ISSUED: November 15, 1993
I. Purpose
This Temporary Instruction (TI) sets forth procedures for implementing the
parties' October 21, 1992 Settlement Agreement, approved by the United
States District Court for the District of Connecticut on October 26, 1992,
in the Martel v. Sullivan class action involving
the standard for determining disability in surviving spouse claims.
Adjudicators throughout the country must be familiar with this TI because
Martel class members who now reside outside of
Connecticut must have their cases processed in accordance with the
requirements of the settlement agreement.
II. Background
On April 3, 1989, plaintiff filed a complaint challenging the Secretary's
listings-only policy of evaluating disability with respect to the title II
claims of widows, widowers and surviving divorced spouses.¹ On
October 8, 1989, plaintiff filed an amended complaint seeking class status
and relief.
Congress enacted the Omnibus Budget Reconciliation Actof 1990 (OBRA 90)
(Pub. L. 101-508) on November 5, 1990. Section 5103 of OBRA 90 amended
§ 223 of the
Social Security Act to repeal the special definition of disability
applicable in widows' claims and conform the definition of disability for
widows to that for all other title II claimants and title XVI adult
claimants. The amendment became effective for entitlement to monthly
benefits payable for January 1991, or later, based on applications filed
or pending on January 1, 1991, or
filed later.
The U.S. District Court for the District of Connecticut certified a
statewide class on May 14, 1991 (see
Part IV. below, for class definition).
On May 22, 1991, the Commissioner of Social Security published
Social Security Ruling (SSR)
91-3p to provide a uniform, nationwide standard for the evaluation
of disability in widows' claims for the pre-1991 period.
Because the merits of plaintiffs' challenge were resolved by the enactment
of § 5103 of OBRA 90 and the publication of
SSR 91-3p, the parties
agreed to settle the remaining class relief issues. On October 26, 1992,
the district court approved the parties' October 21, 1992 Settlement
Agreement setting forth the terms for the implementation of relief to
class members (Attachment 1).
¹ Hereinafter (except in
Part IV. below), the term
“widows” is used only for convenience; it is intended to
refer to all persons treated similarly under title II, i.e., widows,
widowers and surviving divorced spouses.
III. Guiding Principles
Under Martel, the Secretary will reopen and
readjudicate the claims of those persons who: 1) respond to notice
informing them of the opportunity for review and 2) are determined to be
class members after screening (see
Part V. below). The Disability Review
Section in the Northeastern Program Service Center (NEPSC) will screen
folders for class membership, unless there is a current claim pending at
OHA. Regardless of the state of the claimant's current residence, the
Connecticut Disability Determination Service (CDDS) will, in most cases,
perform the agreed upon readjudications, irrespective 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 necessary; 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 CDDS will be processed at the reconsideration
level regardless of the final level at which the claim 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).
Adjudicators must use the disability evaluation standards reflected in
§ 5103 of OBRA 90 (42 U.S.C. § 423(d)(2) (1992)) and
SSR 91-3p for evaluating
disability in Martel class member claims. The
disability evaluation standard enacted by § 5103 of OBRA 90 is
effective for entitlement to monthly benefits payable for January 1991 or
later.² (See HALLEX TI 5-315, issued
February 11, 1991, for further instructions on processing disabled widows'
claims under the provisions of § 5103 of OBRA 90.) The disability
evaluation standard announced in
SSR 91-3p must be used
for the evaluation of disability and entitlement to benefits payable for
the pre-1991 period.
² The final rules implementing § 5103 of OBRA 90
were published in the Federal Register on July 8, 1992, at 57 Fed. Reg.
30116. (See 20 CFR
§§ 404.1505(a) and
404.1511(a).)
IV. Definition of Class
For purposes of implementing the terms of the settlement agreement, the
Martel class is divided into two subclasses. The
first consists of all Connecticut residents who:
•
filed for or received title II benefits as a disabled widow, widower or
surviving divorced spouse; and
•
were issued a less than fully favorable (i.e., later onset, closed period,
denied or terminated) final administrative determination or decision,
based on medical reasons, between May 1, 1983, and August 12, 1989,
inclusive; and
•
timely filed a request for reconsideration of the initial determination or
reapplied for disabled widow's benefits between the date of the initial
determination and May 22, 1991, inclusive.
The second subclass consists of all Connecticut residents who:
•
filed for or received title II benefits as a disabled widow, widower or
surviving divorced spouse; and
•
were issued a less than fully favorable (i.e., later onset, closed period,
denied or terminated) final administrative determination or decision,
based on medical reasons, between August 13, 1989, and May 22, 1991,
inclusive.
A person is not a class member eligible for class relief if
(1) the individual received an adverse decision on a worker's claim for
disability benefits under title II or title XVI (adult) at steps 4 or 5 of
the sequential evaluation and that decision covered the timeframe at issue
in all of the potential Martel claims; or
(2) the individual received a favorable determination or decision after
May 21, 1991, on a subsequent claim that raised the issue of disability
and covered the timeframe at issue in the potential
Martel claim, i.e., the onset date alleged in
connection with the subsequent claim was on or before the onset date
alleged in connection with the potential Martel
claim. This exception applies only if the individual has received all
benefits to which he or she could be entitled based on the potential class
member claim.
V. Determination of Class Membership and Preadjudication
Actions
1.
Notification
On April 23, 1993, SSA sent notices to all potential class members
identified by computer run. Individuals had 60 days from the date of
receipt of the notice to request that SSA readjudicate their claims under
the terms of the Martel settlement agreement.
Notices returned as undeliverable will be mailed a second time if SSA
obtains an updated address.
The Office of Disability and International Operations (ODIO) will retrieve
the disability claim files of late responders and send them, together with
the untimely responses, to the servicing Social Security field office
(i.e., district or branch office) to develop good cause for the untimely
response. Good cause determinations will be based on the standards in
20 CFR §
404.911. If good cause is established, the field office will
forward the claim for screening.
