ISSUED: August 28, 1996
I. Purpose
This Temporary Instruction (TI) sets forth procedures for implementing the
parties' joint Stipulation and Order of Settlement, approved by the United
States District Court for the Southern District of New York on February 9,
1996, and entered on February 16, 1996, in the S.P. v.
Chater class action involving the evaluation of disability
claims under title II and/or title XVI that allege disability based in
whole or in part on infection with the human immunodeficiency virus (HIV)
and/or acquired immune deficiency syndrome (AIDS) (see
Part IV below for the definition of the
class).
Adjudicators throughout the country must be familiar with this TI because
of case transfers and because S.P. class members
who now reside outside of New York must have their cases processed in
accordance with the requirements of the joint stipulation and order.
II. Background
On October 1, 1990, plaintiffs filed a class action complaint challenging
the standards, policies, practices and procedures used by the Social
Security Administration in evaluating disability claims under titles II
and title XVI of the Social Security Act that allege disability based in
whole or in part on infection with HIV and/or AIDS.
On June 7, 1991, the United States District Court for the Southern
District of New York denied plaintiffs' motion for class certification
with leave to renew the motion and denied the Secretary's [1] second motion to dismiss the action.
On December 17, 1991, the Secretary published
Social Security Ruling (SSR)
91-8p in order to revise and update the guidelines for the
evaluation of claims for disability based on allegations of HIV and/or
AIDS.
On July 2, 1993, the Secretary published a final rule in the
Federal Register establishing new listing
sections called “Immune System” (Listings 14.00 and 114.00).
The new listings included criteria for HIV (Listings 14.08 and 114.08).
These criteria replaced SSR
91-8p, which was rescinded as of the date of the publication of the
new regulations.
In order to avoid further litigation, on October 13, 1995, the parties
submitted a jointly negotiated proposed settlement agreement to the court.
In December 1995, SSA mailed display posters to various field offices and
organizations identified by plaintiffs. The posters provided public notice
of the proposed settlement pursuant to Rule 23(e) of the Federal Rules of
Civil Procedure.
On February 9, 1996, the district court held a hearing, pursuant to Rule
23(e) of the Federal Rules of Civil Procedure, to consider the fairness of
the proposed settlement and approved the parties' joint Stipulation and
Order of Settlement (Attachment 1). The Stipulation and Order of
Settlement was entered on February 16, 1996.
III. Guiding Principles
Under the terms of the S.P. settlement agreement,
the Commissioner will readjudicate the title II and/or title XVI claims of
those persons who: 1) respond to notice informing them of the opportunity
for review or who do not receive notice but who otherwise self-identify
and request review (e.g., “walk-ins”); and 2) are determined,
after screening, to be class members entitled to relief (see
Parts IV. and V. below). The class action
section in the Office of Disability and International Operations (ODIO)
will screen title II and concurrent title II and title XVI claims for
eligibility for class relief, and the Northeastern Program Service Center
(NEPSC) will screen title XVI only claims, unless there is a current
claim, i.e., a potential class member claim or a subsequent claim, pending
in the Disability Determination Services (DDS) or OHA, or stored at OHA.
Regardless of the state of the claimant's current residence, in most
cases, the New York Office of Disability Determinations (ODD) will perform
the agreed-upon readjudications at the reconsideration level, irrespective
of the administrative level at which the claim was last decided.
The DDS servicing the claimant's current address will perform the
readjudication in terminal illness (TERI) cases and if a face-to-face
review is necessary, i.e., cessation case.
OHA will screen cases and perform readjudications under limited
circumstances (see Part V.B.
below).
Cases readjudicated by the DDS will be processed at the reconsideration
level regardless of the final level at which the claim was previously
decided. The type of readjudication will be a
"redetermination" (see
Part VI. below). 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 will use the disability evaluation standards reflected in
Listings 14.08 and 114.08 in evaluating disability claims involving
allegations of disabling HIV infection, including AIDS, by S.P. class members.
S.P. class member claims should be processed as
expeditiously as possible. (See HALLEX
HA 01210.040 and
HA 01310.005 for TERI
procedures.)
IV. Definition of Class
Except as noted below, for purposes of implementing the terms of the
Stipulation and Order, the S.P. class potentially
entitled to relief consists of all individuals who:
•
filed for disability benefits under titles II and/or title XVI of the
Social Security Act alleging disability based in whole or in part on
infection with HIV and/or AIDS; and
•
were issued a less than fully favorable (i.e., later onset, closed period,
denied or terminated) final administrative determination or decision
(exhaustion of administrative remedies is not required),
based on medical reasons, on or after
July 27, 1990, and before July 2, 1993, while residing in the State of New
York.
A person is not a class member eligible for class relief if
(1) the last administrative denial or termination received on the
potential S.P. claim was issued before July 27,
1990, or on or after July 2, 1993; or
(2) the individual received a final judicial decision on the potential
S.P. claim; or
(3) the individual had a subsequent claim denied on or after July 2, 1993,
and the subsequent claim covered the entire period of disability at issue
in the potential S.P. claim.
V. Determination of Class Membership and Eligibility for Relief and
Preadjudication Actions
A. Pre-Screening Actions - General
1.
Notification
Within 10 business days of the date SSA issues final implementation
instructions, SSA shall make a good faith effort to send an individual
notice to the last known address of every individual who has been
identified by computer run as a potential class member and whose primary
or secondary diagnosis code identified on SSA's data processing system was
0420 (AIDS), 0430 (HIV symptomatic) or 0440 (HIV asymptomatic).
Individuals will have 60 days from the date of receipt of the notice to
request that SSA readjudicate their claims under the terms of the
S.P. stipulation and order. SSA will presume an
individual's receipt of the notice five days after the date of the notice,
unless the individual establishes that receipt actually occurred later. An
individual who does not receive written notice of the settlement may,
nonetheless, request relief by contacting any SSA office within one year
after the date that SSA mails the notices referred to above to the
systems-identified potential class members. Such a request will be
considered timely if it is filed within one year of the date that the
notices are mailed.
ODIO will contact the servicing Social Security field office (FO) (i.e.,
district or branch office) for development of possible evidence of good
cause for any untimely responses. Good cause determinations will be based
on the standards in 20
CFR §§ 404.911 and
416.1411. If good
cause is established, the field office will forward the good cause
determination and any claim files currently in the FO, to ODIO (title II
claims and concurrent claims) or NEPSC (title XVI claims) to retrieve any
other relevant claim files and for class membership screening.
2.
Alert and Folder Retrieval Process
All response forms will be returned to ODIO so that the information can be
entered into the Civil Actions Tracking System (CATS). Alerts will then be
generated and released to ODIO. See Attachment 2 for a sample
S.P. alert.
ODIO will associate the computer-generated alert with the reply form and
will forward them to the appropriate component for folder retrieval. ODIO
will retrieve available title II and concurrent title II and title XVI
potential class member claim file(s), except those found in the DDS or
OHA, and conduct the screening. For title XVI only claims, the NEPSC will
retrieve available title XVI claim files, except those found in
Wilkes-Barre (WB), the DDS or OHA, and conduct the screening (see
Part III. above). WB will send any title
XVI folders it locates to NEPSC for screening.
3.
Alerts Sent to OHA
If ODIO or the NEPSC 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).
If the claim is located in a hearing office (HO), ODIO or the NEPSC will
forward the alert and claim file(s), if any, directly to the HO for
processing. If the claim is located in OHA headquarters, ODIO or the NEPSC
will forward the alert and 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 Skyline 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 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 (see
Part VIII below).
4.
Folder Reconstruction
In general, ODIO or the NEPSC will coordinate any necessary reconstruction
of prior claim files. OHA requests for reconstruction of potential
S.P. 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, therefore, making reconstruction unnecessary.
OHA (the HO or the OAO branch) will direct any necessary reconstruction
requests to the FO servicing the claimant's address. The request will be
made by memorandum and will include the alert and any accompanying claim
file(s) (if the claim file(s) is not needed for adjudication purposes) as
attachments. The request will also include documentation of the attempts
to locate the file. The memorandum will request the FO to send the
reconstructed file to OHA after it completes its reconstruction action.
