiffs
appealed the district court's dismissal to the court of appeals.
On May 8, 1992, the Associate Commissioner issued a memorandum to all OHA
adjudicators informing them of the court's February 24, 1992 order. The
memorandum instructed OHA decision makers to resume using the severity
step in adjudicating adult disability claims. The memorandum also
rescinded TI 5-4-19, Weathers, et al. v. Bowen,
which had originally been issued as Staff Guides and Programs Digest
Bulletin III-1(86), on July 31, 1986, to provide instructions for
implementing the district court's March 10, 1986 order.
While the case was on appeal, the parties negotiated a settlement. On
April 26, 1993, pursuant to plaintiffs' unopposed motion, the court of
appeals remanded the case to the district court for further proceedings.
The circuit court felt that the lower court was in a better position to
assess the fairness of the parties' proposed settlement. On July 23, 1993,
the district court approved the parties' joint Stipulation and Order
setting forth the definition of the class and terms for the implementation
of relief (Attachment 1).
III. Guiding Principles
Under Prue/Weathers, the Secretary will redetermine
the claims of those persons who: 1) respond to notice informing them of
the opportunity for readjudication; and 2) are determined to be class
members after screening (see Part V.
below). Regardless of the claimant's current state of residence, the
Office of Disability and International Operations (ODIO) will, in most
cases, screen for class membership and the District of Columbia Disability
Determination Service (DDS) will perform the agreed upon readjudications,
regardless of the administrative level at which the claim was last
decided.
The DDS servicing the claimant's current address will perform the
readjudication if a face-to-face review is appropriate, i.e., cessation or
terminal illness (TERI) cases.
OHA will screen cases and perform readjudications under limited
circumstances (see Part V.B. below).
Cases readjudicated by the DDS will be redetermined at the reconsideration
level regardless of the final level at which the case was previously
decided. Class members who receive adverse readjudication determinations
will have full appeal rights (i.e., Administrative Law Judge (ALJ)
hearing, Appeals Council and judicial review).
Prue/Weathers does not require any change in OHA's
current adjudicatory policies or practices because
Social Security Ruling (SSR)
85-28 remains the proper standard for adjudicating claims at step
two of the sequential evaluation.
IV. Definition of Class
Except as noted below, for purposes of implementing the July 23, 1993
Stipulation and Order, the Prue/Weathers class
consists of all individuals who:
•
resided in the District of Columbia between July 28, 1984, and March 4,
1985, inclusive; and
•
were issued a final administrative determination or decision denying or
terminating title II or title XVI disability benefits based on a finding
of “no severe” impairment, i.e., a step two denial.
A person is not a class member if
(1) the last administrative denial or termination the individual received
on the potential Prue/Weathers claim was issued
after March 4, 1985;
(2) the last administrative denial or termination the individual received
on the potential Prue/Weathers claim was not based
on a finding of “no severe” impairment, i.e., a step two
denial;
(3) a federal court affirmed the denial at any time; or
(4) the individual had a subsequent claim denied after March 4, 1985, and
the subsequent claim covered the entire period of disability at issue in
the potential Prue/Weathers claim.
V. Determination of Class Membership and Preadjudication
Actions
1.
Notification
On February 18, 1994, SSA sent notices to all potential class members
identified by computer run. Individuals have 60 days from the date of
receipt of the notice to request that SSA readjudicate their claims under
the terms of the Prue/Weathers Stipulation and
Order.
The Office of Disability and International Operations (ODIO) sendS
untimely responses to the servicing Social Security field office (i.e.,
district office or branch office) to develop good cause for the untimely
response. Good cause determinations are based on the standards set forth
in 20 CFR §§
404.911 and
416.1411 and
SSR 91-5p. If good cause
is established, the field office will forward the claim for screening.
If a mental impairment (now or in the past) is alleged, ODIO will deem
good cause for the untimely response and proceed with screening for class
membership.
2.
Alert and Folder Retrieval Process
All response forms and undeliverable notices will be returned to ODIO
where they will be entered into the Civil Action Tracking System (CATS).
CATS will generate folder alerts to ODIO for all response forms. See
Attachment 2 for a sample Prue/Weathers alert.
In most instances, ODIO will associate the computer-generated alerts with
any claim file(s) that it has within its jurisdiction or that it retrieves
from another location. ODIO will then forward class member files to the
appropriate office for readjudication.
3.
Alerts Sent to OHA
If ODIO determines that a current claim, i.e., either a potential class
member claim or a subsequent claim, is pending appeal or stored at OHA, it
will forward the alert to OHA, along with any prior claim file(s) not in
OHA's possession, for screening, consolidation consideration and
readjudication (if consolidated).
ODIO will send all alerts potentially within OHA jurisdiction and related
prior claim file(s), if any, to the Office of Appellate Operations (OAO),
at the following address (case locator code 5007):
Office of Hearings and Appeals
Office of Appellate
Operations
One Sky Tower Suite 701
5107 Leesburg
Pike
Falls Church, VA 22041-3200
ATTN:
OAO CLass Action Coordinator
The OAO Class Action Coordinator is responsible for controlling and
reconciling the disposition of class alerts shipped to OHA Headquarters
for association with pending or stored claims. The OAO Class Action
Coordinator will maintain a record of all alerts received and the
location, if any, to which they are transferred. This information will be
necessary to do the final class membership reconciliation.
4.
Folder Reconstruction
Generally, ODIO will initiate any necessary reconstruction of prior claim
files through the servicing FO. Consequently, OHA requests for
reconstruction of potential Prue/Weathers class
member cases should be rare. Prior to requesting reconstruction, OHA will
determine whether available systems data or other information provides
satisfactory proof that the claim would not confer class membership.
However, if it becomes necessary for OHA to request reconstruction, the
OHA component (the HO or the OAO Branch) will forward the alert and any
accompanying claim file(s) (if the claim file(s) is not needed for
adjudication purposes) to the servicing FO, along with documentation of
attempts to locate the file and a covering memorandum requesting that the
reconstructed file be forwarded to OHA. HOs will route any reconstruction
requests directly to the servicing FOs. The OAO branch will route requests
to the servicing FO and send copies of all requests to the OAO Class
Action Coordinator. For CATS purposes, HO personnel and the OAO Class
Action Coordinator will forward a copy of the reconstruction request
memorandum to Litigation Staff at the following address:
Litigation Staff
Office of Policy and Planning
3-K-26
Operations Building
6401 Security Boulevard
Baltimore,
MD 21235
ATTN: Prue/Weathers
CoordinatorThe HO or OAO will not delay action on a pending claim when a prior claim
is being reconstructed for screening purposes, unless the claim is needed
for the adjudication of the pending claim. If OHA completes action on the
pending claim prior to the receipt of the reconstructed file, the HO or
OAO, as appropriate, will forward the class action material, including the
alert, unneeded claim files, if any, and the reconstruction request to the
OAO Class Action Coordinator, along with a copy of the action on the
pending claim. For additional information on reconstruction procedures,
see the Generic Class Implementation Instructions, HALLEX
HA 01170.005 C.
5.
Class Membership Denials
ODIO or OHA will hold all non-class member claim files pending review by
class counsel. If an individual wishes to request SSA's further
consideration of a class membership denial determination, he or she must
do so through class counsel. Class counsel has 60 days from receipt of the
notice of non-class membership to notify the Office of the General Counsel
(OGC) of their disagreement. Upon timely written request by class counsel
(i.e., within 60 days of receipt of the notice of non-class membership) to
review the files, Litigation Staff will coordinate with ODIO or OHA to
forward the claim files within 30 days of the request, to:
SSA District Office
2100 M Street, N.W.
Washington,
D.C. 20203
The files may also be sent to another mutually acceptable location.