2.
Alert and Folder Retrieval Process
All response forms will be returned to ODIO and the information will be
entered into the Civil Actions Tracking System (CATS). CATS will generate
alerts to ODIO. See Attachment 2 for a sample
Martel alert.
In most instances, ODIO will associate the computer-generated alerts with
any ODIO-jurisdiction potential class member claim file(s) and forward
them to the NEPSC for retrieval of any additional claim files and
screening (see Part III. above).
3.
Alerts Sent to OHA
If ODIO or NEPSC determines that either a potential class member claim or
a subsequent claim is pending appeal 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 or NEPSC will send all alerts potentially within OHA jurisdiction and
related prior claim files to the Office of Civil Actions (OCA), Division
I, at the following address:
Office of Hearings and Appeals
Office of Civil
Actions, Division I
One Skyline Tower, Suite 601
5107
Leesburg Pike
Falls Church, VA 22041-3200
ATTN:
Martel Screening Unit4.
Folder Reconstruction
In general, ODIO or NEPSC will coordinate any necessary reconstruction of
prior claim files.
5.
Class Membership Denials
The NEPSC or OHA will hold all non-class member claim files pending review
by class counsel. Upon timely request by class counsel, NEPSC or OHA will
forward claim files to the Willimantic, Connecticut District Office
located at:
SSA District Office
54 North Street
Willimantic,
Connecticut 06226Upon review of the files, class counsel will contact the Office of the
General Counsel (OGC) directly to resolve any remaining class membership
disputes.
1.
Pre-Screening Actions
a.
Current Claim in OHA
As provided in Part V.A.3. above, if
there is a current claim pending at OHA, OCA will receive the alert and
related Martel claim file(s). OCA will determine
which OHA component has the current claim and forward for screening as
follows:
•
If the current claim is in a hearing office (HO), OCA will forward the
alert and the prior claim file(s) to the HO for screening using Attachment
3.
•
If the current claim is before the Appeals Council, OCA will forward the
alert and prior claim file(s) to the appropriate Office of Appellate
Operations (OAO) branch for screening using Attachment 3.
•
If the current claim file is in an OAO branch minidocket or Docket and
Files Branch (DFB), OCA will request the file, associate it with the alert
and prior claim file(s) and perform the screening.
If OCA is unable to locate the current claim file within OHA, OCA will
broaden its claim file search and arrange for folder retrieval, alert
transfer or folder reconstruction, as necessary.
OCA, Division I is responsible for controlling and reconciling the class
alert workload of potential class member claims shipped to OHA for
association with a current claim. Because this is a relatively small
class, the OHA alert workload will be minimal and a manual accounting
should suffice. OCA should maintain a record of all alert packages
transferred to other locations (to include the pertinent information about
destinations), and a copy of all screening sheets. This information will
be necessary to do the final class membership reconciliation.
b.
Current Claim Pending in Court
If OCA receives an alert for a claimant who has a civil action pending,
either on the alerted case or on a subsequent or prior claim, OCA,
Division I will associate the alert with the claim file(s) (or court
transcript) and screen for Martel class membership.
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 then complete a
screening sheet (see Attachment 4) as follows:
If the claim pending at OHA is the only potential class member claim, then
the individual is not a class member (see
Part IV. above). Complete the screening
sheet and follow the instructions in
Part V.B.3.a. below for processing
non-class member claims.
•
Consider all applications denied (including
res judicata denials/dismissals)
during the Martel 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;
•
Sign and date the original screening sheet, place it in the claim file (on
the top right side of the file); and
•
Forward a copy of the screening sheet to:
Office of Hearings and Appeals
Division of Litigation
Analysis and
Implementation
One Skyline Tower, Suite
702
5107 Leesburg Pike
Falls Church, VA
22041-3200
ATTN:
Martel Coordinator
The Division of Litigation Analysis and Implementation will forward copies
of the screening sheet to OCA Division I and the Litigation Staff at SSA
Headquarters.
If the HO or OAO branch receives an alert only or an alert associated with
a prior claim file(s) for screening, and no longer has the current claim
file, it will return the alert and the prior claim file(s) to OCA Division
I (see address in Part V.A.3. above) and
advise OCA of what action was taken on the current claim. OCA will
determine the claim file location and forward the alert and any
accompanying prior claim file(s) to that location (see Attachment
5).
b.
Special OCA Screening Instructions if a Civil Action Is Involved
As noted in Part V.B.1.b. above, OCA will
screen for Martel class membership when a civil
action is involved. OCA's class membership determination will dictate the
appropriate post-screening action.
•
If the claim pending in court is the potential
Martel class member claim, OCA will immediately
notify OGC so that OGC can notify the claimant of the option to have the
case remanded for readjudication.
•
If the claim pending in court is a subsequent claim, and the final
administrative decision on the claim was adjudicated in accordance with
the disability evaluation standards reflected in § 5103 of OBRA 90
and SSR 91-3p, OCA will
modify the case flag in Attachment 12 to indicate that there is a
subsequent claim pending in court, but that the
Martel class member claim is being forwarded for
separate processing.
•
If the final administrative decision on the claim pending in court was not
adjudicated in accordance with the disability evaluation standards
reflected in § 5103 of OBRA 90 and
SSR 91-3p, or is legally
insufficient for other reasons, OCA 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 circumstances 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:
Sheldon A. Mossberg, Esq.
670 Main Street
Willimantic,
Connecticut 06226•
retain the claim file(s) for 90 days pending possible class membership
dispute;
•
if class counsel makes a timely review request, send the non-class member
claim file to the Willimantic, Connecticut District Office using the
pre-addressed route slip in Attachment 7;
•
if after 90 days no review is requested,return the file(s) to the
appropriate location.
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.