HOs will route any reconstruction requests directly to the FO servicing
the claimant's address. The OAO branch will route reconstruction requests
through 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:
Office of the Deputy Commissioner
for
Programs and Policy
Litigation Staff
3-K-26 Operations
Building
6401 Security Boulevard
Baltimore, MD
21235
Attn: S.P.Coordinator
HO personnel and the OAO branch will identify in the reconstruction
request the OHA location of any existing claim file(s) being retained for
adjudication purposes, and the date(s) of the claim(s) involved.
The HO or OAO will not delay action on a pending claim when a prior claim
is being reconstructed for screening purposes, unless the prior claim is
needed for the adjudication of the pending claim. If OHA completes action
on the pending claim prior to 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 taken on the
formerly pending claim. For additional information on reconstruction
procedures, see the Class Action Implementation instructions in
HALLEX I-1-705C.
5.
Class Membership Denials (Non-Eligibility for Relief)
ODIO, the NEPSC or OHA, as appropriate, will hold for 90 days all claim
files of individuals to whom SSA sends notice of non-class membership and
ineligibility for relief, pending review by claimants or class counsel. If
an individual wishes to dispute SSA's class membership/eligibility for
relief determination, he or she must give timely written notice of the
disagreement to the Office of the General Counsel (OGC) (i.e., within 60
days of receipt of notice that the individual is not a class member
eligible for relief). Upon request, class counsel, subject to the Privacy
Act Protective Order that is part of the settlement order, will be given
reasonable and timely access to potential class members' claim files for
the purpose of resolving class membership disputes.
Upon request by class counsel to review claim files, the Litigation Staff
will coordinate with ODIO, the NEPSC or OHA to forward the claim files to:
SSA, New York Regional Office
Disability
Programs Branch
26 Federal Plaza, Room 40-114
New
York, NY 10278
Attn: S.P.Coordinator
1.
Determining Jurisdiction for Screening
a.
Current Claim in OHA
As provided in Part V.A.3. above, if
there is a current claim pending or stored at OHA Headquarters, the OAO
Class Action Coordinator will receive the alert and related
S.P. claim file(s). The OAO Class Action
Coordinator may also receive alerts (forwarded in error) for cases in
which there is no current claim pending or stored at OHA Headquarters. 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 forward the alert
and any prior claim file(s) located in OHA Headquarters to the HO for
screening using Attachment 3.
(Part V.B.2.a. below provides
instructions to 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 DFB), the
Coordinator will forward the alert and any prior claim file(s) to the
appropriate OAO branch for screening using Attachment 3.
(Part .B.2.a. below provides instructions
to the OAO branches regarding the action to be taken if they receive an
alert package 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 the claim file
search and arrange for alert transfer or folder reconstruction, as
necessary.
Do not screen pending cases unless an alert has been received. The
presence of an alert is evidence that the claimant has responded to notice
of potential class membership and that his or her case is ready for
review. However, if a claimant with a non-alerted pending case should
allege class membership, contact the S.P. coordinator in the Division of Litigation Analysis and
Implementation (DLAI) for assistance in determining the claimant's status.
DLAI's address is
and Implementation
Office
of Hearings and Appeals
One Skyline Tower, Suite 702
5107
Leesburg Pike
Falls Church, VA 22041-3255
Attn: S.P.Coordinator
Telephone number: (703) 305-0723
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 a subsequent
or prior claim, the Coordinator will forward the alert and any
accompanying claim file(s) to the appropriate OAO 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 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(s) pending at OHA is the potential class member claim(s),
then the individual is not a class member entitled to relief under
S.P. (see Part IV.
above). Complete the screening sheet and follow the instructions in
Part V.B.3.a. below for processing the
claims of individuals who are not class members eligible for relief.
•
Consider all applications denied/ceased during the S.P. timeframe;
Although not the “final decision of the Agency,” an Appeals
Council denial of a request for review is the last action of the Agency,
and the date of such 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 or an HO,
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 will forward the screening sheet to DLAI.) HO personnel may
also forward material by telefax to the Coordinator at (703) 305-0655.
(DLAI will retain a copy of each screening sheet received from the
Coordinator and will forward a copy to Litigation Staff.)
If the HO 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 send 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 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.
If an OAO branch receives an alert only, or an alert associated with a
prior claim file(s), and no longer has the current claim file (and it is
not located in mini-dockets or 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 material to the OHA
location. If the file(s) is no longer in OHA, the OAO branch will use
Attachment 5 to forward the material to the non-OHA location. The OAO
branch will advise the OAO Class Action Coordinator of its actions.
Final determinations or decisions made on or after July 2, 1993, on
another claim filed by a potential S.P. class
member may have adjudicated the entire timeframe covered by the
S.P. claim. Instead of applying the doctrine of
administrative res judicata to the S.P. claim, a non-class membership/ineligibility for relief
determination must be made.
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 S.P. class
membership/eligibility for relief when a civil action is involved. The
CCPRB's class membership/eligibility for relief determination will dictate
the appropriate post-screening action.
•
If the claim pending in court is the potential class member claim, the
CCPRB will notify OGC which will notify the claimant of the option to have
the case remanded for readjudication under
S.P.
•
If the claim pending in court is a subsequent claim that was adjudicated
by the ALJ (or the Appeals Council if it issued the final decision, as
defined for screening purposes in a. above) on or after July 2, 1993, in
accordance with the disability evaluation standards reflected in Listings
14.08 and 114.08 and resolved all S.P. issues, the
claimant is not an S.P. class member entitled to
relief. The CCPRB will follow the instructions in
Part V.B.3.a. below for processing such
claims.
•
If the claim pending in court was adjudicated by the ALJ (or the Appeals
Council) on or after July 2, 1993, in accordance with Listings 14.08 and
114.08, but it did not resolve all S.P. issues or
adjudicate the entire period covered by the S.P. claim, the CCPRB will forward the S.P. claim to the New York ODD for separate review. The CCPRB will
modify the case flag in Attachment 12 to indicate that the pending court
case does not resolve all S.P. issues and that the
S.P. class member claim is being forwarded for
separate processing. The CCPRB will notify the Class Action Coordinator of
its action.
•
If the final administrative decision on the claim pending in court was not
adjudicated on or after July 2, 1993, in accordance with the disability
evaluation standards reflected in Listings 14.08 and 114.08, or is legally
insufficient for other reasons, the CCPRB will initiate voluntary remand
proceedings. The CCPRB will forward the S.P. claim
to the New York ODD for separate review to avoid processing delay.
3.
Post-Screening Actions
a.
Screened Out Cases
If the screening component determines that the individual is not a class
member eligible for relief, the component will:
•
notify the individual and representative, if any, (with a copy to class
counsel) of that determination using Attachment 6 (modified as necessary
to fit the circumstances and posture of the case when there is a current
claim);
Include the date and claim number at the top of Attachment 6 in the spaces
indicated.
•
retain a copy of the notice in the claim file;
•
send a copy of the notice to S.P. class
counsel:
The HIV Law Project
841 Broadway, Suite 608
New
York, NY 10003
An individual who wishes to dispute a determination of non-class
membership and ineligibility for relief may do so directly, through their
representative of record, or through S.P. class
counsel. Accordingly, the screening component should:
•
retain the claim file(s) for 90 days pending a possible class membership
dispute; and,
•
if class counsel makes a timely request to review a screened out claim
file, send the file to:
SSA, New York Regional Office
Disability Programs
Branch
26 Federal Plaza, Room 40-114
New York,
NY 10278
Attn: S.P Coordinatorusing 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 OGC resolves the dispute in the claimant's favor: 1) OGC will notify
the claimant, or representative, if any, and class counsel, and will alert
Litigation Staff to prepare a revised screening sheet; 2) OHA jurisdiction
cases will proceed in accordance with
Part VI. below; 3) Litigation Staff will
notify DLAI of the revised 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;
•
if the dispute cannot be resolved, OGC will send the claimant, and class
counsel, a notice indicating that the claimant will have 60 days to
request district court review of the class membership/eligibility for
relief determination;
•
if after 90 days no review is requested, return the file(s) to the
appropriate storage location if not otherwise needed.
b.