Class counsel will then have 30 days to review the file. If class
counsel's review establishes that there is a dispute, they must notify
OGC. If the parties are unable to resolve a dispute, OGC will so notify
class counsel. Class counsel may submit any unresolved dispute to the
court for final resolution by proper motion made within 30 days of the
date of written notice by OGC.
1.
Pre-Screening Actions
a.
Current Claim in OHA
As provided in Part V.A.3. above, if
there is a current claim pending or stored at OHA, the OAO Class Action
Coordinator will receive the alert and related
Prue/Weathers claim file(s). The OAO Class Action
Coordinator will determine OHA jurisdiction for screening and forward as
follows.
•
If the current claim is in an HO, the Coordinator will use Attachment 3 to
forward the alert and prior claim file(s) to the HO for screening.
(Part V.B.2.a. below provides
instructions to the HOs regarding the action to be taken if they receive
an alert package but no longer have a current claim pending.)
•
If the current claim is before the Appeals Council, or is located in an
OAO branch mini-docket or in the OAO Docket and Files Branch, the
Coordinator will use Attachment 3 to forward the alert and prior claim
file(s) to the appropriate OAO branch for screening.
(Part V.B.2.a. below provides
instructions to the OAO branches regarding the action to be taken if they
receive an alert package from the OAO Class Action Coordinator but no
longer have a current claim pending.)
If the Coordinator (or designee) is unable to locate the current claim
file within OHA, the Coordinator (or designee) will broaden its claim file
search and arrange for alert transfer or file reconstruction, as
necessary.
b.
Current Claim Pending in Court
If the OAO Class Action Coordinator receives an alert for a claimant who
has a civil action pending, either on the alerted case or on another
claim, the Coordinator will forward the alert and any accompanying claim
file(s) to the appropriate Court Case Preparation and Review Branch
(CCPRB) for screening using Attachment 3. See
Part V.B.2.b. below for special screening
instructions when a civil action is involved.
2.
Screening
a.
General Instructions
The screening component will associate the alert, if any, and any prior
claim file(s) with the claim file(s) in its possession and complete the
screening sheet (see Attachment 4) as follows.
If the claim pending at OHA is the only potential
Prue/Weathers claim, then the individual is not
entitled to relief under Prue/Weathers (see
Part IV. above). Complete the screening
sheet and follow the instructions in
Part V.B.3.a. below for processing
non-Prue/Weathers claims.
•
Consider all applications denied (including res
judicata denials/dismissals) during the
Prue/Weathers timeframe;
Although not the “final decision of the Secretary,” an
Appeals Council denial of a request for review is the last action of the
Secretary, and the date of such a denial controls for class membership
screening purposes.
•
Follow all instructions on the screening sheet and the screening sheet
instructions;
•
Sign and date the original screening sheet; place it in the claim file (on
the top right side of the file); and
•
If the screening component is an OHA Headquarters component, forward a
copy of the screening sheet to the OAO Class Action Coordinator at the
address in Part V.A.3. above. (The
Coordinator will enter information from the screening sheet into a
database and forward a copy of the screening sheet to the Division of
Litigation Analysis and Implementation (DLAI)). If the screening component
is an HO, forward a copy of the screening sheet directly to DLAI at the
following address:
Office of Hearing and Appeals
Division of Litigation
Analysis and Implementation
One Skyline Tower, Suite
702
5107
Leesburg Pike
Falls Church, VA 22041-3255HO personnel may also forward material by telefax to DLAI at (703)
305-0655. (DLAI will retain a copy of each screening sheet and forward a
copy to the OAO Class Action Coordinator and to Litigation Staff.)
If the HO receives an alert only, or an alert associated with a prior
claim file(s), and the HO no longer has the current claim file, it will
return or forward the alert and any prior claim file(s) to the OAO Class
Action Coordinator (see address in
Part V.A.3. above) and advise the
Coordinator of the action taken on the current claim and its destination.
The Coordinator will determine the current claim file location and, if it
is located in OHA Headquarters, will forward the alert and any
accompanying prior claim file(s) to the responsible OAO Branch for
screening, using Attachment 3. If the file(s) is no longer in OHA, the
Coordinator will use Attachment 5 to send the alert and any accompanying
prior claim file(s) to the non-OHA location and request that the file(s)
be forwarded to the appropriate DDS for screening.
If an OAO branch receives an alert only, or an alert associated with a
prior claim file(s), and the branch no longer has the current claim file
(and it is not located in an OAO branch mini-docket or in the OAO DFB), it
will determine the location of the current claim file. If the current
claim file is located within OHA, the OAO branch will use Attachment 3 to
forward the alert and any accompanying prior claim file(s) to the current
OHA location. If the file(s) is no longer in OHA, the OAO branch will use
Attachment 5 to forward the alert and any accompanying prior claim file(s)
to the non-OHA location and request that the file(s) be forwarded to the
appropriate DDS for screening. The OAO branch will also advise the OAO
Class Action Coordinator of its actions.
Final determinations or decisions made after March 4, 1984, on a
subsequent claim filed by a potential Prue/Weathers
class member may have adjudicated the entire timeframe at issue in the
Prue/Weathers claim. Instead of applying the
doctrine of administrative res judicata to the
Prue/Weathers claim, these claims should be denied
class membership.
b.
Special OAO Screening Instructions if a Civil Action Is Involved
As noted in Part V.B.1.b. above, the
CCPRB will screen for Prue/Weathers class
membership when a civil action is involved. The CCPRB's class membership
determination will dictate the appropriate post-screening action.
•
If the claim pending in court was adjudicated in accordance with
SSR 85-28 and resolved
all Prue/Weathers issues, the claimant is not a
Prue/Weathers class member. The CCPRB will follow
the instructions in Part V.B.3.a. below
for processing non-class member claims.
•
If the claim pending in court was adjudicated in accordance with
SSR 85-28, but did not
resolve all Prue/Weathers issue(s), e.g., there is
a prior (inactive) Prue/Weathers claim and the
claim pending in court did not include the entire period covered by the
Prue/Weathers claim, and the claimant elects to
have the case remanded to the Commissioner for a redetermination (instead
of proceeding in court), the CCPRB will forward the
Prue/Weathers claim to the District of Columbia DDS
for readjudication. The CCPRB will modify the case flag in Attachment 9 to
indicate that the pending court case does not resolve all
Prue/Weathers issues and that the
Prue/Weathers class member claim is being forwarded
for separate processing. The CCPRB will notify the OAO Class Action
Coordinator of this action.
•
If the final administrative decision on the claim pending in court was not
adjudicated in accordance with
SSR 85-28 or is legally
insufficient for other reasons, the CCPRB will initiate voluntary remand
proceedings and consolidate the claims.
3.
Post-Screening Actions
a.
Non-Class Member Cases
If the screening component determines that the individual is not a class
member, the component will:
•
notify the individual, and representative, if any, of non-class membership
using Attachment 6 (modified as necessary to fit the facts and posture of
the case when there is a current claim);
Include the address and telephone number of the servicing Social Security
field office at the top of Attachment 6.
•
retain a copy of the notice in the claim file;
•
send a copy of the notice to:
Michael Schuster, Esq.
Legal Counsel for the Elderly
601
E. Street, N.W.
Washington, D.C. 20049•
retain the claim file(s) for 90 days pending a possible class membership
dispute;
•
if the screening component is not an OHA Headquarters component, and the
file(s) is not needed for adjudication, forward the file(s) for storage to
OAO at the address in Part V.A.3. above;
and
•
if class counsel makes a timely request for review, send the non-class
member claim file(s) to the District of Columbia field office (or other
mutually acceptable location) using the pre-addressed route slip in
Attachment 7.