An individual who wishes to appeal a determination of non-class membership
should do so 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 CDDS, or any other DDS servicing Connecticut residents, will usually
conduct the first Martel review. An exception may
apply where the class member claim is a cessation or TERI case. An
exception will also apply for cases consolidated at the OHA level (see
Part VI.E. below). The DDS determination
will be a reconsideration determination, regardless of the administrative
level at which the class member 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 Martel DDS
review cases in the same manner as for any other case.
B. Payment Reinstatement for Cessation Cases
If the Martel claim involves a cessation, the usual
reinstatement provisions apply. Following an adverse DDS readjudication
determination, a class member may elect to have disability benefits
reinstated pending appeal. In general, the servicing Social Security field
office has responsibility for processing benefit reinstatements.
If a class member contacts OHA requesting benefit reinstatement, OHA
will:
1.
contact the servicing field office by telephone and advise them of the
pending Martel claim that may be eligible for
benefit reinstatement;
2.
document the file accordingly; and
3.
provide the servicing field office with identifying information and any
other information requested.
C. OHA Adjudication of Class Member Claims
The following instruction applies to both consolidation cases in which the
ALJ or Appeals Council conducts the Martel
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 Martel 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
Pursuant to the Martel settlement agreement,
regardless of whether the claim under review is an initial claim or
cessation case, the type of review to be conducted is a reopening. The
claim of each class member must be fully reopened to determine whether the
claimant was disabled at any time from the onset date alleged in the
Martel claim through the present (or through the
date the claimant last met the prescribed period requirements if
earlier).
2.
Disability Evaluation Standards
Adjudicators must use the disability evaluation standards reflected in
§ 5103 of OBRA 90 and SSR
91-3p for evaluating disability in class member claims. The
disability evaluation standard enacted by § 5103 of OBRA 90 is
effective for entitlement to monthly benefits payable for January 1991 or
later. (See HALLEX TI 5-315, issued
February 11, 1991, for further instructions on processing disabled widows'
claims under the provisions of § 5103 of OBRA 90.) The disability
evaluation standard announced in
SSR 91-3p must be used
for the evaluation of disability and entitlement to benefits payable for
the pre-1991 period.
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.
D. Claim at OHA But No Current Action Pending
If a claim file (either a class member or a subsequent claim file) 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, OCA 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, OCA will attach a
Martel class member flag (see Attachment 8) to the
outside of the file and forward the claim file(s) to the CDDS for review
of the Martel class member claim.
•
If less than 120 days have elapsed, OCA will attach a
Martel class member flag (see Attachment 9) to the
outside of the file to ensure the case is routed to the CDDS, or other
appropriate DDS, after expiration of the retention period. Pending
expiration of the retention period, OCA 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 component will monitor the retention period and, if the
claimant does not seek further administrative or judicial review, route
the file(s) to the CDDS in a timely manner.
E. 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 Martel
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 Has Been Scheduled or Held, and All Remand Cases
Except as noted below, if a Martel 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 Martel case with the appeal on the
current claim.
The ALJ will not consolidate the claims if
•
the current claim and the Martel 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.E.2.c. below. If the claims are
not consolidated, follow Part VI.E.2.d.
below.
b.
Hearing Not Scheduled
Except as noted below, if a Martel 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
Martel claim and the current claim. Instead, the
ALJ will dismiss the request for hearing on the current claim and forward
both the Martel claim and the current claim to the
DDS for further action (see
Part VI.E.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 the issues raised by the application
that makes the claimant a Martel class member, the
ALJ will consolidate the claims.
If the claims are consolidated, follow
Part VI.E.2.c. below. If the claims are
not consolidated, follow Part VI.E.2.d.
below.
c.
Actions If Claims Consolidated
When consolidating a Martel claim with any
subsequent claim, the issue is whether the claimant was disabled at any
time from the earliest alleged onset date through the present (or through
the date the claimant last met the prescribed period requirements, if
earlier).
If the ALJ decides to consolidate the current claim with the
Martel 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 Martel claim raises any additional issue(s) not
raised by the current claim;
•
offer the claimant a supplemental hearing if the ALJ has already held a
hearing and the Martel claim raises an additional
issue(s), unless the ALJ is prepared to issue a fully favorable decision
with respect to the Martel claim;
•
issue one decision that addresses both the issues raised by the current
request for hearing and those raised by the Martel
claim (the ALJ's decision will clearly indicate that the ALJ considered
the Martel claim pursuant to the
Martel settlement agreement).
d.
Action If Claims Not Consolidated
If common issues exist but the ALJ decides not to consolidate the current
claim with the Martel claim because the hearing has
not yet been scheduled, the HO will:
•
dismiss the request for hearing on the current claim without prejudice,
using the language in Attachment 10 and the covering notice in Attachment
11;
•
send both the Martel claim and the current claim to
the CDDS for consolidation and further action.
If the ALJ decides not to consolidate the current claim with the
Martel 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 Martel claim for DDS review using
Attachment 12; immediately route it to the CDDS for adjudication; and
retain a copy of Attachment 12 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 determines the
disposition of the Martel claim. Therefore, OAO
must keep the claim files together until the Appeals Council completes its
action on the current claim. The following sections identify possible
Appeals Council actions on the current claim and the corresponding action
on the Martel claim.
a.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision
on the Current Claim -- No Martel Issue(s) Will
Remain Unresolved.
This will usually arise when the current claim duplicates the
Martel review claim, i.e., the current claim raises
the issue of disability and covers the period adjudicated in the
Martel claim, and the current claim has been
adjudicated in accordance with the provisions of § 5103 of OBRA 90
and SSR 91-3p. 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
Martel claim.
b.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision
on the Current Claim -- Martel Issue(s) Will Remain
Unresolved.