Cases Determined to Be Class Members Entitled to Relief
If the individual is found to be a class member entitled to relief (either
during the initial screening or after rescreening), the claim will be
processed and adjudicated in accordance with the instructions in
Part VI. below.
VI. Processing and Adjudication
A. Cases Reviewed by the DDS
The New York ODD, or any other DDSs servicing residents of New York, will
usually conduct the S.P. review. An exception may
apply when the S.P. claim is a 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). (See
Part VI.B. below.)
B. OHA Adjudication of Class Member Claims
The following instructions apply to both consolidation cases in which the
ALJ or Appeals Council conducts the S.P. readjudication and to DDS readjudication cases in which the
claimant requests a hearing or Appeals Council review. Except as noted
herein, HOs and OHA Headquarters will process S.P. class member cases according to all other current practices
and procedures including coding, developing evidence, routing, etc.
However, pursuant to the parties' stipulation and order, SSA must exert
its best efforts to resolve all S.P. class members'
claims as expeditiously as possible.
Implementation of the S.P. order should not delay
the processing of TERI claims or interfere with the operation of TERI
procedures on such claims. (See HALLEX
HA 01210.040 and
HA 01310.005.)
1.
Type of Review and Period to Be Considered
1.
Pursuant to the S.P. stipulation and order,
regardless of whether the claim under review is an initial claim or a
cessation case, the type of review to be conducted is a
redetermination. The redetermination
shall be a de
novo evaluation 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 determination or decision(s) that forms the basis
for S.P. class membership, i.e., through the date
of the last determination or decision on the latest class member
claim.
2.
If the redetermination results in a favorable decision, the adjudicator
will determine whether the individual's disability has been continuous
through the date of the redetermination or to the date of the most recent
allowance.
3.
If the evidence establishes that disability began only at some point
after the administrative
determination(s)/decision(s) that forms the basis for S.P. class membership, the class member must file a new application
to establish eligibility.
2.
Disability Evaluation Standards
The redeterminations will be made in accordance with all applicable rules
and regulations for evaluating disability claims, including review under
the sequential evaluation. Additionally, adjudicators must use the
disability evaluation standards reflected in Listings 14.08 and 114.08 for
evaluating disability based, in whole or in part, on allegations of
infection with HIV and/or AIDS in class member claims.
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 a claim file (either a class member or another disability 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 received from ODIO
with the file and screen for class membership. (The OAO Class Action
Coordinator will coordinate the necessary actions, as explained in
Part V.) (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 an
S.P. class member flag (see Attachment 8) to the
outside of the file and forward the claim file(s) to the New York ODD (or
to the appropriate DDS if the exception in
Part III. above applies) for review of
the S.P. class member claim.
•
If less than 120 days have elapsed, OAO will attach an S.P. class member flag (see Attachment 9) to the outside of the
file to ensure the case is routed to the New York ODD (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 component will monitor the retention period and, if the
claimant does not seek further administrative or judicial review, route
the file(s) to the New York ODD in a timely manner. See
Parts VI.D.3. and
V.B.1.b., respectively, if the claimant
seeks administrative or judicial review of the non-class member
claim.
D. Processing and Adjudicating Class Member Claims in Conjunction with
Current Claims (Consolidation Procedures)
Even claims subject to consolidation should be consolidated only to the
extent practicable. Thus, if consolidation would unreasonably delay a
decision on the current claim, consolidation is not required.
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 S.P. 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 an S.P. 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, including court
remands, the ALJ will consolidate the S.P. case
with the appeal on the current claim.
The ALJ will not consolidate the claims if
•
the current claim and the S.P. 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 at the OHA level, follow
Part VI.D.2.c. below. If the claims are
not consolidated at the OHA level, follow
Part VI.D.2.d. below.
b.
Hearing Not Scheduled
Except as noted below, if an S.P. class member has
a request for hearing pending on a current claim and the HO has not yet
scheduled a hearing, the ALJ will not consolidate the S.P. claim and the current claim at the OHA level. Instead, the ALJ
will dismiss the request for hearing on the current claim and forward both
the S.P. claim and the current claim to the New
York ODD (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 the issues raised by the application
that makes the claimant an S.P. class member, the
ALJ will consolidate the claims.
If the claims are consolidated at the OHA level, follow
Part VI.D.2.c. below. If the claims are
not consolidated at OHA, follow
Part VI.D.2.d. below.
c.
Actions If Claims Consolidated at the OHA Level
When consolidating an S.P. claim with any
subsequent claim and the two claims involve overlapping periods at issue,
the issue is whether the claimant was disabled at any time from the
earliest alleged onset date through the present or to the date of the most
recent allowance (or through the claimant's date last insured or the date
the claimant last met prescribed period requirements, if applicable and
earlier). Accordingly, in effect, consolidation will result in a reopening
of the S.P. claim through the time period at issue
in the current claim. However, if the period to be adjudicated in the
current claim does not overlap the period to be readjudicated in the
S.P. claim, the two claims should be considered
separately. Nonetheless, if the claimant is found to be disabled within
the timeframe of the S.P. claim, the claim will be
reopened through the date at issue in the current claim. If the ALJ
decides to consolidate the current claim with the
S.P.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 S.P.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 S.P. claim raises an additional
issue(s), unless the ALJ is prepared to issue a fully favorable decision
with respect to the S.P. claim; and
•
issue one decision that addresses both the issues raised by the current
request for hearing and those raised by the S.P. claim (the ALJ's decision will clearly indicate that the ALJ
considered the S.P. claim pursuant to the
S.P. stipulation and order).
d.
Action If Claims Not Consolidated at the OHA Level
If common issues exist but the ALJ decides not to consolidate the current
claim with the S.P. claim because the hearing has
not yet been scheduled, the ALJ 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; and
•
send both the S.P. claim and the current claim to
the New York ODD (or to the appropriate DDS if the exception in
Part III. above applies) for
consolidation and further action.
•
in those instances where cases return to OHA after new denials at the DDS,
the ALJ will schedule the consolidated claims for hearing using the
original request for hearing date to determine scheduling priority.
If the ALJ decides not to consolidate the current claim with the
S.P. 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 S.P. claim for DDS review using Attachment
12; immediately route it to the New York ODD for readjudication
(photocopies of any relevant material from either file should be made and
placed in the other file before shipping) 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 S.P. 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 S.P. claim.
1.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision
on the Current Claim -- No S.P. Issue(s) Will
Remain Unresolved.
This will usually arise when the current claim duplicates the
S.P. review claim, i.e., the current claim raises
the issue of disability and covers the entire period adjudicated in the
S.P. claim, and the current claim has been
adjudicated in accordance with the provisions Listings 14.08 and 114.08 on
or after July 2, 1993. 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 S.P. claim.
2.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision
on the Current Claim -- S.P. Issue(s) Will Remain
Unresolved.
This will usually arise when the current claim does not duplicate the
S.P. claim, e.g., the current claim raises the
issue of disability but does not cover the entire period adjudicated in
the S.P. claim. For example, the S.P. 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 an S.P. case flag (Attachment
12; appropriately modified) to the S.P. claim,
immediately forward the S.P. claim to the New York
ODD 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 S.P. issues and that the S.P. 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.
3.
Appeals Council Intends to Issue a Favorable Decision on the Current Claim
-- No S.P. 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 in the application that makes the claimant an
S.P. class member, the Appeals Council should
proceed with its intended action. In this instance, the Appeals Council
will consolidate the claims, reopen the final determination or decision on
the S.P. claim and issue a decision that
adjudicates both applications. The Appeals Council's decision will clearly
indicate that the Appeals Council considered the S.P. claim pursuant to the S.P. stipulation
and order.
4.
Appeals Council Intends to Issue a Favorable Decision on the Current Claim
-- S.P. 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 S.P. 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 New York ODD 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:
"S.P. court case review needed -- following
effectuation forward the attached combined folders to the New York ODD (or
to the appropriate DDS if the exception in
Part III. applies)."
5.
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 ALJ based
on its own review of the case or as the result of a court remand, 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 S.P. 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 S.P. 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 S.P. class member claim to the New York ODD, for separate review.