Photocopy any material contained in the prior file that is relevant to the
current claim and place it in the current claim file before shipping the
prior file.
•
if SSA, through OGC, resolves the dispute in the claimant's favor: 1) the
original screening component or Litigation Staff will prepare a revised
screening sheet; 2) OHA jurisdiction cases will proceed in accordance with
Part VI. below; and 3) the rescreening
component will notify DLAI, at the address in
Part V.B.2. above, of the revised
screening determination by forwarding a copy of the revised screening
sheet to DLAI; and 4) DLAI will coordinate with the OAO Class Action
Coordinator, as necessary. OGC will notify class counsel of the reversal
of class membership, and class counsel will notify the claimant.
An individual who wishes to appeal a determination of non-class membership
may do so only through class counsel, as explained in the notice
(Attachment 6).
b.
Cases Determined To Be Class Members
If the screening component determines that the individual is a class
member, it will proceed with processing and adjudication in accordance
with the instructions in Part VI.
below.
VI. Processing and Adjudication
A. Cases Reviewed by the DDS
The District of Columbia DDS will conduct the first
Prue/Weathers review, except for cases consolidated
at the OHA level (see Part VI.D. below)
and cases in which a face-to-face review is appropriate (see the exception
in Part III. above). The DDS
determination will be a reconsideration determination regardless of the
administrative level at which the class member's claim(s) was previously
decided with full appeal rights (i.e., ALJ hearing, Appeals Council and
judicial review).
Except as otherwise noted in this instruction, ALJs should process and
adjudicate requests for hearing on Prue/Weathers
DDS review cases in the same manner as for any other case.
B. OHA Adjudication of Class Member Claims
The following instruction applies to both consolidation cases in which the
ALJ or Appeals Council conducts the Prue/Weathers
readjudication and to DDS readjudication cases in which the claimant
requests a hearing or Appeals Council review. Except as noted herein, HOs
and Headquarters will process Prue/Weathers class
member cases according to all other current practices and procedures
including coding, scheduling, developing evidence, routing, etc.
1.
Type of Review and Period To Be Considered
a.
Pursuant to the Prue/Weathers Stipulation and
Order, regardless of whether the claim under review is an initial claim or
cessation case, the type of review to be conducted is a redetermination.
The readjudication shall be a de novo reevaluation
of the class member's eligibility for benefits based on all evidence in
his or her file including newly obtained evidence relevant to the period
that was at issue in the administrative decision(s) that forms the basis
for Prue/Weathers class membership
b.
If the readjudication results in a favorable decision, the adjudicator
will determine, under the medical improvement standard, whether the class
member's disability has continued through the date of the readjudication
(or through the date of onset of disability established in any allowance
on a subsequent application)
c.
If the evidence establishes that disability began only at some point
after the administrative
determination(s)/decision(s) that forms the basis for
Prue/Weathers class membership, the class member
must file a new application to establish eligibility
2.
Step Two of the Sequential Evaluation
Prue/Weathers does not require any change in OHA's
current adjudicatory policies or practices with respect to step two of the
sequential evaluation. Effective with the enactment of the 1984 Amendments
to the Social Security Act, OHA's adjudicators have considered the
combined effect of individual “not severe” impairments in
evaluating disability claims at step two. ALJs and the Appeals Council
may, if appropriate, continue to deny or cease the disability claims of
District of Columbia residents in accordance with
20 CFR §§
404.1520(c),
404.1521,
404.1523,
416.920(c),
416.921 and
416.923 as well as SSR
85-28. The Acting Associate Commissioner's memorandum, dated
February 21, 1991 (Attachment 8), regarding the proper standard for
adjudicating claims at step two, remains in effect.
3.
Class Member Is Deceased
If a class member is deceased, the usual survivor and substitute party
provisions and existing procedures for determining distribution of any
potential underpayment apply.
C. Claim at OHA but No Current Action Pending
If the claim file (either a class member or a subsequent claim) is located
in OHA Headquarters, but there is no claim actively pending administrative
review, i.e., Headquarters is holding the file awaiting potential receipt
of a request for review or notification that a civil action has been
filed, OAO will associate the alert with the file and screen for class
membership. (See Part V.B.3., above, for
non-class member processing instructions.)
•
If the 120-day retention period for holding a claim file after an ALJ
decision or Appeals Council action has expired, OAO will attach a
Prue/Weathers class member flag (see Attachment 9)
to the outside of the file and send the claim file(s) to the District of
Columbia DDS (or to the appropriate DDS if the exception in
Part III. above applies) for review of
the Prue/Weathers class member claim.
•
If less than 120 days have elapsed, OAO will attach a
Prue/Weathers class member flag (see Attachment 10)
to the outside of the file to ensure that the case is routed to the
District of Columbia DDS (or to the appropriate DDS if the exception in
Part III. above applies) after expiration
of the retention period. Pending expiration of the retention period, OAO
will also:
•
return unappealed ALJ decisions and dismissals to DFB, OAO; and
•
return unappealed Appeals Council denials to the appropriate OAO
minidocket.
The respective OAO components will monitor the retention period and, if
the claimant does not seek further administrative or judicial review,
route the file(s) to the District of Columbia DDS (or the appropriate DDS
if the exception in Part III. above
applies) in a timely manner.
D. Processing and Adjudicating Class Member Claims in Conjunction with
Current Claims (Consolidation Procedures)
1.
General
If a class member has a current claim pending at any administrative level
and consolidation is warranted according to the guidelines below, the
appropriate component will consolidate all
Prue/Weathers class member claims with the current
claim at the level at which the current claim is pending.
2.
Current Claim Pending in the Hearing Office
a.
Hearing Scheduled or Held and all Remand Cases
Except as noted below, if a Prue/Weathers class
member has a request for hearing pending on a current claim, and the ALJ
has either scheduled or held a hearing, and in all remand cases, the ALJ
will consolidate the Prue/Weathers case with the
appeal on the current claim.
The ALJ will not consolidate the claims if
•
the current claim and the Prue/Weathers claim do
not have any issues in common; or
•
a court remand contains a court-ordered time limit and it will not be
possible to meet the time limit if the claims are consolidated.
If the claims are consolidated, follow
Part VI.D.2.c. below. If the claims are
not consolidated, follow Part VI.D.2.d.
below.
b.
Hearing Not Scheduled
Except as noted below, if a Prue/Weathers class
member has an initial request for hearing pending on a current claim and
the HO has not yet scheduled a hearing, the ALJ will not consolidate the
Prue/Weathers claim and the current claim. Instead,
the ALJ will dismiss the request for hearing on the current claim and
forward both the Prue/Weathers claim and the
current claim to the District of Columbia DDS (or to the appropriate DDS
if the exception in Part III. above
applies) for further action (see
Part VI.D.2.d. below).
If the hearing has not been scheduled because the claimant waived the
right to an in-person hearing, and the ALJ is prepared to issue a fully
favorable decision on the current claim, and this decision would also be
fully favorable with respect to all issues raised by the application that
makes the claimant a Prue/Weathers class member,
the ALJ will consolidate the claims.
If the claims are consolidated, follow
Part VI.D.2.c. below. If the claims are
not consolidated, follow Part VI.D.2.d.
below.
c.