This will usually arise when the current claim does not duplicate the
Martel claim, e.g., the current claim raises the
issue of disability but does not cover the entire period adjudicated in
the Martel claim. For example, the
Martel 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 Martel case flag
(Attachment 12; appropriately modified) to the
Martel claim, immediately forward the
Martel claim to the CDDS for adjudication, and
retain a copy of Attachment 12 in the current claim file. OAO will modify
Attachment 12 to indicate that the Appeals Council's action on the current
claim does not resolve all Martel issues and that
the Martel 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 Martel 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
Martel 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 Martel claim and issue a decision that
adjudicates both applications. The Appeals Council's decision will clearly
indicate that the Appeals Council considered the
Martel claim pursuant to the
Martel settlement agreement.
d.
Appeals Council Intends to Issue a Favorable Decision on the Current Claim
-- Martel 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 Martel 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 CDDS 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:
"Martel court case review needed -- following
effectuation forward the attached combined folders to Division of
Vocational Rehabilitation, Bureau of Disability Determination, 600 Asylum
Avenue, 2nd Floor, Hartford, Connecticut 06105."
e.
Appeals Council Intends to Remand the Current Claim to an Administrative
Law Judge.
If the Appeals Council intends to remand the current claim to an
Administrative Law Judge, 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
Martel claim with the action on the current claim
pursuant to the instructions in
Part VI.E.2.a. above.
The Appeals Council will not direct the ALJ to consolidate the claim
if:
•
the current claim and the Martel 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
Martel class member claim to the CDDS, or other
appropriate DDS, for separate review. The case flag in Attachment 12 must
be modified to indicate that the Appeals Council, rather than an
Administrative Law Judge, is forwarding the Martel
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.E. 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.b. above apply and, the ALJ
dismisses the request for hearing on the current claim, HO personnel
should enter OTDI in the DSP field.
To identify class member cases in HOTS, HO personnel will code
“MR” in the “Class Action” field. No special
identification codes will be used in the OHA CCS.
VIII. Inquiries
HO personnel should direct any questions to their Regional Office.
Regional Office personnel may contact the Division of Field Practices and
Procedures in the Office of the Chief Administrative Law Judge at (703)
305-0022.
Attachment 1. Settlement Agreement Filed October 21, 1992, and Approved by the
Court on October 26, 1992
UNITED STATES DISTRICT COURT
FOR THE
DISTRICT OF
CONNECTICUT
JOAN J. MARTEL, et al.,
Plaintiffs,
CIVIL NO. H-89-196(AMN)
v.
LOUIS W. SULLIVAN, M.D., Secretary
Of Health and Human Services,
Defendant,
[Filed October 21, 1992]
SETTLEMENT AGREEMENT
WHEREAS the Court issued an order on May 14, 1991 certifying a plaintiff
class, and
WHEREAS the parties have agreed to resolve all of the outstanding disputes
in this case without further litigation,
THEREFORE, the parties to this action, by their undersigned counsel,
hereby agree to a settlement of plaintiff's claims in this litigation in
accordance with the following terms and conditions:
1.
The class members who shall be entitled to seek relief pursuant to this
settlement shall be limited to those defined as follows:
a.
all Connecticut residents who applied for or were receiving disabled
widows', widowers' or surviving divorced spouses' benefits
(“DWB”), who received final unfavorable administrative
decisions from May 1, 1983 through August 12, 1989, resulting in a denial
or termination of such benefits under 42 U.S.C. §423 (d)(2)(B), and
who filed a timely request at the reconsideration level of administrative
review, 20 C.F.R. §
404.907 (1991), or higher,
20 C.F.R. 404.929,
904.967(1991), or
reapplied for DWB benefits from the date of the initial determination
through May 22, 1991, and
b.
all Connecticut residents who applied for or were receiving DWB, and who
received final unfavorable administrative decisions at any level of
administrative review from August 13, 1989 through May 22, 1991, resulting
in a denial or termination of such benefits under 42 U.S.C. § 423
(d)(2), without consideration of their actual ability to perform any
gainful activity.
c.
However, the class shall exclude the DWB claims of those individuals who
filed concurrent applications for DWB and for disability benefits under
Title II or XVI claims were denied or terminated at either step 4 or 5 of
the sequential evaluation process,
20 C.F.R. §§
404.1520 (e) and 416.920 (e), and the decision covered the entire
period of time covered by the DWB claim.
2.
In readjudicating claims pursuant to this Agreement, SSA shall apply the
standard set forth in Social
Security Ruling (SSR) 91-3p, which was effective on May 22, 1991,
to DWB claims for benefits payable for any month prior to January 1991,
except that SSA will not use any residual functional capacity assessment
from any previous Title II or Title XVI determination as the basis for a
denial of benefits. For purposes of determining entitlement to DWB for
months after December 1990, Section 5103 of the Omnibus Budget
Reconciliation Act (OBRA) of 1990 (also known as Public Law 101-508) shall
be the standard.
3.
SSA shall, by means of its data processing systems, identify the names,
Social Security Numbers and last known addresses of potential class
members, in accordance with the criteria set forth in ¶1. This
process of identification shall be within 90 days of the Court's approval
and entry of this Agreement.
4.
Within 120 days of the Court's approval and entry of this Agreement, SSA
will issue Instructions for its effectuation, including the notice
referred to ¶ 5 and the proper standard for evaluating the
eligibility of claim members for disability benefits, to all adjudicators
responsible for conducting adjudications hereunder.
a.
During the 120 day period mentioned above and prior to its expiration, SSA
will provide plaintiffs' counsel with a draft copy of the proposed notice
for review and allow plaintiffs 10 days after receipt to comment on the
notice.
b.
The notice will instruct potential class members that they may be entitled
to have their DWB claims readjudicated and will further inform such
individuals that they must return the enclosed pre-addressed and postage
prepaid envelope and “Court Case Review Request Form”, within
60 days from the date of receipt of the notice, in the event that such
redetermination is desired. A short statement will also be included in the
notice indicating that if the named claimant is deceased, benefits may
still be payable and SSA should be contacted for further assistance. The
notice will contain the name and telephone number of designated class
counsel and will advise the individual that legal assistance is
available.
c.