The case flag in Attachment 12 should be modified to indicate that the
Appeals Council, rather than an ALJ, is forwarding the S.P. 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 S.P. claim is
consolidated with a current claim already pending at the hearing level
(see Part VI.D. 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.D.2.b. above apply, the ALJ
should dismiss the request for hearing 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
“SP” 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 (i.e., a record of alerts processed
by OHA, and a record of cases screened and consolidated by OHA), as
reported by HOs and OAO.
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. OHA Headquarters personnel should contact the Division of
Litigation Analysis and Implementation at 305-0708.
Attachment 1. S.P. Stipulation and Order of Settlement;
Approved by the Court on February 9, 1996; Entered on February 16,
1996.
|
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[Date Filed 02/15/1996] |
Mary Jo White
United
States Attorney for the
Southern District of New York
By:
LORRAINE S. NOVINSKI (LN 8234)
Assistant United States
Attorney
100 Church Street - 19th Floor
New York,
NY 10007
Tel.: (212) 385-4358
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United States District Court
Southern
District of New York
- - - - - - - - - - - -
- - - - - - - x
S.F., M.C., J.M., L.K., and P.S.,
:
On Behalf of Themselves and All
Others Similarity
Situated, :
Plaintiffs, :
v. :
Shirley S. Chater,¹ Commissioner
:
Of
Social Security,
Defendant.
:
- - - - - - - - - - - - - - - - - - -
x
|
STIPULATION
AND ORDER
OF
SETTLEMENT
90
Civ. 6294 (MGC)
|
WHEREAS, plaintiffs filed a class action
complaint on October 1, 1990, challenging the standards, policies,
practices, and procedures used by the Social Security Administration
(“SSA”) in evaluating disability claims under Titles II and
XVI of the Social Security Act which claims allege disability based in
whole or in part on infection with the Human Immunodeficiency Virus
(“HIV”) and/or Acquired Immune Deficiency Syndrome
(“AIDS”) (hereinafter “HIV-related claims”);
and
WHEREAS, on June 7, 1991, this Court denied
Plaintiffs' motion for class certification with leave to renew the motion
and denied Defendant's second motion to dismiss the action; and
WHEREAS, the parties wish to avoid further
litigation and fully and finally resolve this dispute;
IT IS HEREBY STIPULATED AND AGREED, by and
between the attorneys for the parties that:
1.
Certification of a Class. Solely for
purposes of this Stipulation and Order of Settlement (“this
Stipulation”), a class shall be certified as follows.
a.
The class will consist of:
all individuals whose HIV-related claims for disability benefits under
Title II and/or Title XVI of the Social Security Act were finally denied,
in whole or in part, for medical reasons, at any administrative level, on
or after July 27, 1990, and before July 2, 1993, while that individual was
a resident of the State of New York and which claims have not been the
subject of a final judicial decision.
b.
For purposes of paragraph 1 (a), a claim was finally denied on the date of
the administrative determination or decision that became the binding
decision of the Secretary pursuant to
20 C.F.R. §§
404.905,
404.921, 404.955,
404.972, 404.981, 416.1405, 416.1421, 416.1455, 416.1472, and 416.1481.
Throughout this Stipulation, reference to the final denial of a claim for
benefits are to be understood as including decisions that terminate an
individual's benefits for medical reasons. To be a member of the class it
is not necessary that an individual have exhausted administrative remedies
as set forth at 42 U.S.C §§ 405(g) and 405(h).
c.
For the purposes of paragraph 1(a), a claim is denied for medical reasons
when the denial is based on consideration of medical or vocational
factors. Denials based on other factors,
e.g., substantial gainful activity,
excess income or resources, etc., are not made “for medical
reasons.”
d.
Claims that satisfy all of the criteria set forth in paragraph 1(a) will
hereinafter be referred to as “qualifying claims.”
2.
Right to Redetermination of Qualifying Claims.
Each member of the class as defined above is entitled to request a
redetermination of his or her qualifying claim.
3.
Instructions to Adjudicators. SSA will
notify its adjudicators of the rights granted to class members by this
Stipulation and shall provide the adjudicators with instructions for its
implementation.
a.
SSA will make a good faith effort to provide plaintiffs' counsel with
draft instructions within 110 days after entry of judgment pursuant to
this Stipulation.
b.
Plaintiffs' counsel will make a good faith effort to provide SSA with
their comments on the draft instructions within 14 days after counsel's
receipt of the instructions.
c.
SSA will make a good faith effort to issue final instructions within 45
days after its receipt of counsel's comments or, if no comments are
received, within 45 days after the due date for such comments.
d.
SSA will consider counsel's comments, and SSA may, but is not required
to, incorporate the comments into its final instructions.
e.
SSA will provide plaintiffs' counsel with a copy of the final
instructions, as well as a copy of any subsequent revisions thereto, at
the time that they are issued.
f.
SSA will not review any qualifying claims of class members until after
final instructions have been issued except that SSA reserves its right to
reopen claims pursuant to
20 C.F.R. §§
404.987 et seq. and 416. 1487
et seq. for reasons unrelated to this
action.
4.
Notice to Class Members. SSA will take
the following steps to inform potential class members of their rights
pursuant to this Stipulation.
a.
SSA shall send an individual notice (Attachment 1) to every individual
whose qualifying claim had a primary or secondary diagnosis code, as
reflected in SSA's data processing system, of “0420”
“0430” or “0440”, and who, while a resident of
the State of New York, had an HIV-related claim for disability benefits
finally denied for medical reasons at any administrative level on or after
July 27, 1990 and before July 2, 1993. The notices shall be sent by
first-class mail to the last known address of the individual. SSA will
make a good faith effort to complete the sending of these notices within
10 business days after issuance of the final instructions referred to in
paragraph 3(c) above. As soon as practicable after issuance of these
notices, SSA shall provide plaintiffs' counsel with a list of all notices
that are issued pursuant to this paragraph and are returned by the Postal
service as “undeliverable.” SSA will make a good faith effort
to provide this list within 120 days after issuance of the notices.
b.
In order to obtain a redetermination of a qualifying claim, an individual
who receives the notice referred to in paragraph 4(a) must respond to the
notice within 60 days after presumptive receipt (pursuant to
20 C.F.R. §§
404.901,
416.1401) or
provide SSA with evidence of good cause (as defined in
20 C.F.R. §§
404.911 and
416.1411) for
failing to respond within 60 days. The response shall be made by one of
the following means:
1.
By returning the reply form in the pre-addressed postage-paid envelope
provided with the notice; or
2.
By contacting any SSA field office, in person, by telephone or in writing,
and requesting a redetermination pursuant to this Stipulation.
c.
An individual who does not receive the notice referred to in paragraph
4(a) but who believes that he or she is entitled to a redetermination
pursuant to this Stipulation may request a redetermination of a qualifying
claim by contacting any SSA office within one year after the date of
issuance of the notices referred to in paragraph 4(a).
d.
As soon as practicable after receipt of an individual's request for
redetermination, SSA will send the individual an acknowledgment letter
(Attachment 2).
e.
If SSA determines that an individual who requests a redetermination
pursuant to this Stipulation is not a class member entitled to such
relief, SSA will send the individual a notice (Attachment 3) with a copy
to plaintiffs' counsel, advising the individual of its determination and
the reason for it. If the individual disagrees with the determination, he
or she must contact the Office of the General Counsel
(“OGC”), at the address provided in the notice, within 60
days after presumptive receipt (pursuant to
20 C.F.R. §§
404.901,
416.1401) of the
notice. If the individual does not contact OGC within the prescribed time,
and does not show good cause for failing to do so, SSA's determination
will become final and will not be subject to further review. OGC will seek
to resolve any disputes regarding class membership. If OGC is unable to
resolve a dispute, it will so advise the individual, with a copy to
plaintiffs' counsel. The individual, acting through plaintiffs' counsel,
may request that the Court review SSA's determination within 60 days after
presumptive receipt (pursuant to
20 C.F.R. §§
404.901,
416.1401) of
OGC's notice. If no timely request is made, SSA's determination will be
final and binding. Notwithstanding the provisions of the first and fifth
sentences of this subparagraph, no copies of notices will be sent to
plaintiffs' counsel until and unless the Privacy Act Protective Order
submitted to the Court with this Stipulation has been signed and entered
by the Court.