Action if Claims Are Consolidated
If the ALJ decides to consolidate the current claim with the
Prue/Weathers claim(s), the HO will:
•
give proper notice of any new issue(s) as required by
20 CFR §§
404.946(b) and
416.1446(b), if
the Prue/Weathers claim raises an additional
issue(s) not raised by the current claim;
•
offer the claimant a supplemental hearing if the ALJ already has held a
hearing and the Prue/Weathers claim raises an
additional issue(s), unless the ALJ is prepared to issue a fully favorable
decision with respect to the Prue/Weathers claim;
and
•
issue one decision that addresses both the issues raised by the current
request for hearing and those raised by the
Prue/Weathers claim (the ALJ's decision will
clearly indicate that the ALJ considered the
Prue/Weathers claim pursuant to the
Prue/Weathers Stipulation and Order).
d.
Action if Claims Not Consolidated
If common issues exist but the ALJ decides not to consolidate the current
claim with the Prue/Weathers claim because a
hearing has not yet been scheduled, the ALJ will:
•
dismiss, without prejudice, the request for hearing on the current claim,
using the language in Attachment 11 and the covering notice in Attachment
12; and
•
send both the Prue/Weathers claim and the current
claim to the District of Columbia DDS (or to the appropriate DDS if the
exception in Part III. above applies) for
DDS consolidation and further action.
If the ALJ decides not to consolidate the
Prue/Weathers claim with the current claim because:
1) the claims do not have any issues in common; or 2) there is a
court-ordered time limit, the ALJ will:
•
flag the Prue/Weathers claim for DDS review using
Attachment 13; immediately route it to the District of Columbia DDS (or to
the appropriate DDS if the exception in
Part III. above applies) for
readjudication; and retain a copy of Attachment 13 in the current claim
file; and
•
take the necessary action to complete the record and issue a decision on
the current claim.
3.
Current Claim Pending at the Appeals Council
The action the Appeals Council takes on the current claim dictates the
disposition of the Prue/Weathers claim. Therefore,
OAO must keep the claim folders together until the Appeals Council
completes its action on the subsequent claim. The following sections
identify the possible Appeals Council actions on the current claim and the
appropriate corresponding action on the
Prue/Weathers claim.
a.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision
on the Current Claim — No Prue/Weathers
Issue(s) Will Remain Unresolved
This will usually arise when the current claim duplicates the
Prue/Weathers review claim, i.e., the current claim
raises the issue of disability and covers the entire period adjudicated in
the Prue/Weathers claim, and the current claim has
been adjudicated in accordance with the provisions of
SSR 85-28 and the
current severity regulations, i.e.,
20 CFR §§
404.1520(c),
404.1521,
404.1523,
416.920(c),
416.921 and/or
416.923. In this
instance, the Appeals Council will consolidate the claims and proceed with
its intended action.
The Appeals Council's order, decision or notice of action will clearly
indicate that the ALJ's or Appeals Council's action resolved or resolves
both the current claim and the Prue/Weathers
claim.
b.
Appeals Council Intends To Dismiss, Deny Review or Issue a Denial Decision
on the Current Claim — Prue/Weathers Issue(s)
Will Remain Unresolved
This will usually arise when the current claim does not duplicate the
Prue/Weathers claim, e.g., the current claim raises
the issue of disability but does not cover the entire period adjudicated
in the Prue/Weathers claim. For example, the
Prue/Weathers claim raises the issue of disability
for a period prior to the period adjudicated in the current claim. In this
instance, the Appeals Council will proceed with its intended action on the
current claim.
OAO staff will attach a Prue/Weathers case flag
(Attachment 9) to the Prue/Weathers claim,
immediately forward the Prue/Weathers claim to the
District of Columbia DDS (or to the appropriate DDS if the exception in
Part III. above applies) for
adjudication, and retain a copy of Attachment 9 in the current claim file.
OAO will modify Attachment 9 to indicate that the Appeals Council action
on the current claim does not resolve all
Prue/Weathers issues and that the
Prue/Weathers class member claim is being forwarded
for separate processing. OAO staff will include copies of the ALJ's or
Appeals Council's decision or order or notice of denial of request for
review on the current claim and the exhibit list used for the ALJ's or
Appeals Council's decision.
c.
Appeals Council Intends To Issue a Favorable Decision on the Current Claim
— No Prue/Weathers Issue(s) Will Remain
Unresolved
If the Appeals Council intends to issue a fully favorable decision on a
current claim, and this decision would be fully favorable with respect to
all issues raised by the application that makes the claimant a
Prue/Weathers class member, the Appeals Council
will proceed with its intended action. In this instance, the Appeals
Council will consolidate the claims, reopen the final determination or
decision on the Prue/Weathers claim, and issue a
decision that adjudicates both applications.
The Appeals Council's decision will indicate clearly that the Appeals
Council considered the Prue/Weathers claim pursuant
to the Prue/Weathers Stipulation and Order.
d.
Appeals Council Intends To Issue a Favorable Decision on the Current Claim
— Prue/Weathers Issue(s) Will Remain
Unresolved
If the Appeals Council intends to issue a favorable decision on a current
claim and this decision would not be fully favorable with respect to all
issues raised by the Prue/Weathers claim, the
Appeals Council will proceed with its intended action. In this situation,
the Appeals Council will request the effectuating component to forward the
claim files to the District of Columbia DDS (or to the appropriate DDS if
the exception in Part III. above applies)
after the Appeals Council's decision is effectuated.
OAO staff will include the following language on the transmittal sheet
used to forward the case for effectuation:
“Prue/Weathers court case review needed
— following effectuation forward the attached combined files to the
District of Columbia Disability Determination Service [address] (or to the
appropriate DDS if the exception in
Part III. above applies).”
e.
Appeals Council Intends To Remand the Current Claim to an ALJ
If the Appeals Council intends to remand the current claim to an ALJ, it
will proceed with its intended action unless one of the exceptions below
applies. In its remand order, the Appeals Council will direct the ALJ to
consolidate the Prue/Weathers claim with the action
on the current claim pursuant to the instructions in
Part VI.D.2.a. above.
The Appeals Council will not direct the ALJ to consolidate the claim
if
•
the current claim and the Prue/Weathers claim do
not have any issues in common; or
•
a court remand contains a court-ordered time limit and it will not be
possible to meet the time limit if the claims are consolidated.
If the claims do not share a common issue or a court-ordered time limit
makes consolidation impractical, OAO will forward the
Prue/Weathers class member claim to the District of
Columbia DDS (or to the appropriate DDS if the exception in
Part III. above applies) for separate
review. The case flag in Attachment 9 should be modified to indicate that
the Appeals Council, rather than an ALJ, is forwarding the
Prue/Weathers class member claim for separate
processing.
VII. Case Coding
HO personnel will code prior claims into the Hearing Office Tracking
System (HOTS) and the OHA Case Control System (OHA CCS) as
“reopenings.” If the prior claim is consolidated with a
current claim already pending at the hearing level (see
Part VI. above), HO personnel will not
code the prior claim as a separate hearing request. Instead, HO personnel
will change the hearing type on the current claim to a
“reopening.” If the conditions described in
Part VI.E.2.c. above apply, the ALJ
should dismiss the request for rehearing on the current claim, and HO
personnel should enter “OTDI” in the “DSP”
field.
To identify class member cases in HOTS, HO personnel will code
“WE” in the “Class Action” field. No special
identification codes will be used in the OHA CCS.
VIII. Reconciliation of Implementation
At an appropriate time, Litigation Staff will request SSA components to
reconcile their screening activity and disposition of class member claims
with information available on CATS. Within OHA, the OAO Class Action
Coordinator is responsible for maintaining a personal computer-based
record of OHA implementation activity (e.g., a record of alerts processed
by OHA, and a record of cases screened and consolidated by OHA), as
reported by HOs and OAO to the Coordinator. See
Part V.B.2.a. and
HALLEX
HA 01170.012 with respect
to the reporting requirements.