Plaintiffs' counsel will also furnish SSA, for inclusion in the notice,
short tag statements in Spanish, Italian, Polish, and French stating that
the individual may be entitled to additional benefits and to contact SSA
for further assistance. Such statements are to be furnished at the same
time the notice comments are provided to SSA.
d.
Following the expiration of the 10 day period for plaintiffs' comments, if
any, on the proposed notice, SSA will prepare and send it for final
printing. The authority to approve the language of the final notice shall
rest with SSA.
5.
Within 60 days of the issuance of the instructions described in ¶ 4,
SSA shall send a notice by first class mail to each potential class member
identified in ¶ 3, at his or her last known address.
6.
SSA shall attempt to obtain updated addresses for potential class members
whose notices are mailed pursuant to the receding paragraph and returned
as undeliverable, by requesting the state of Connecticut to ask its
Department of Income Maintenance, Department of Human Resources, and State
Department on Aging or their successor agency to march their records to
provide current addresses through a computerized match with public
assistance, food stamp, or other relevant records.
a.
SSA requests for computer matches with the State agencies' data systems
will be subject to the requirements of the Privacy Act, as amended by the
Computer Matching and Privacy Protection Act, 5 U.S.C. § 552a.
Furthermore, SSA shall not be required to institute legal proceedings to
gain access to State data system records to reimburse or compensate the
State of Connecticut for this matching operation.
b.
SSA will thereafter mail a second notice by first-class mail to all
potential class members for whom the computerized match produces an
updated address and will have no further obligation to locate those
individuals whose current addresses have not been obtained despite the
efforts undertaken pursuant to this Agreement.
c.
No later than 45 days after mailing the second notice, SSA shall provide
plaintiffs' counsel with a list of the names of all undeliverable notices
for those individuals whom it is still unable to locate. The list shall be
organized in alphabetical order by last name and contain the address(es)
to which each class member's notice was mailed. An updated list of
undeliverable notices shall be provided to plaintiffs every 120 days
thereafter.
7.
SSA shall provide informational posters alerting the public to this
settlement to all Social Security Field Offices serving Connecticut. SSA
shall also mail posters to those health agencies, hospitals, and
non-profit organizations for which Plaintiffs provide mailing labels. In
addition, SSA shall provide public service announcements to radio stations
in Connecticut advising of this settlement, but will be under no
obligation to ensure that the stations run such announcements.
8.
If a person who receives a notice pursuant to ¶ 5 or ¶ 6(b)
requests a review of his claim by responding more than 6 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 and SSR
91-5p. SSA will send to class counsel a copy of any determination
where “good cause” cannot be found to excuse a potential
class members' failure to respond timely to me notice. Class counsel may
seek to resolve the question of “good cause” by negotiations
with the Office of the General Counsel.
9.
The claims folders of those individuals who timely respond to the Notice
described in either ¶ 5 or ¶ 6(b) will be screened for class
membership. If SSA determines, that an individual is not a class member, a
notice will be sent to the individual, with a copy to class counsel, with
an explanation of the reason for denial of class membership. The notice
will contain the name and telephone number of designated class counsel and
will advise the individual that he or she may call class counsel for
assistance in requesting review of the denial of class membership.
a.
Clams counsel may, within 60 days of the date of the non-class membership
determination notice, in turn notify in writing an individual to be
designated in the Office of the General Counsel, Department of Health and
Human Services, Boston, MA 02203 that review of the individual's claims
file or other records relied upon by SSA in making the non-class
membership determination is desired.
b.
Within 30 days of the receipt of counsel's written request to review such
records indicated above, SSA will make available that individuals records
at a designated SSA field office location in Connecticut and will notify
class counsel in writing. Such records will be available for review by
class counsel for a period of 30 days.
c.
At the expiration of 30 days, if class counsel has still not reviewed the
records, 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.
10.
If class counsel's review of the relevant SSA records establishes that
there is a dispute as to whether the individual is a clam member entitled
to relief, class counsel will notify the Office of the General Counsel,
Department of Health and Human Services, Boston, MA by telephone or in
writing, within 30 days of such review. Both parties will then attempt to
resolve the dispute, and the Office of the General Counsel will issue a
final response within 30 days.
1.
In the event the parties are still unable to resolve 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
reaffirmation, by the Office of the General Counsel, of the prior
non-class membership determination, and the defendant shall have the
opportunity to respond thereto consistent with federal and local court
rules.
2.
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.
11.
Except as noted in ¶ ¶ 13 and 14 of this Agreement, all claims
entitled to readjudication under the terms of this settlement shall be
reopened and readjudicated at the reconsideration level, with
determinations being appealable to an Administrative Law Judge upon
request made pursuant to the procedures set forth at
20 C.F.R. §
404.933. Appeal of an Administrative Law Judge's decision will be
to the Appeals Council, upon request made pursuant to the procedures set
forth at 20 C.F.R. §
404.968. Class members will retain rights to judicial review as
provided in 42 U.S.C. § 405(g).
12.
In conducting the readjudications required by this settlement, SSA
adjudicators will apply all applicable law and regulations.
13.
At the option of SSA, class members with subsequent disability claims
active and simultaneously pending at any administrative level of review at
the time the class claim is being evaluated may have all claims covered by
this Agreement consolidated with the current claim.
14.
Class members having individual actions pending in federal court with
respect to the unfavorable administrative decision resulting in class
membership may elect either to seek a remand of their claim(s) for review
by an Administrative Law Judge or to have the action proceed in federal
court pursuant to, and subject to the limitations contained in, 42 U.S.C.
§ 405(g). Nothing in this Agreement shall be construed to avoid or
preclude the res judicata effect of a final court decision where a class
member decides to proceed with his or her individuals action in federal
court.