5.
Redetermination of Qualifying Claims.
a.
Qualifying claims with respect to which SSA receives a timely request for
redetermination will be redetermined at the reconsideration level of
administrative review, see
20 C.F.R. §§
404.907 and
416.1407, except
that SSA may, at its option, consolidate an individual's qualifying claim
with another disability claim by the same individual that is pending at
any level of administrative review at the time of the redetermination. SSA
will make a good faith effort to ensure that adjudication of the other
claim(s) is not delayed by such consolidation.
b.
The redeterminations make pursuant to this Stipulation will be made in
accordance with all applicable rules and regulations as they now exist and
as they may hereafter be amended, including Listings 14.08 and 114.08 of
20 C.F.R. Part 404, Subpart P, Appendix 1.
c.
The redeterminations made pursuant to this Stipulation will be based on
the evidence of record upon which the qualifying claim was denied except
that
1.
the adjudicator will obtain additional evidence if he or she determines
that the evidence of record is insufficient to make the
redetermination,
2.
the class member may submit additional evidence relevant to the period
covered by the qualifying claim and the adjudicator will consider such
evidence if he or she determines that it is relevant, and
3.
the adjudicator shall advise the class member that the class member has
the right to submit additional evidence relevant to the period covered by
the qualifying claim, and shall advise the class member how and where to
submit such evidence.
d.
If the redetermination make pursuant to this Stipulation results in a
finding that the individual was disabled at a time covered by the
qualifying claim, the claim will be reopened, the adjudicator will
evaluate evidence of the class member's disability through the date of
current adjudication or, if there has been a subsequent allowance through
the date of onset established in the subsequent allowance and issue a new
determination.
e.
Class members shall have the same rights to administrative and judicial
review of the decisions resulting from the redeterminations made pursuant
to this Stipulation as they have with respect to any decisions made at the
reconsideration level of administrative review.
See 20 C.F.R. Part 404, Subpart J, and
Part 416, Subpart N, 42 U.S.C. §§ 405(g) and 1383(c)(3).
f.
SSA will exert its best efforts to complete all redeterminations made
pursuant to this Stipulation as expeditiously as possible.
6.
Upon request, and subject to the requirements of the Privacy Act, all
other applicable privacy statutes or regulations, and the provisions of
the Privacy Act Protective Order referred to in paragraph 4(e) herein, SSA
will provide plaintiffs' counsel with reasonable and timely access to
information concerning the implementation of this Stipulation. The
information provided by SSA will include access to a potential class
member's files when there is a dispute regarding the individual's
membership in the class.
7.
SSA shall use its best efforts to maintain, by computerized tracking
system, a record of the following information:
a.
The number of class notices sent;
b.
The number of individuals responding to the notices;
c.
The number of notices returned as undeliverable;
d.
The number of individuals determined not to be entitled to
redeterminations;
e.
The number of redeterminations that result in a change in the Secretary's
final denial of a qualifying claim; and
f.
The number of redeterminations that result in no change in the
Secretary's final denial of a qualifying claim.
SSA shall provide reports containing the information specified in
subparagraphs a - f of this paragraph to plaintiffs' counsel once every
three months commencing 90 days after the issuance of notices pursuant to
paragraph 4(a) of this Stipulation. SSA shall continue to provide
plaintiffs' counsel with reports until every timely request for
redetermination is resolved or for two years after the issuance of the
first report, whichever is later. SSA shall also permit plaintiffs'
counsel to review, for each of the five offices that make disability
determinations in New York State, the first five redeterminations that
result in no change in the Secretary's final denial of a qualifying claim.
These reviews will be permitted solely for informational purposes, and the
only appeal rights in existence with respect to these redeterminations are
the rights to administrative and judicial review referred to in paragraph
5(e) of this Stipulation.
8.
The Commissioner shall pay plaintiffs' counsel $65,000.00 (sixty-five
thousand dollars) in full satisfaction of any and all claims for
attorneys' fees and expenses in connection with this litigation.
9.
Counsel for plaintiffs and defendant, by their signatures on this
Stipulation, warrant that they are sole counsel to the plaintiffs and to
the defendant, respectively, whose interests are represented in this
action, and that they are authorized to stipulate to the resolution of the
issues in this action.
10.
Members of the class certified pursuant to this Stipulation shall be
barred and enjoined forever from prosecuting any claims or causes of
action concerning SSA's standards, policies, practices or procedures for
evaluating HIV-related claims for disability that were in effect between
July 27, 1990 and July 1, 1993. Nothing in the preceding sentence is
intended to limit the rights to judicial review referred to in paragraph
5(e) of this Stipulation.
11.
This Stipulation does not constitute an admission by the Commissioner that
any standard, policy, practice or procedure addressed in this action
violated or failed to comply with either the language or the intent of any
applicable law, rule or regulation. This Stipulation does not constitute
an admission by the Commissioner that her position in this litigation was
not substantially justified.
12.
The Commissioner, her successors, and any department, agency or
establishment of the United States and any officers, employees, agents or
successors of any such department, agency or establishment, are hereby
discharged and released from any claims and causes of action that have
been asserted in this action by reason of, with respect to, in connection
with or arising out of any matters alleged in this action, provided,
however, that nothing in this paragraph shall relieve the Commissioner,
her successors, any department, agency or establishment from the duty to
comply with this Stipulation.
13.
The complaint is hereby dismissed with prejudice. Final judgment in
accordance with the terms hereof shall be entered upon entry of this
Stipulation. This Stipulation and the covenants and conditions contained
herein shall become effective upon entry of the Stipulation by the Court.
The Court will retain jurisdiction over this action only for the limited
purposes of resolving any disputes regarding class membership and
enforcing compliance with the terms of the Stipulation. No party shall
seek relief from the Court on any matter related to enforcement without
having first made a good faith attempt to resolve the matter with the
adverse party and without giving the adverse party fourteen days notice of
the request for relief.
Dated: New York, New York
October
5, 1995
Attorneys for
Plaintiffs:
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_______________/s/_____________
THERESA
MCGOVERN, Esq.
The HIV Law Project
841 Broadway,
Suite 608
New York, New York 10011
Telephone:
(212) 674-7590
TM-5445
|
_______________/s/_____________
JILL
ANN BOSKEY, Of Counsel
To Wayne G. Mawley, Esq.
MFY
Legal Services, Inc.
35 Avenue A
New York, New
York 10009
Telephone: (212) 475-8000
JB-3257
|
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_______________/s/_____________
LESLIE
SALEMAN, Esq.
Cardozo Bet Tzedek Legal
Services
85
Fifth Avenue, 17th Floor
New York, New York 10003
Telephone
(212) 790-0240
LS-0588
|
_______________/s/_____________
NANCY
CHANG, Esq., Of Counsel
to JOHN C. GRAY, Jr., Esq.
Brooklyn
Legal Services, Corp. B
105 Court Street, 3rd Floor
Brooklyn,
New York 11201
Telephone: (718) 237-5500
MC-5331
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_______________/s/_____________
SUZANNE
B. GOLDBERG, Esq.
Lambda Legal Defense
and Education
Fund
666 Broadway, 12th Floor
New York, New York,
10012
Telephone: (212) 995-8585
BG-4451
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Attorney for Defendant:
|
MARY JO
WHITE
United States Attorney for the
Southern
District of New York
Attorney for the Defendant
By:
_______________/s/_____________
LORRAINE S. NOVINSKI
Assistant
United States Attorney
100 Church Street, 19th Floor
New
York, New York 10007
Telephone: (212) 385-4358
LN-8234
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SO ORDERED:
_______________/s/_____________
Miriam
Goldman Cedarbaum
United States District Judge
February
9, 1996
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United States District Court
Southern
District of New York
- - - - - - - - - - - -
- - - - - - - x
S.P., M.C., J.M., L.K., and P.S.,
:
On Behalf of Themselves and All
Others Similarity
Situated, :
Plaintiffs, :
v. :
SHIRLEY S. CHATER, :
Commissioner
of Social Security,
Defendant.