IX. Inquiries
HO personnel should direct any questions to their Regional Office.
Regional Office 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. Prue/Weathers v. Sullivan Stipulation and
Order; Approved by the United States District Court for the District of
Columbia and Filed July 23, 1993.
UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
Nos. 84-3035 and 84-3870 (TPJ)
[filed July 23, 1993]
LILIA M. WEATHERS,
JESSIE PRUE, Plaintiffs,
v.
LOUIS W. Sullivan, M.D.,
Secretary of Health and
Human
Services, Defendant.
STIPULATION AND ORDER
IT IS STIPULATED by plaintiffs and defendant, through their respective
counsel, that the following terms are agreed to in full settlement of the
above-captioned civil action.
1.
Pursuant to this Stipulation and Order, the individual appeals of Lilia M.
Weathers and Jessie Prue, which were dismissed, shall be reviewed by the
District Court in accordance with 42 U.S.C. 405(g).
2.
Pursuant to this Stipulation and Order, the class entitled to relief now
consists of:
all persons who resided in the District of Columbia between July 28, 1984
and March 4, 1985, inclusive', and who were issued a decision which became
final at any level of the administrative appears process, denying or
terminating disability insurance benefits or Social Security income
payments under the Social Security Act, 42 U.S.C. § 401 et seg. based
upon a finding that they did not have a severe impairment(s).
3.
The Social Security Administration (SSA) shall, by means of it's data
processing systems, commence identification of the names, Social Security
numbers and last known addresses of all potential class members. SSA shall
make good faith efforts to complete such identification within 120 days of
the date of entry of this Stipulation and Order.
4.
Within 150 days of entry of this Order, SSA will issue instructions to SSA
adjudicators for screening potential class members claims and for
reviewing the claims of class members. SSA will simultaneously provide
copies of all instructions and directives to class counsel.
5.
Upon completion of the identification procedure described in paragraph 3,
and within 60 days of the issuance of instructions in paragraph 4, SSA
shall send a notice by first class mail to each potential class member so
identified at his/her last known address. A copy of the notice is attached
to this Stipulation and Order. The notice will advise potential class
members of possible entitlement to a redetermination of their claims and
will further state that the potential class member must return the
pre-addressed postage-paid envelope and accompanying response form within
60 days from the date of receipt of the notice in order to receive
consideration for relief.
6.
If a person who receives a notice pursuant to paragraph 4 requests review
more than 60 days after receiving such notice, the Secretary shall
determine whether that person has “good cause” for the late
request, as defined in 20
C.F.R. §§ 404.911,
416.1411. The
time in which a potential class member must respond to the notice shall
begin to run upon receipt of the notice by the potential class member.
20 C.F.R. §§
404.901,
416.1401.
7.
For those individuals who timely respond to the notice described in
paragraph 4 above, SSA will screen the applicable claims folders or other
relevant records to determine if they are class members. Those individuals
who have been determined not to be class members will be notified in
writing of such determination and will be further informed of their right
to request a review of their administrative record in accordance with the
procedures set forth in paragraphs 8 through 11.
8.
Individuals who disagree with a finding that they do not meet the class
membership criteria may contact or write class counsel. Class counsel may,
within 60 days of the date of the class determination notice, notify in
writing the Office of the General Counsel, Department of Health and Human
Services, Social Security Division, Social Security Administration,
Altmeyer Building, 6401 Security Boulevard, Baltimore, Maryland 21235,
that they wish to review the individual claim file. Within 30 days of
class counsel's written request to review the file, SSA will make
available that individual's claim file or other relevant documents on
which the class membership decision was based at a designated SSA field
office in Washington, D.C. or other mutually acceptable location, and will
notify class counsel in writing. A staff person within the Office of the
General Counsel, shall be designated to facilitate the resolution of the
class membership disputes and the name and telephone number of that person
shall be provided to class counsel. Class counsel must reviewed files
within 30 days of the date the files are made available to them.
If, at the expiration of the 30 days, class counsel have not reviewed the
file, it shall be assumed that review is no longer desired and SSA's
non-class membership determination shall become final and not subject to
further review.
9.
If class counsel's review of the file establishes that there is a dispute
as to whether the individual is a class member, class counsel will again
notify the Office of the General Counsel. Both parties will then attempt
to resolve the dispute. In the event the parties are unable to settle the
dispute, class counsel may submit any unresolved dispute to the Court for
final resolution by proper motion made within 30 days of the date of
written notice, by the Office of the General Counsel. Failure of class
counsel to request a judicial determination within the aforesaid 30 day
period shall render SSA’s non-class membership determination final
and not subject to further review,
10.
The Social Security Administration will not review the claim of any
potential class member who:
a.
appealed the administrative determination resulting in class membership
which:
i.
culminated in a subsequent administrative determination after March 4,
1985;
ii.
culminated in a subsequent administrative determination on or before March
4, 1985, if the determination was not based upon a finding of a not severe
impairment; or
iii.
was affirmed by a federal court at any time or;
b.
was issued an administrative or judicial determination on a subsequent
application which covered the entire period at issue in the individual's
claim covered by this action.
11.
The claim of class members shall be predetermined to ensure that the
decision upon which class membership is based was correct based on the
evidence of record. The Secretary shall redertimine the applications of
all persons found to be class members using the Secretary’s present
severity regulations.
20 C.F.R. §§
404.1520(c),
416.920(c).
Where, upon such review, an individual's impairments are considered to
have been severe (either individually or in combination), the Secretary
shall evaluate the individual's claim in accordance with the sequential
evaluation process set forth at
20 C.F.R. §§
404.1520,
416.920 (1991).
The claims of all class members shall be redetermined at the
reconsideration stage of the administrative process.
20 C.F.R. §§
404.907-913a,
416.1404-1413a.
The Secretary will consider new evidence, but only as it pertains to the
period covered by the decision rendered during the time period at issue in
the instant case. For consideration of a disability beginning subsequent
to the decision upon which class membership is based, class members are
required to have filed a new application. All class members who requested
redetermination will receive notices informing them of the decision made
concerning their claims following redetermination. Class members shall
retain all rights to administrative and judicial review of decisions made
as a consequence of this order.
12.
At the option of SSA, class members with subsequent disability claims,
active and simultaneously pending at my administrative level of review at
the time the class claim is being evaluated, may have all other claims
consolidated with the class Claim and reviewed simultaneously.
13.
Class members having individual actions pending in Federal court
challenging the unfavorable administrative decision resulting in class
membership may elect either to have their claims remanded to the Secretary
for redetermination pursuant to paragraph 11 of this Stipulation and Order
or to have the action proceed in Federal court pursuant to, and subject
to, the limitations contained in 42 U.S.C. § 405(g). A class member
opting to continue his civil litigation in Federal court waives his rights
under this Stipulation and Order.
14.
The claims of individuals determined to be class member will be reviewed
and, if determined to be eligible, class member will be paid from:
a.
the sixth month following the date of established onset of disability, or
12 months prior to this date of filing, whichever is later, in cases where
benefits under title II were denied;
b.
the date of application, in cases where benefits under title XVI were
denied; or
c.
the date of the termination of benefits.
15.