15.
On readjudication, SSA shall develop the record in accordance with SSA
policy, e.g., 20 C.F.R.
§§ 404.1512 to 404.1518. Class members may submit new
evidence pertaining to the readjudication of their claim.
16.
The resort by class counsel to the dispute resolution or written objection
procedures set forth in ¶ 9 and ¶ 10 of this Agreement shall
serve to stay SSA's duty to comply with any time limitations otherwise set
forth herein. The stay shall be continued until resolution of such dispute
or objection, at which time SSA shall have the benefit of the unexpired
remainder of the time limitation or 10 additional days, whichever is
longer, subject to the Court's expansion or modification thereof.
17.
The Secretary agrees that plaintiffs are the prevailing party in this
action for purposes of an award of attorney's fees pursuant to the Equal
Access To Justice Act. The amount of such fees, including an appropriate
cost-of-living increase, will be determined by the court following
approval of the Agreement and the filing of a timely fee
application.
18.
This Settlement is entered into by agreement of the parties, as a means of
avoiding further litigation. The terms of this Agreement shall not be
cited as precedent in any other case. This Agreement is not an admission
by the Secretary that he has in the past violated or failed to comply with
any federal law, rule of regulation dealing with any matter within the
scope of the allegations contained in the complaint or otherwise raised by
the plaintiffs.
19.
This Agreement resolves all claims, by individuals who satisfy the
conditions of paragraph 1, regarding the standard used to determine
eligibility for DWB as more particularly set forth in the pleadings filed
in the above entitled action.
20.
The claims of all individuals who were included in the class originally
certified by the court, but who are not entitled to readjudication
pursuant to ¶ 1 of this Agreement, will be dismissed without
prejudice.
__________________________
Sheldon A. Mossberg
33 Church Street
P.O.
Box 224
Williamantic, CT 06226
#Ct06540Joanne Lewis
Connecticut Legal Services, Inc.
69
Walnut Street
New Britain, CT 06051
#Ct06541John P. Spilka
Connecticut Legal Services, Inc.
P.O.
Box 1208
New London, CT 06320
#Ct06158Attorneys for Plaintiffs
Albert S. Dabruwski
United
States Attorney
Deirdre A. Martini Assistant
U.S.
Attorney
915 Lafayette Boulevard
Bridgeport, CT
06604
Attorney for Defendant
Attachment 2. Martel COURT CASE FLAG/ALERT
TITLE: II CATEGORY:
REVIEW OFFICE PSC MFT DOC ALERT DATE
FUN NAME
SSN OR HUN RESP DTE TOE
000-00-0000
FOLDER LOCATION INFORMATION
TITLE CFL CFL DATE ACN PAYEE
ADDRESS
SCREENING OFFICE ADDRESS:
DHHS, SSA
NORTHEASTERN PROGRAM SERVICE CENTER
ONE
JAMAICA CENTER PLAZA
JAMAICA, NEW YORK 11432-38030
IF CLAIM IS PENDING IN OHA, THEN SHIP FOLDER TO:
OFFICE OF HEARINGS AND APPEALS
OFFICE OF CIVIL
ACTIONS, DIVISION I
ONE SKYLINE TOWER, SUITE 601
5107
LEESBURG PIKE
FALLS CHURCH, VA 22041-3200
ATTN: Martel SCREENING UNIT
Attachment 3. Route Slip or Case Flag For Screening
Martel Class Action Case
SCREENING NECESSARY
Claimant’s Name: __________________________
SSN: __________________________
This claimant may be a Martel 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 Temporary
Instruction 5-435 for additional information and instructions.
TO:
_______________________________________
__________________________________________
__________________________________________
__________________________________________
Attachment 4. Martel Screening Sheet and Screening Sheet
Instructions
|
CLASS ACTION CODE: M R |
|
|
1. WAGE EARNER'S SSN
___ ___ ___ - ___ ___ - ___ ___ ___ ___
|
BIC
___ ___
|
|
2. CLAIMANT'S NAME |
|
3. SCREENING DATE
___ ___ - ___ ___- ___ ___
|
|
4. a. MEMBERSHIP DETERMINATION
MEMBER (J) NONMEMBER (F)
___ ___
|
b. SCREENOUT CODE
___ ___
(see Item 12 for screenout codes)
|
|
5. Is this a title II disabled widow/widower or surviving divorced spouse (DWB) claim? |
___ Yes ___ No
(if No, go to 12)
|
|
6. Did the responder reside in the State of Connecticut at any time from May 1, 1983 through May 22, 1991, inclusive? |
___ Yes ___ No
(if No, go to 12)
|
|
7. Was a less than fully favorable denial/termination issued on this claim for some reason other than the claimant's medical condition (e.g., SGA)? |
___ Yes ___ No
(if No, go to 12)
|
|
8.a. Was a less than fully favorable determination/decision issued on this claim at the reconsideration level or higher by the Connecticut DDS, OHA, or any office servicing the State of Connecticut, from May 1, 1983, through August 12, 1989, inclusive, and did this 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.)
or
b. If the claimant did not appeal a less than fully favorable determination made at the initial level of administrative review and made within the timeframes given in a. above, did the claimant reapply for DWB benefits between the date of the initial determination and May 22, 1991, inclusive?
|
___ Yes ___ No
(if No, go to 12)
___ Yes ___ No
(if No, go to 12)
|
|
9. Was a less than fully favorable denial/termination issued on this claim at any administrative level from August 13, 1989, through May 22, 1991, inclusive, without consideration of claimant's actual ability to perform any gainful activity? |
___ Yes ___ No
(if No, go to 12)
|
|
10. Did the claimant receive a subsequent fully favorable determination/decision which covered the timeframe at issue in the potential Martel claim? |
___ Yes ___ No
(if No, go to 12)
|
|
11. Was a claim for title XVI or title II worker's disability benefits covering the timeframe at issue in the potential Martel claim, concurrently denied/ceased at steps 4 or 5 of the sequential evaluation process? |
___ Yes ___ No
(if No, go to 12)
|
|
12. The responder is not a Martel class member eligible for class relief.
Check the NONMEMBER block in item 4 and enter the screenout code as follows:
Enter 05 if question 5 was answered “NO.”