:
- - - - - - - - - - - - - - - - - - -
x
|
PRIVACY
ACT
PROTECTIVE ORDER
90
Civ. 6294 (MGC)
|
Pursuant to 5 U.S.C. § 552a(b)(11), 42
U.S.C. § 1306(a), and
20 C.F.R. §
401.340, IT IS HEREBY ORDERED that:
1.
Defendant may disclose to plaintiffs' counsel information required to be
disclosed to plaintiffs' counsel under the Stipulation and Order of
settlement (the “Stipulation”) executed by the parties in
this case notwithstanding the fact that such information is subject to
restrictions on disclosure under the Privacy Act, 5 U.S.C. §§
552 et seq., and the Social Security
Act, 42 U.S. §§ 400 et seq.,
without obtaining the prior written consent of the individual to whom such
records pertain, for the purposes of monitoring compliance with the
Stipulation, facilitating implementation of the Stipulation and assisting
class members and potential class members in effectuating their rights
under the Stipulation. Such information consists of names, addresses, and
claims files of potential class members, and other claimant-specific
information reasonably relevant to the implementation of the
Stipulation.
2.
Plaintiffs' counsel shall use the information disclosed pursuant to
paragraph 1 of this Order only for the purposes described in paragraph 1.
Except as provided in paragraph 4 of this Order, plaintiffs' counsel shall
not make disclosures of such information except: (1) to each other, (2) to
members of plaintiffs' counsel's staff; (3) to defendant or her agents or
counsel, (4) to the Court in this action; or (5) to other persons
participating in the accomplishment of the purposes described in paragraph
1. Any disclosure to persons described in item (5) of the preceding
sentence shall be conditioned upon such persons having read this Order and
acknowledged in writing that they understand the Order and agree to be
bound by it. Plaintiffs' counsel shall inform all non-attorney staff in
their offices who have access to information subject to this order of the
requirements of this Order and shall instruct them to comply with its
terms. Additionally, plaintiffs' counsel may disclose information
pertaining to a particular class member or potential class member to that
particular individual or to a representative acting on behalf of such
individual.
3.
Plaintiffs' counsel and members of their staff shall limit the making of
copies of the records disclosed pursuant to paragraph 1 of this Order to
those necessary to the purposes described in paragraph 1. All such copies,
and any documents created by plaintiffs' counsel or any member of their
staff that contain information disclosed pursuant to paragraph 1, shall be
kept confidential, consistent with the Rules of Professional Conduct. All
such copies and documents concerning individuals who do not individually
engage class counsel's assistance shall be returned to the defendant or
destroyed upon the completion of implementation of the Stipulation.
4.
Nothing is this Order shall prejudice the rights of plaintiffs' counsel to
use the information that they receive pursuant to the Stipulation in this
action that is not subject to restrictions on disclosure contained in the
Privacy and Social Security Acts, or their rights to use information
obtained outside of the context of the Stipulation.
5.
Failure to comply with this Order shall subject the responsible individual
and/or his or her attorney to appropriate sanctions by the Court,
including a finding of contempt.
6.
This Order does not constitute any agreement or ruling as to the
discoverability or admissibility of any record or information.
7.
Upon twenty days' notice to the other parties, any party may seek
modification of this Order.
SO ORDERED:
_______________/s/_____________
Miriam
Goldman Cedarbaum
United States District Judge
February
9, 1996
________________
¹ Pursuant to Pub. L. No. 103-296, the Social Security Independence
and Program Improvements Act of 1994, the functions of the Secretary of
Health and Human Services (the “Secretary”) in Social
Security cases were transferred to the Commissioner of Social Security
(the “Commissioner”) effective March 31, 1995. In accordance
with section 106 (d) of Pub. L. 203-296, Shirley S. Chater, Commissioner
of Social Security, should be substituted as the defendant in this action.
Throughout this document, references to the Secretary should be understood
as referring equally to the Commissioner.
Attachment 2. S.P. COURT CASE FLAG/ALERT
|
REVIEW OFFICE |
PSC |
DOC |
TOE |
ALERT DATE |
RESPONSE DATE |
OLD BOAN/PAN |
|
SSN |
(BOAN or PAN)
|
NAME |
BIRTH DATE |
REFERENCE # |
|
|
|
|
FOLDER LOCATION INFORMATION |
|
|
*CAN/HUN |
BIC/MFT |
CATG |
TITLE |
CFL |
CFL DATE |
ACN |
A separate screening sheet must be prepared for each CAN/HUN printed
above.
PAYEE ADDRESS
|
SCREENING OFFICE ADDRESS: |
|
|
|
|
|
|
|
Title II and CON Claims |
Title XVI |
|
|
|
|
|
SSA, ODIO
SSA, ODIO
Class
Action Section
P.O. Box 17369
Baltimore, MD
21235-0050
|
Northeastern PSC
Disability
Review Section
P.O. Box 316900
Jamaica, NY
11431-6900
|
|
|
ATTN: S.P. Screening Unit |
ATTN: S.P. Coordinator |
|
SPECIAL INSTRUCTIONS:
IF CURRENT CLAIM IS PENDING OR STORED IN OHA HEADQUARTERS OR FEDERAL
DISTRICT COURT, THEN SHIP FOLDER(S) 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) |
|
IF CURRENT CLAIM IS PENDING IN AN OHA HEARING OFFICE, THEN SHIP FOLDER(S)
DIRECTLY TO THAT OFFICE.
Attachment 3. Route Slip or Case Flag for Screening
S.P. Class Action Case
SCREENING NECESSARY
|
Claimant's name: |
___________________________ |
|
SSN: |
___________________________ |
|
|
This claimant may be an S.P. 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 5-454 for additional information and instructions.
|
|
|
TO: |
__________________________________
__________________________________
__________________________________
__________________________________
|
|
CLASS ACTION CODE: S P
|
|
1. CLAIMANT'S SSN
______ - ____ - ______
|
|
2. CLAIMANT'S NAME (Last, First) (Please Print)
|
|
3. DATE OF BIRTH (Month, Day, Year) (MM, DD, YYYY)
____-____-____
|
|
4. CLAIM NUMBER
____-____-____-________
(BIC/ID)
|
|
5. SCREENING DATE (MM, DD, YYYY)
____-____-____
|
|
a. SCREENING RESULT
____MEMBER (J) ____NONMEMBER (F)
|
b. SCREENOUT CODE
____-____(see item 13 for screenout codes)
|
|
6. Was a less than fully favorable title II or title XVI determination/decision issued on any claim(s) at any administrative level while the claimant was a resident of New York?
|
Yes___No___
(if No go to 13)
|
|
7. Was the less than fully favorable determination/decision(s) referred to in Question 6 issued at any administrative level on or after July 27, 1990, and before July 2, 1993, and did this become the final decision of the Agency?
(Note: Although not the “final decision of the Agency,” an Appeals Council denial of a request for review is the last action of the Agency, and the date of such a denial controls for class membership screening purposes.)
|
Yes___No___
(if No go to 13)
|
|
8.Did the determination/decision(s) referred to in Question 6 involve an allegation or diagnosis of HIV infection or AIDS?
|
Yes___No___
(if No go to 13)
|
|
9.Was the determination/decision(s) issued on the potential S.P. claim(s) based on some reason other than the individual's medical condition (e.g., SGA)?
|
Yes___No___
(if Yes go to 13)
|
|
10.Did the individual receive a subsequent fully favorable determination/decision which established entitlement to and paid benefits commencing with the earliest possible month based on the earliest potential S.P. claim(s)?
|
Yes___No___
(if Yes go to 13)
|
|
11.Did the individual receive a final decision/determination,based on substantive medical review (i.e., not based on SGA, res judicata or technical reasons) on or after July 2, 1993, that covered the entire period at issue in the earliest potential S.P. claim?
|
Yes___No___
(if Yes go to 13)
|
|
12.Did the individual receive a final decision from a federal district or appellate court based on an administrative denial/termination decision on the potential S.P. claim(s)?
|
Yes___No___
(If Yes, go to 13. If No, claimant is a class member entitled to relief. Check member block in item 5.a.)
|
|
13. The claimant is not an S.P. class member eligible for relief. 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 "YES".