SSA will monitor the implementation of this Order and will provide to
class counsel, on a quarterly basis, reports containing the following
information:
a.
the number of persons notified initially of potential class
membership;
b.
the number of persons who responded to the notice;
c.
the number of persons responding who were determined not to be class
members;
d.
the number of persons responding determined to be class members
e.
the number of class members found eligible for disability benefits upon
readjudication by the District of Columbia Department of Human Resources,
Disability Determination division (DDD);
f.
the number of class members whose applications were denied upon
readjudication by the DDD.
Upon agreement between the parties, this reporting requirement may be
altered or amended.
16.
The parties may, by written agreement, alter any time period specified in
this Stipulation and Order. Such agreements need not be filed with the
court, unless either party deems it appropriate to do so.
17.
If either party seeks judicial resolution any dispute arising under this
Stipulation and Order, the time limits set forth in this Stipulation and
Order which are affected thereby will be suspended, and will begin running
anew only following resolution of the issue by the court.
18.
Within 30 days of the approval of this stipulation and order by the Court,
SSA shall make good faith efforts to pay to class counsel attorney fees in
the amount of $35,000.00 in full and final settlement of any and all
claims in this action for attorney fees, expenses or costs pursuant to any
statute or other basis for services that have been performed.
19.
With respect to this action, the court shall retain jurisdiction only over
matters relating to compliance with terms of this Stipulation and Order
and previous orders of this Court.
20.
This Stipulation and Order is not and shall not be construed as an
admission by the Secretary of the truth of any allegations or the validity
of any claim asserted in this action or of defendant's liability therein,
nor is it a concession or an admission of any fault or omission in any act
or failure to act, or any statement, written document or report heretofore
issued, filed, or made by any Secretary nor shall this Stipulation and
Order nor any papers related hereto, nor any of the terms hereof be
offered or received in evidence or in any way referred to in any civil,
criminal, or administrative action or proceeding other than such
proceedings as may be necessary to consummate or enforce this Stipulation
and Order, nor shall they be construed by anyone for any purpose
whatsoever as an admission of any wrongdoing on the part of
defendant.
21.
The terms set forth in this Stipulation and Order shall be in full
settlement and satisfaction of any and all claims and demands, of whatever
nature, the plaintiffs had or may hereafter acquire against the defendant,
and any of his agencies, agents, employees, or instrumentalities on
account of and with respect to the incidents, claims or circumstances
giving rise to and/or alleged in the pleadings filed herein.
22.
The undersigned plaintiffs' counsel hereby represent, warrant, and
guarantee that they are duly authorized to execute this Stipulation and
Order on behalf of the plaintiffs and all of the members of the class they
represent, and all counsel for individual plaintiffs. The Secretary's
counsel, by signing below, represent that they are authorized to stipulate
to the settlement of issues in this action.
23.
This Stipulation and Order shall be effective only upon entry of the order
by the court.
Respecctfully submitted,
/s/
Michael Schuster, Bar 934133
Legal Counsel
for the Elderly
601 E Street, N.W.
Washington,
D.C. 20049
/s/
Gay Gellhorn,
District of Columbia School
of Law
719 13th St., N.W.
Washington, D.C.
20005
/s/
Peter Meyers
George Washington University
Community
Legal Clinic
720 20th St., N.W. Suite 101
Washington,
D.C. 20052
/s/
Jay B. Stwvens, D.C. Bar #177840
United States
Attorney
John D. Bates, D.C. Bar #934927
Assistant
United States Attorney
/s/
Claire Whiteker, D.C. Bar #354530
Assistant
United States Attorney
Judiciary Center Building
555
4th St., N.W. Room 4211
Washington, D.C. 20001
/s/
So ordered: Dated: 7/23/93 Honorable Thomas P. Jackson United States
District Judge
Attachment 2 -. PRUE/WEATHERS COURT CASE FLAG/ALERT
TITLE: CATEGORY:
REVIEW
OFFICE
PSC MFT DOC ALERT
DATE
BOAN OR
PAN NAME
CAN
OR HUN RESP
DTETOE
FOLDER LOCATION
INFORMATION
TITLE CFL CFL
DATE ACN PAYEE
ADDRESS
SCREENING OFFICE
ADDRESS:
Office of Disability and
International Operations
P.O. Box
17369
Baltimore, MD
21298-0050
OR
Appropriate
DDS
ATTN:
Prue/Weathers Screening
Unit
IF CLAIM IS PENDING OR STORED IN
OHA, THEN SHIP TO:
Office of Hearings
and Appeals
Office of Appellate Operations
(OAO)
One Skyline Tower, Suite
701
5107 Leesburg
Pike
Falls Church, VA
22041-3200
ATTN: OAO Class Action
Coordinator
(Case locator code
5007)
Attachment 3. Prue/Weathers Class Action Case
SCREENING NECESSARY
Claimant's Name: __________________________________
SSN: __________________________________
This claimant may be a Prue/Weathers class member.
The attached folder location information indicates that a current claim
file is pending in your office. Accordingly, we are forwarding the
attached alert [and prior claim file(s)] for association, screening for
class membership, consolidation consideration and possible
readjudication.
Please refer to HALLEX TI 5-4-19 for
additional information and instructions.
TO:
__________________________
_____________________________
_____________________________
_____________________________
Attachment 4. PRUE/WEATHERS SCREENING SHEET
|
1. CLASS ACTION CODE: W E |
|
|
2. WAGE EARNER'S SOCIAL SECURITY NUMBER
___ ___ ___ - ___ ___ - ___ ___ ___ ___
|
BIC
___ ___
|
|
3. CLAIMANT'S NAME (FIRST, MI, LAST)
|
|
4. SCREENING DATE (MONTH, DAY, YEAR)
___ ___ - ___ ___- ___ ___
|
|
5. a. SCREENING RESULT
[____] MEMBER (J) [____] NONMEMBER (F)
|
b. SCREENOUT CODE
[____] [____]
(see Item 13 for screenout codes)
|
|
6. Is this a DIB, CDB claim or a SSID adult claim? |
___ Yes ____ No
(if No, go to 13)
|
|
7. Did the claimant reside in the District of Columbia and receive a title II or title XVI less than fully favorable determination/decision or termination at any administrative level between July 28, 1984, and March 4, 1985, inclusive? |
___ Yes ____ No
(if No, go to 13)
|
|
8. Did this determination/decision become the final decision of the Secretary? (Note: Although not the “final decision of the Secretary,” an Appeals Council denial of a request for review is the last action of the Secretary, and the date of such a denial controls for class membership screening purposes.) |
___ Yes ____ No
(if No, go to 13)
|
|
9. Was the determination/decision made on the basis of a finding of a “not severe” impairment(s)? |
___ Yes ____ No
(if No, go to 13)
|
|
10. Was the administrative decision affirmed by a Federal Court at any time? |
___ Yes ____ No
(if Yes, go to 13)
|
|
11. Did the claimant receive a subsequent fully favorable determination/decision which established entitlement and paid benefits commencing with the earliest possible month of entitlement in the potential Prue/Weathers claim (i.e., based on the earliest alleged onset date?) |
___ Yes ____ No
(if Yes, go to 13)
|
|
12. Did the claimant receive an administrative or judicial decision, either favorable or unfavorable, after March 4, 1985, on a subsequent claim which covered the entire timeframe at issue in the potential Prue/Weathers claim? |
___ Yes ____ No
(if Yes, go to 13)
|
|
13.The claimant is not a Prue/Weathers class member.
Check the nonmember block in item 5.a. and enter the screenout code in item 5.b. as follows:
Enter 06 if question 6 was answered “NO.”
Enter 07 if question 7 was answered “NO”
Enter 08 if question 8 was answered “NO.”
Enter 09 if question 9 was answered “NO.”