Enter 06 if question 6 was answered “NO.”
Enter 07 if question 7 was answered “YES”
Enter 09 if question 9 was answered “NO.”
Enter 10 if question 10 was answered “YES.”
Enter 11 if question 11 was answered “YES.”
|
No other screenout code
entry is appropriate.
|
|
SIGNATURE OF SCREENER |
COMPONENT |
DATE |
|
Enter dates of all applications screened.
________________ _________________ ________________ _________________
|
MARTEL SCREENING SHEET INSTRUCTIONS
Questions 1 - 3
Fill in wage earner's SSN, beneficiary identification code, widow(er)'s or
surviving divorced spouse's name, and current date.
Question 4
Do not fill in the member/non-member blocks and screenout code until the
screening is completed.
Question 5 - 6
Screen for type of claim and residency. If either question is answered
“No”, enter the appropriate screenout code in item 4 as
directed in item 12 on the screening sheet and check the non-member
block.
Question 7
To answer this question look for non-medical denial codes in item 22 of
the SSA-831-U3 or SSA-833-U3, or on the SSA-3687-U2 or the SSA-3428-U2.
The non-medical denial codes are: N1, N2, L1, L2, M7, M8. (For a complete
list of DWB denial codes see
DI 26510.045.) For
cases previously decided at the OHA level, the answer can be found in the
Administrative Law Judge or Appeals Council decision. If the answer to
question 7 is “Yes”, enter the appropriate screenout code in
item 4 as directed in item 12 on the screening sheet and check the
non-member block.
Question 8
Screen for date of decision, not date of application. Individuals are
class members if they received a denial, cessation or a less than fully
favorable decision (e.g., later onset, closed period, payment of benefits
beginning 1/1/91 under OBRA despite an earlier onset) at the
reconsideration level or higher which became the final decision of the
Secretary, or if they reapplied for DWB benefits prior to May 23, 1991.
(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.) If the answer to 8a or 8b is “Yes”,
proceed to question 10. If the answer to 8a is “No”, go to
part b. If the answer to 8b is “No”, go to question 9.
Question 9
Review the file to determine whether the claimant received a decision at
any administrative level between August 13, 1989, and May 22, 1991,
inclusive, which did not consider the claimant's ability to perform any
gainful activity (i.e., was not
denied at step 4 or 5 of the sequential evaluation process.) If the answer
to question 9 is “No”, enter the appropriate screenout code
in item 4 as directed in item 12 on the screening sheet. Be sure to check
the non-member block in item 4 of the screening sheet.
Question 10
This class relief exception applies only if the individual has received
all benefits to which he or she could be entitled based on the potential
class member claim. Review the file to determine whether benefits were
subsequently allowed or continued beginning with the earliest alleged
onset date, cessation date, or control date within the timeframes for
class membership (May 1, 1983, through May 22, 1991, inclusive) and that
all benefits have been paid. The allowance or continuance could have been
either on the same claim or on a subsequent application. If the answer to
question 10 is “Yes”, enter the appropriate screenout code in
item 4 as directed in item 12 on the screening sheet and check the
non-member block found in item 4.
Question 11
Check file(s) and queries (e.g., ACT, SSID) to determine whether claimant
received a denial/cessation decision on a concurrent claim for SSI, or
worker's disability which covered the timeframe at issue in the potential
Martel claim. If so, review the file(s) to
determine whether the claimant's residual functional capacity (RFC) was
assessed. The following codes in block 22 of the SSA-831-U3, SSA-832-U3,
and SSA-833-U3 indicate denial/cessation on the basis that claimant
retained the RFC to perform SGA. Title II denials: H1, H2, J1, J2 and
sometimes E3. Title XVI denials: N31, N32, N42, N43. For cases previously
decided at the OHA level, review the Administrative Law Judge or Appeals
Council decision to determine if the claimant's RFC was assessed. If the
answer to question 11 is “Yes”, enter the appropriate
screenout code in item 4 as directed in item 12 on the screening sheet and
check the non-member block in item 4 of the screening sheet.
Be sure to check the appropriate block on the non-class member
notice.
After signing the screening sheet, please remember to list the dates of
all applications for which determinations/decisions were screened to
determine class membership.
Processing Class Member Determinations
a.
Retain the original screening sheet in the claim file. Send a copy
to:
Martel Court Case Coordinator
P.O. Box 17729
Baltimore, Maryland 21235
b.
Follow procedures in DI
42574.001B.2. for class member cases.
OHA screeners, see TI 5-435 for instructions.
Processing Non-class Member Cases
a.
Retain the original screening sheet in the claim file. Send a copy
to:
Martel Court Case Coordinator
P.O. Box 17729
Baltimore, Maryland 21235
b.
Follow procedures in POMS
DI 42574.001B.3.
for non-class member cases.
OHA screeners, see TI 5-435 for instructions.
Attachment 5. Route Slip for Routing Class Member Alert and Prior Claim File(s)
to ODIO or PSC -- OHA No Longer Has Current Claim
|
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 |
|
|
Martel 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 the Northeastern Program Service Center for screening and possible readjudication. SEE POMS DI 42574.005 OR DI 12574.005 |
|
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|
|
|
|
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. Martel Non-Class Membership Notice
You asked Social Security to look again at your claim for disability
benefits. We have looked at your case. You are not a member of the
Martel class for the reason given below. This means
that we will not review your claim.