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.
|
|
14.On the lines below, please enter the date(s) of all applications and final decisions considered in the screening process and indicate the administrative level at which the final decision was made (i.e., DDS, ALJ, AC).
Date of Application(s) Date of Decisions Level of Final Decision
_______________ __________________ ________________
_______________ __________________ ________________
_______________ __________________ ________________
|
|
15. IDENTIFICATION OF SCREENER
(Print name and phone number and also enter signature)
|
COMPONENT
|
DATE
|
INSTRUCTIONS FOR COMPLETING S.P. SCREENING
SHEET
Questions 1 - 4
You must consider all applications decided during the period covered by
the court order when making the class membership determination.
A SEPARATE SCREENING SHEET MUST BE PREPARED FOR EACH CLAIM NUMBER.
Multiple applications during the period covered by the court order on the
same claim number should be screened using the same screening sheet.
Fill in the identifying information as requested. Make sure the Claim
Number, BIC/ID and SSN are correct and legible. (If the SSN is different
from the claim number, copy the SSN from the BOAN/PAN field on the
alert).
Question 5
Complete this information last. Do not fill in the member/nonmember
information in Question 5 until the screening process is completed.
Questions 6-15 -- General
a.
In a multiple claims case, begin screening with the earliest claim in the
S.P. period and stop with the last claim in the
S.P. period. Remember, a separate screening sheet
must be completed for each claim number. Multiple claims covered by the
court order under the same claim number should be screened using the same
screening sheet.
b.
To answer the questions in DDS cases, use the SSA-831 for denial cases and
SSA-832/833 for cessation cases. In OHA adjudicated cases, read the ALJ/AC
decision to answer the questions.
c.
If the SSA-831/832/833 or OHA decision does not yield enough information
to answer the questions, look further into the file.
d.
If the claim folder(s) cannot be located, but queries establish that the
determination(s)/decision(s) was made outside the S.P. timeframe, that the claim was denied for a nonmedical reason,
that the claimant did not reside in New York or that the claimant was
fully paid as of the earliest potential S.P. claim,
screen out the claim(s) without reconstructing the lost folder(s).
e.
If questions 6-8 are answered “NO,” or questions 9-12 are
answered “YES,” check the nonmember block found in Question
5.a. of the screening sheet, then enter the appropriate screenout code in
Question 5.b. as directed in question 13 of the screening sheet.
f.
Remember to follow instructions for members/nonmembers.
Question 6
Screen for residency as of the date of the final determination/decision,
not date of application. (See Question 7 below for more information.) If
the claimant was not a resident of New York as of the date of the final
decision, the claimant is not a class member eligible for relief under the
S.P. settlement.
Question 7
Screen for date of decision, not date of application. Individuals are
potentially entitled to relief if they received a denial or less than
fully favorable decision (e.g., later onset, closed period) on or after
July 27, 1990, and before July 2, 1993 which became the final decision of
the Agency. The phrase “final decision of the Agency,” used
in this context, refers to the date of the administrative decision that
became the final decision of the Commissioner and does
not mean that a class member must have
exhausted administrative remedies.
Question 8
Review Items 16a/b of the SSA-831 and Items 22/21 of the SSA-832/833. If
diagnosis code 0420, 0430, or 0440 is present, indicate “YES”
for Question 8 and go to the next question. If none of these codes are
present, also review the disability interview form for an allegation of
HIV infection, including AIDS. Look at Item D, page 1 of the SSA-3368-BK;
Item 3A of the SSA-3820-F6; or Item 1a and 1c of the SSA-454-BK, or the
OHA decision as applicable. If these items indicate that HIV infection or
AIDS has been alleged, indicate “YES” for Question 8 and go
to the next question.
Question 9
Check item 33 of the SSA-831 or item 11 of the SSA-832/833. The reg-basis
codes that indicate a non-medical initial or post-adjudicative denial for
title II are M7, M8, N1, N2 or S1. N01, N02, N03, N04, N05, N06, N09, N10,
N11, N12, N13, N14, N17, N33, N44 (for adult claimants only) and N54, are
the non-medical initial or post-adjudicative denial codes for title XVI.
For a complete list of the title II denial codes see
SM 00380.270. For
a complete list of title XVI denial or payment status codes see
SM 01005.440 and
SM
01305.001F.
Question 10
Review the file and case control queries. Determine if a subsequent
reversal was fully favorable, allowing the earliest possible
entitlement/onset date as alleged on the S.P. claim(s). In order for an individual to be screened out under
this question, benefits must have been paid based on the earliest date of
entitlement/eligibility. (If full retroactive benefits have not been paid,
forward the file to a claims authorizer in the Program Service Center with
SSN jurisdiction for processing. Annotate the route slip: “Fully
Favorable Medical Decision - Retroactive Payments are Due.”).
Question 11
Review all claims files and queries to determine whether decision(s) made
on or after July 2, 1993, readjudicated the merits of the entire period
covered by the S.P. claim(s). An S.P. claim may be screened out when there is a subsequent denial
determination or decision issued on or after July 2, 1993,
and
1.
the alleged onset date (AOD) for the subsequent claim is the same as, or
earlier than the S.P. claim, and
2.
medical evidence describing the condition at the AOD was available to the
adjudicator of the subsequent claim, and
3.
the rationale in the DDS' determination of the subsequent claim (including
supporting documentation such as forms SSA-2506 and SSA-4734) or the
ALJ/AC decision indicates that disability was considered back to the
AOD.
Per POMS DI
27510.001A and
DI
27510.005A.1.a., DDS adjudicators generally limit consideration of
subsequent claims to the period after the previously adjudicated period.
Therefore, a claim cannot be screened out on the basis of Question 11
unless it is clear that the DDS
adjudicated the entire period covered by the S.P. claim back to the earliest alleged onset/entitlement date. At
the OHA level, ALJ and Appeals Council decisions that do not consider the
previously adjudicated period usually will indicate that the claimant's
request for hearing has been dismissed on the basis of res
judicata with respect to the previously adjudicated period.
These cases cannot be screened
out.
Question 12
Screen to determine if a district or appellate court issued a final, i.e.,
unappealed, decision on the S.P. application(s).
The period within which an appeal of a district court decision may be
filed is 60 days from the date of entry of judgment. For example, a
district court decision entered on October 2, usually becomes unappealable
on December 2, the 61st day after entry of judgment if no appeal was
filed. Consult the Litigation Staff, as needed.
Item 13
Self-explanatory
Item 14
Fill in the dates of the application(s), decision(s) and the level of
adjudication of the final decision(s), that were reviewed in deciding
class membership for the claim number in item 4. Remember a separate
screening sheet must be prepared for each claim number.
INSTRUCTIONS FOR MEMBERS
a.
Check the “MEMBER” block in Question 5.a. of the screening
sheet.
b.
Sign the form and retain the original screening sheet in the claim
file.
c.
OHA Headquarters components and Hearing Offices will send a copy of the
screening sheet to:
Office of Hearings and Appeals
Office of
Appellate Operations
One Skyline Tower, Suite 701
5107
Leesburg Pike
Falls Church, VA 22041-3200
Attn: OAO Class Action Coordinator
The Class Action Coordinator will enter the screening sheet information
into a data base and forward the screening sheet to the Division of
Litigation Analysis and Implementation (DLAI).
[DLAI will retain a copy of each screening sheet received from the OAO
Class Action Coordinator and forward a copy to Litigation Staff at SSA
Headquarters for entry into the Civil Actions Tracking System.]
d.
Follow HALLEX I-5-454,
V.B.3.b.
INSTRUCTIONS FOR NONMEMBERS
a.
Check the “NONMEMBER” block in Question 5.a. and enter the
appropriate screenout code (the number of the question that determined the
individual is not a class member, numbers 6-12; see Question 13 on the
screening sheet) in item 5.b.
b.
Follow items b. and c. above.
c.
Prepare and send the class membership denial notice (Attachment 6) to the
claimant with a copy to his/her representative, if any, and class counsel.
Retain a copy of the denial letter in the folder. Forward the claim
file(s) as indicated in HALLEX I-5-454,
V.B.3.a.