Enter 10 if question 10 was answered “YES.”
Enter 11 if question 11 was answered “YES.”
Enter 12 if question 12 was answered “YES.”
|
No other screenout code entry is appropriate.
After completing 5.b. check the appropriate box in 5.a.
|
|
ENTER SCREENER’S NAME:
SIGNATURE:
|
SCREENING COMPONENT CODE AND PHONE NO.
|
DATE
|
|
Enter dates of all applications screened and the date of the final determination/decision for each application.
__________ __________ __________ __________
|
Attachment 5. Route Slip for Routing Court Case Alert (and Prior Claim
Files)—OHA No Longer Has Current Claims
|
ROUTING AND TRANSMITTAL SLIP |
DATE: |
|
TO: |
INITIALS |
DATE |
|
1. |
|
|
|
2. |
|
|
|
3. |
|
|
|
4. |
|
|
|
5. |
|
|
|
6. |
|
|
|
7. |
|
|
|
XX |
ACTION |
|
FILE |
|
NOTE AND RETURN |
|
|
APPROVAL |
|
FOR CLEARANCE |
|
PER CONVERSATION |
|
|
AS REQUESTED |
|
FOR CORRECTION |
|
PREPARE REPLY |
|
|
CIRCULATE |
|
FOR YOUR INFORMATION |
|
SEE ME |
|
|
COMMENT |
|
INVESTIGATE |
|
SIGNATURE |
|
|
COORDINATION |
|
JUSTIFY |
|
|
REMARKS
PRUE/WEATHERS CASE
Claimant: ___________________________
SSN: ________________________________
OHA received the attached alert [and prior claim file(s)] for screening
and no longer has the current claim file. Our records show that you now
have possession of the current claim. Accordingly, we are forwarding the
alert and any accompanying prior claim file(s) for association with the
current claim. After associating the alert with the current claim, please
forward to ODIO or to the DDS, if appropriate, for screening.
SEE POMS DI 12530.001 ff., DI 32530.001 ff., OR DI 42530.001 ff.
Attachment
DO NOT use this form as a RECORD of approvals, concurrences,
disposals,
clearances, and similar actions.
|
FROM:
Office of Hearings and Appeals
__________________________________________
|
SUITE/BUILDING |
|
PHONE NUMBER |
OPTIONAL FORM 41 (Rev. 7-76)
*U.S.GPO:1985-0-461-274/20020
Prescribed by GSA
FPMR (41 CFR) 101-11.206
Attachment 6. Non-Class Membership Notice
SOCIAL
SECURITY Important Information
NOTICE
_____________________________________________________________
From: Department of Health and Human Services
Social Security Administration
_____________________________________________________________
___________________________ DATE: __________________
___________________________ CLAIM NUMBER: __________________
___________________________ DOC: ___________________________
We are writing to tell you that we received your request to review your
earlier claim for disability benefits under the
Prue/Weathers settlement agreement. We have looked
at your case and have decided that you are not a class member. This means
that we will not review our earlier decision that you were not
disabled.
Why You Are Not a Class Member
You are not a Prue/Weathers class member
because:
|
[ ] |
You never filed a claim for disability benefits or Supplemental Security Income benefits. |
|
[ ] |
You did not reside in the District of Columbia at any time between July 28, 1984, and March 4, 1985, inclusive. |
|
[ ] |
Your claim for disability benefits was not denied or ceased at any administrative level between July 28, 1984, and March 4, 1985, inclusive. |
|
[ ] |
You received a less than fully favorable or termination decision from Social Security between July 28, 1984, and March 4, 1985, inclusive, but it was not based on a finding of “no severe” impairment(s). |
|
[ ] |
Your case was decided by a Federal court. |
|
[ ] |
You received a fully favorable decision based on your earliest onset date and you were fully paid. |
|
[ ] |
You received a decision on a later claim, which covered the entire timeframe at issue in the potential Prue/Weathers claim. |
|
[ ] |
Your benefits were denied or terminated for a reason other than your medical condition. The reason was:
_____________________________________________________
_____________________________________________________
_____________________________________________________
|
|
[ ] |
Other (Explain) _____________________________________ |
If you disagree with our decision, you should call or write class counsel,
who will answer your questions about class membership. Class counsel have
only 60 days from the date you receive this notice to let Social Security
know you disagree with our reason as to why you are not a class member.
You may contact the Prue/Weathers class counsel by
calling (202) 434-2170. Class counsel will answer your questions about
class membership without charge. The names and addresses of class counsel
are:
Gay Gellhorn
District of Columbia Schoool of Law
Public
Entitlements Clinic
719 13th Street, N.W.
Washington,
D.C. 20005Michael Schuster
Legal Counsel for the Elderly
601
E Street, N.W.
Washington, D.C. 20049Peter Meyers
George Washington University
Community
Legal Clinic
720 20th Street, N.W. SL 101
Washington,
D.C. 20052
We Are Not Deciding If You Are Disabled
It is important for you to know that we are not making a decision about
whether you are currently disabled. We are deciding only that you are not
a Prue/Weathers class member.
If You Are Disabled Now
If you think you are disabled now, you should fill out a new application
at any Social Security Office. A new application, however, is not the same
as receiving a review of your prior claim. Class counsel can give you
further advice.
If You Have Any Questions
If you have any questions, you may contact class counsel or your local
Social Security Office. Most questions can be answered by telephone. The
address and telephone number are printed at the top of this letter. If you
call or visit Social Security, please have this letter with you. It will
help us answer your questions.
Si usted no entiende esta carta, llevela a la oficina de Seguro Social arriba mencionada para que se la expliquen.
cc: Michael Schuster
Washington, D.C.
20049
(Representative, if any)
Attachment 7. Route Slip for Non-Class Membership Cases
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ROUTING AND TRANSMITTAL SLIP |
DATE: |
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TO: |
INITIALS |
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1. SSA District Office |
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2. 2100 M Street, N.W. |
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3. Washington, D.C. 20203 |
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4. |
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5. [or other mutually acceptable location] |
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7. |
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XX |
ACTION |
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FILE |
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NOTE AND RETURN |
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APPROVAL |
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FOR CLEARANCE |
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PER CONVERSATION |
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AS REQUESTED |
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FOR CORRECTION |
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PREPARE REPLY |
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CIRCULATE |
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FOR YOUR INFORMATION |
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SEE ME |
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COMMENT |
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INVESTIGATE |
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SIGNATURE |
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COORDINATION |
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JUSTIFY |
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REMARKS
PRUE/WEATHERS
Claimant: ___________________________
SSN: ________________________________
We have determined that this claimant is not a
Prue/Weathers class member. (See screening sheet
and copy of non-class membership notice in the attached claim folder(s).)
Class Counsel has timely requested to review this determination and the
attached claim folder(s).
SEE POMS DI 12530.001 ff.
Attachment
DO NOT use this form as a RECORD of approvals, concurrences,
disposals,
clearances, and similar actions.
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FROM:
Office of Hearings and Appeals
__________________________________________
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SUITE/BUILDING |
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PHONE NUMBER |
OPTIONAL FORM 41 (Rev. 7-76)
*U.S.GPO:1985-0-461-274/20020
Prescribed by GSA
FPMR (41 CFR) 101-11.206
Attachment 8. Acting Associate Commissioner's Memorandum Dated February 21, 1991,
Entitled “The Standard for Evaluating 'Not Severe'
Impairments.”