A copy of this letter will be mailed to the attorney representing the
Martel class. If you think we are wrong, you should
call class counsel right away at the telephone number shown below. You
have 60 days from the date you receive this notice to let class counsel
know you disagree with our reason as to why you are not a class member, so
do not wait. They will answer your questions about class membership
without charge. The name and address of the attorney is:
Sheldon A. Mossberg, Esq.
670
Main Street
P.O. Box 165
Willimantic, CT 06226
Telephone 1-800-772-5586
REASON FOR UNFAVORABLE DECISION
You are not a Martel class member because:
|
______ |
You never filed a claim for disabled widow(er)'s or surviving divorced spouse's benefits. |
|
|
|
|
______ |
You did not reside in the State of Connecticut at any time between May 1, 1983 through May 22, 1991, inclusive. |
|
|
|
|
______ |
Your claim was not denied or ceased for medical reasons. Your claim was denied because: |
|
|
________________________________________________________ |
|
|
________________________________________________________ |
|
|
|
|
______ |
You did not receive a final medical decision denying or terminating disability benefits at the reconsideration level or above between May 1, 1983 and August 12, 1989, inclusive. |
|
|
|
|
______ |
You did not file a timely request for an administrative review of the unfavorable decision, or reapply for disabled widow(er)'s or surviving divorced spouse's benefits, before May 23, 1991. |
|
|
|
|
______ |
Your claim was not denied or ceased at any administrative level between August 13, 1989 and May 22, 1991, inclusive, without consideration of your actual ability to perform any gainful activity. |
|
|
|
|
______ |
We already changed our earlier decision and found that you were disabled. You have received all benefits due. |
|
|
|
|
______ |
You received a decision denying or terminating disability benefits on a concurrent claim, which was based on a consideration of your residual functional capacity and covered the timeframe at issue in the potential Martel claim. |
|
|
|
|
______ |
Other (Explain) _________________________________________ |
|
|
_________________________________________________________ |
|
|
|
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 disabled. We are deciding only that you are not a
Martel 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.
IF YOU HAVE ANY QUESTIONS
If you have questions you should write, call or visit any Social Security
office. Most questions can be answered by telephone. If you call or visit
a Social Security office, please have this letter with you. It will help
us answer your questions.
cc: Sheldon A. Mossberg, Esq.
Attachment 7. Route Slip for Non-Class Membership Cases
|
ROUTING AND TRANSMITTAL SLIP |
DATE: |
|
TO: |
INITIALS |
DATE |
|
1. SSA District Office |
|
|
|
2. 54 North Street |
|
|
|
3. Willimantic, Connecticut 06226 |
|
|
|
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
Martel CASE
Claimant: ___________________________
SSN: _____________________________
We have determined that this claimant is not a
Martel class member. (See screening sheet and copy
of non-class membership notice in the attached claim file(s).)
SEE POMS DI 12574.010
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 |
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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. Martel Class Member Flag for Headquarters Use (DDS Readjudication
-- Retention Period Expired)
Martel Class Action Case
READJUDICATION NECESSARY
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Claimant's Name: |
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SSN : |
__________________________________ |
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This claimant is a Martel class member. Accordingly, we are forwarding the attached claim file(s) to the Connecticut DDS for readjudication. |
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We are sending the files to: |
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Division of Vocational
Rehabilitation
Bureau of Disability Determination
600
Asylum Avenue, 2nd Floor
Hartford, Connecticut 06105.
(Destination
code: S08)
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Attachment 9. Martel Class Member Flag for Headquarters
Use (DDS Readjudication -- Retention Period has not Expired)
Martel Class Action Case
READJUDICATION NECESSARY
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Claimant's Name: |
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SSN : |
__________________________________ |
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This claimant is a Martel class member. After expiration of the retention period, forward claim file(s) to the Connecticut DDS for readjudication. |
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Send folders to: |
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Division of Vocational
Rehabilitation
Bureau of Disability Determination
600
Asylum Avenue, 2nd Floor
Hartford, Connecticut 06105.
(Destination
code: S08)
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If the claimant has filed a civil action and elected to remain in court
for review of the current claim, forward the Martel
claim file(s) without delay to the Connecticut DDS for
readjudication.
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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 _________________. |
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In accordance with the Settlement Agreement negotiated by the parties and approved by the United States District Court for the District of Connecticut in the case of Martel v. Sullivan,Civil No. H-89-196 (D. Conn. October 26, 1992), the claimant has requested readjudication of the final (determination/decision) on the prior application(s) filed on ______________. The claimant has been identified as a Martel class member and is entitled to have the final administrative denial of the prior application(s) reviewed under the terms of the Settlement Agreement. 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. |
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The claimant's current application(s) will be associated with the prior claim(s) and forwarded to the Connecticut Disability Determination Service which will conduct the Martel readjudication. |
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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. |
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_________________________
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Administrative Law Judge |
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_________________________
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Attachment 11. 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 Connecticut Disability
Determination Service 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
Martel class member claim back to the Connecticut
Disability Determination Service for further processing. The enclosed
order explains why.
The Next Action on Your Claim
The Connecticut Disability Determination Service will contact you to tell
you what you need to do. If you do not hear from the Connecticut
Disability Determination Service 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 12. Martel Class Member Flag for HO Use (DDS
Readjudication)
Martel Class Action
Case
READJUDICATION NECESSARY
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Claimant's Name: |
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SSN: |
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__________________________________ |
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This claimant is a Martel class member. The attached Martel 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. |
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OR |
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The claims have not been consolidated because |
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[state reason(s)] |
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______________________________________________ |
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______________________________________________ |
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Accordingly, we are forwarding the attached alert and prior claim file(s) to your location for any necessary Martel readjudication action. |
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We are sending the alert and prior file(s) to: |
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Division of Vocational
Rehabilitation
Bureau of Disability Determination
600
Asylum Avenue, 2nd Floor
Hartford, Connecticut
06105.
(Destination code: S08)
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