Attachment 5. Route Slip for Routing Class Member Alert and Prior Claim Fill(s)
to ODIO or PSC -- OHA No Longer Has Current Claim
|
ROUTING AND TRANSMITTAL SLIP
|
DATE |
|
TO:
1.
|
INITIALS |
DATE |
|
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 |
_____OTHER |
REMARKS
S.P. 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 the NEPSC (using the address indicated on the alert)
for screening and possible readjudication.
SEE I-5-454 Part V.B.2.a.
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
_______________
|
*U.S.GPO:1985-0-461-274/20020
Prescribed by GSA
FPMR
(41 CFR) 101-11.206
Attachment 6. Notice of Non-Class Membership/Ineligibility for Relief
|
SOCIAL
SECURITY NOTICE
|
|
Important Information
|
|
From: |
Services Social Security Administration
|
|
|
____________________________Date:____-____-____ |
|
|
|
|
|
____________________________Claim Number:____________________ |
|
|
|
|
|
____________________________DOC___________________________ |
|
THIS NOTICE IS ABOUT YOUR SOCIAL SECURITY DISABILITY CLAIM. |
|
PLEASE READ IT CAREFULLY! |
We have considered your request for a review of your old claim for
disability benefits or SSI in accordance with the court case
S.P. v. Chater. For the reason checked below, we
have decided that you are not
entitled to a new decision on your old claim.
|
___ |
You did not live in New York when your old claim was denied or your benefits were terminated.
|
|
___ |
We did not make a final decision denying your old claim or terminating your benefits on or after July 27, 1990, and before July 2, 1993.
|
|
___ |
Your old claim was not based in whole or in part on HIV or AIDS.
|
|
___ |
Your claim was denied for some reason other than your medical condition. That reason was
__________________________________________________________
__________________________________________________________.
|
|
___ |
You have already received a final decision by a United States District Court on your old claim.
|
|
___ |
You have already received all the benefits you could receive if we reviewed your old claim again.
|
|
___ |
You filed a new claim that covered the time period covered by your old claim, and your new claim was decided on or after July 2, 1993.
|
|
___ |
Other:__________________________________________________________
_______________________________________________________________
|
|
|
|
|
WE ARE NOT DECIDING IF YOU ARE DISABLED |
It is important for you to understand that we are not making a decision
about whether you are disabled. We are deciding only that you are not
entitled to a new decision on your old claim based on the court case
S.P. v. Chater.
IF YOU DISAGREE WITH THIS DETERMINATION YOU MUST WRITE TO US WITHIN 60 DAYS AT:
Office of the General Counsel
(OGC)
Social Security Administration
600 Altmeyer
Building
6401 Security Boulevard
Baltimore, MD
21235
|
IF YOU NEED HELP WRITING TO US, OR IF YOU DON'T UNDERSTAND THIS NOTICE,
you may contact the lawyers representing the S.P. v.
Chater class members at:
|
|
The
HIV Law Project
841
Broadway, Suite 608
New
York, NY 10003
Telephone:
(212) 674-7590
|
|
These lawyers can advise you and, if appropriate, assist you in notifying
Social Security that you disagree with this decision.
If you have a lawyer or representative, you should show this letter to him
or her.
ESTE ES UN AVISO IMPORTANTE RELACIONADO CON BENEFICIOS DE SEGURO SOCIAL O SSI. FAVOR DE PEDIR QUE SE LO TRADUZCAN IMMEDIATAMENTE Y DE LLAMAR A SU OFFICINA DE SEGURO SOCIAL O A UN ABOGADO PARA UN EXPLICACION. LOS DIRECIONES Y NUMEROS DE OFICINAS LEGALES ESTAN MENCIONADAS ARRIBA.
Attachment 7. Route Slip for Non-Class Member/Ineligibility for Relief
Cases
|
ROUTING AND TRANSMITTAL SLIP
|
DATE |
|
TO:
SSA, New York Regional Office
|
INITIALS |
DATE |
|
Disability Programs Branch |
|
|
|
26 Federal Plaza, Room 40-114 |
|
|
|
New York, NY 10278 |
|
|
|
Attn: S.P. Coordinator |
|
|
|
|
|
|
|
|
|
|
|
__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 |
_____OTHER |
REMARKS
S.P. CASE
|
Claimant: |
___________________________ |
|
SSN: |
___________________________ |
We have determined that this claimant is not an S.P. class member entitled to relief. (See screening sheet and copy
of notice of non-class membership/ineligibility for relief in the attached
claim file(s).) We are forwarding this file to your office because the
claimant disputes the non-class membership determination and class counsel
has asked to review the file.
SEE HALLEX HA 01540.054 Part V.B.5.
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
_______________
|
*U.S.GPO:1985-0-461-274/20020
Prescribed by GSA
FPMR
(41 CFR) 101-11.206
Attachment 8. S.P. Class Member Flag for Headquarters Use
(DDS Readjudication - Retention Period Expired)
S.P. Class Action Case
READJUDICATION NECESSARY
|
Claimant's name: |
___________________________ |
|
SSN: |
___________________________ |
This claimant is an S.P. class member. Accordingly,
we are forwarding the attached claim file(s) to the DDS for
readjudication.
Send the file(s) to:
|
|
New York Office
of Disability
Determinations
5th Floor Mailroom
Cortlandt
Street
New York, New York 10071-3107
(Destination Code: 1335)
|
|
If this is a TERI case or if a face-to-face review necessary, please
forward to the servicing DDS.
Attachment 9. S.P. Class Member Flag for Headquarters Use
(DDS Readjudication -- Retention Period Has Not Expired)
S.P. Class Action Case
READJUDICATION NECESSARY
|
Claimant's name: |
___________________________ |
|
SSN: |
___________________________ |
This claimant is an S.P. class member. After
expiration of the retention period, forward claim file(s) to the DDS for
readjudication.
Send the file(s) to:
|
|
New York Office of Disability |
|
|
|
Determinations
5th
Floor Mailroom
22 Cortlandt Street
New York, New
York 10071-3107
|
|
|
|
(Destination Code: 1335) |
|
* If this is a TERI case or if a face-to-face review is necessary, send
the file to the servicing DDS.
If the claimant has filed a civil action and elected to remain in court
for review of the current claim, forward the S.P. claim file(s) without delay to the DDS for readjudication.
|
SOCIAL SECURITY ADMINISTRATION |
|
OFFICE OF HEARINGS AND APPEALS |
|
|
|
ORDER OF DISMISSAL |
|
|
|
|
IN THE CASE OF |
CLAIM FOR |
|
__________________________ |
___________________________ |
|
|
|
|
__________________________ |
___________________________ |
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 Joint Stipulation of the parties and an order of
the United States District Court for the Southern District of New York in
the case of S.P. v. Chater, No. 90 Civ. 6294
(S.D.N.Y. February 16, 1996), the claimant has requested readjudication of
the final (determination/decision) on the prior application(s) filed on
______________. The claimant has been identified as an S.P. class member and is entitled to have the final administrative
denial of the prior application(s) reviewed under the terms of the
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 New York Office of Disability Determinations
[or the “resident” DDS, if appropriate] which will conduct
the S.P. readjudication. The New York Office of
Disability Determinations 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 11. Notice Transmitting ALJ Order 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 New York Office of
Disability Determinations 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
S.P. class member claim back to the New York Office
of Disability Determinations for further processing. The enclosed order
explains why.
The Next Action on Your Claim
The New York Office of Disability Determinations will contact you to tell
you what you need to do. If you do not hear from the
New York Office of Disability Determinations 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. S.P. Class Member Flag for HO Use (DDS Readjudication)
S.P. Class Action Case
READJUDICATION NECESSARY
|
Claimant's Name: |
___________________________ |
|
SSN: |
___________________________ |
This claimant is an S.P. class member. The attached
S.P. 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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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 S.P. readjudication action.
We are sending the alert and prior file(s) to:
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New York Office of Disability |
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Determinations
5th
Floor Mailroom
22 Cortlandt Street
New York, New
York 10071-3107
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(Destination Code: 1335) |
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If this is a TERI case or if a face-to-face review is necessary, send the
alert and the prior claim file to the servicing DDS.