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Social Security Administration
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_______________________________________________________________________
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Refer to: FEB 21, 1991
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Office of Hearings and Appeals
PO
Box 3200
Arlington VA 22203
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MEMORANDUM TO:
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Headquarters Executive Staff
Appeals Council Members
Regional Chief Administrative Law Judges
Hearing Office Chief Administrative Law Judges
Administrative Law Judges
Supervisory Staff Attorneys
Decision Writers
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FROM:
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Acting Associate Commissioner
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SUBJECT:
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The Standard for Evaluating “Not Severe” Impairments — ACTION
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During the past few months, the Office of the General Counsel (OGC) has
requested voluntary remand in a number of cases, denied by the Secretary
at step two of the sequential evaluation, on the grounds that the
decisions have not been fully consistent with SSA policy and the Supreme
Courts opinion in Bowen v. Yuckert, 482 U.S. 137 (1987).
Despite the Yuckert decision, extensive litigation, both in individual
cases and in significant class actions, continues on the issue of how the
Agency applies the step two standard expressed in
Social Security Ruling (SSR)
85-28. Because the courts continue to give step two denials close
scrutiny, I am asking all adjudicators and decision writers to carefully
review SSR 85-28 to
ensure that they are applying the proper standard for adjudicating claims
at step two.
In accordance with SSR
85-28, a step two denial is appropriate only in very limited
situations. The evidence must establish that the claimants impairment, or
combination of impairments, is so slight that it does not have more than a
minimal effect on the individual's ability to perform basic work
activities. When the medical evidence is inconclusive and does not clearly
establish the effect of a claimant impairment(s), or when the evidence
shows more than a minimal effect, the claim may not be denied at step
two.
Decisions denying claims at step two must include a comprehensive analysis
of all the evidence of record and a decisional rationale consistent with
SSR 85-28. Even when
the medical evidence of record clearly fails to establish that the
claimant has more than a slight mental or physical abnormality, the
decision must clearly show that the adjudicator evaluated all the evidence
and must articulate the reasons for finding that the impairment(s) is not
severe. Furthermore, when the claimant has a medically determinable
impairment(s) which might reasonably be expected to cause pain the
decision must include an evaluation of the claimant's subjective
complaints using the factors outlined in
SSR 88-13 or its
equivalent, i.e., SSR
90-1p for Circuit cases.
If hearing office personnel have questions or need copies of applicable
instructions, they should contact the appropriate Regional Office.
Regional Office personnel should direct their questions to the Division of
Field Practices and Procedures, Office of the Chief Administrative Law
Judge.
Lawrence W. Mason for Andrew J. Young
Attachment 9. Class Member Flag for Headquarters Use (DDS Readjudication —
retention period expired)
Prue/Weathers Class Action Case
READJUDICATION NECESSARY
Claimant's Name:
__________________________________
SSN :
__________________________________
This claimant is a Prue/Weathers class member. Accordingly, we are forwarding the attached claim file(s) to the DDS for readjudication.
Send file(s) to:
Department of Human Resources/Vocational
Rehabilitation Administration
Disability
Determination Division
P.O.
Box 37608
Washington,
D.C. 20013
(Destination code: ____ )
If a face-to-face is required, i.e., cessation or terminal illness (TERI)
case, the claim file must be sent to the “resident” DDS (see
Part III. of the TI).
Attachment 10. Class Member Flag for Headquarters Use (DDS Readjudication —
retention period was not expired)
Prue/Weathers Class Action Case
READJUDICATION NECESSARY
Claimant's Name:
__________________________________
SSN :
__________________________________
This claimant is a Prue/Weathers class member.
After expiration of the retention period, forward claim file(s) to the DDS
for readjudication.
Send the file(s) to:
Department of Human Resources/Vocational
Rehabilitation
Administration
Disability Determination Division
P.O.
Box 37608
Washington, D.C. 20013
(Destination code: ____ )
If the claimant has filed a civil action and elected to remain in court
for review of the current claim, forward the
Prue/Weathers claim file(s) without delay to the
DDS for readjudication.
If a face-to-face review is required, i.e., cessation or terminal illness
(TERI) case, the claim file must be sent to the “resident”
DDS (see Part III. of the TI).
DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Social
Security
Administration
OFFICE OF HEARINGS AND APPEALS
ORDER OF DISMISSAL
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IN THE CASE OF
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CLAIM FOR
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__________________________
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__________________________
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__________________________
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__________________________
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This case is before the Administrative Law Judge pursuant to a request for
hearing filed on _________________ with respect to the application(s)
filed on _________________.
In accordance with the Stipulation and Order negotiated by the parties and
approved by the United States District Court for the District of Columbia
in the case of Prue/Weathers, et al. v. Sullivan,
Nos. 84-3035 and 84-3870 (D.D.C. July 23, 1993), the claimant has
requested a redetermination of the final (determination/decision) on the
prior application(s) filed on ______________. The claimant has been
identified as a Prue/Weathers class member and is
entitled to have the final administrative denial of the prior
application(s) reviewed under the terms of the
Prue/Weathers Stipulation and Order. Because the
claimant's current claim shares certain issues in common with the prior
claim, the undersigned hereby dismisses without prejudice the request for
hearing.
The claimant's current application(s) will be associated with the prior
claim(s) and forwarded to the District of Columbia Disability
Determination Service [or the “resident” DDS, if appropriate]
which will conduct the Prue/Weathers
redetermination.
The Disability Determination Service will notify the claimant of its new
determination and of the claimant's right to file a new request for
hearing.
_________________________
Administrative Law Judge
_________________________
Date
Attachment 12. Notice Transmitting ALJ Order of Dismissal
NOTICE OF DISMISSAL
Claimant's Name
Address
City, State Zip
Enclosed is an order of the Administrative Law Judge dismissing your
request for hearing and returning your case to the District of Columbia
Disability Determination Service [or the “resident” DDS, if
appropriate] which makes disability determinations for the Social Security
Administration. Please read this notice and Order of Dismissal
carefully.
What This Order Means
The Administrative Law Judge has sent your current claim and your
Prue/Weathers class member claim back to the
District of Columbia Disability Determination Service [or the
“resident” DDS, if appropriate] for further processing. The
enclosed order explains why.
The Next Action on Your Claim
The District of Columbia Disability Determination Service will contact you
to tell you what you need to do. If you do not hear from the District of
Columbia Disability Determination Service [or the “resident”
DDS, if appropriate] within 30 days, contact your local Social Security
Office.
Do You Have Any Questions?
If you have any questions, contact your local Social Security Office. If
you visit your local Social Security Office, please bring this notice and
the Administrative Law Judge's order with you.
Enclosure
cc: (Name and address of representative, if any)
(Social Security
Office (City, State))
Attachment 13. Class Member Flag for HO Use (DDS Readjudication)
Prue/Weathers Class Action Case
READJUDICATION NECESSARY
Claimant's Name: __________________________________
SSN: __________________________________
This claimant is a Prue/Weathers class member. The
attached Prue/Weathers claim file was forwarded to
this hearing office for possible consolidation with a current claim.
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The Administrative Law Judge has determined that the prior and current claims do not share a common issue and, therefore, should not be consolidated.
OR
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The claims have not been consolidated because:
[state reason(s)]
____________________________________________
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Accordingly, we are forwarding the attached alert and prior claim file(s)
to your location for any necessary Prue/Weathers
readjudication action.
We are sending the alert and prior folder(s) to:
Department of Human Resources/Vocational
Rehabilitation
Administration
Disability Determination Division
P.O.
Box 37608
Washington, D.C. 20013
(Destination
code: ____)
If a face-to-face review is required, i.e., cessation or terminal illness
(TERI) case, the claim file must be sent to the “resident”
DDS (see Part III. of the TI).