ISSUED: December 5, 1997
I. Purpose
This Temporary Instruction (TI) sets forth the procedures for implementing
the parties' joint Stipulation and Order, approved by the United States
District Court for the Southern District of Illinois on June 7, 1996, in
the Small v. Chater class action involving
allegations of misconduct by an Administrative Law Judge (ALJ).
Adjudicators throughout the country must be familiar with this TI because
of case transfers and because Small class members
who are entitled to relief and now reside outside of Illinois and Missouri
must have their cases processed in accordance with the requirements of the
joint Stipulation and Order.
II. Background
On September 13, 1989, plaintiffs filed a class complaint alleging
misconduct by ALJ Robert Ritter (subsequently referred to as the
“subject ALJ”) in the St. Louis, Missouri Hearing Office (HO)
of the Office of Hearings and Appeals.
On September 21, 1992, the U.S. District Court for the Southern District
of Illinois certified a class to include all individuals whose title II or
title XVI claims were the subject of an adverse determination by the
subject ALJ and whose claims were not reversed on any subsequent
administrative appeal or readjudication.
In order to avoid further litigation, the parties agreed to settle their
dispute. On May 15, 1995, the parties filed a jointly negotiated
settlement agreement with the court (Attachment 1). On June 15, 1995, the
district court preliminarily approved the parties' joint Stipulation and
Order for settlement. Following the court's preliminary approval of the
Stipulation, SSA performed a computer search to identify potential class
members.
On February 21, 1996, at the parties' request, the court issued an order
scheduling a fairness hearing, pursuant to Rule 23(e) of the Federal Rules
of Civil Procedure, for June 7, 1996.
On April 10, 1996, SSA mailed notices to 1,824 individuals who had been
identified by SSA's computer systems as potential class members. The
notice informed those individuals of the basic terms of the settlement,
advised them of the opportunity to object to the settlement, and offered
them the opportunity to request relief by returning a review request form.
At the fairness hearing on June 7, 1996, the court considered written
objections to the settlement and found the proposed settlement to be fair
and reasonable. On the same day, the court issued a separate memorandum
and order granting final approval of the settlement agreement.
III. Guiding Principles
In accordance with the Stipulation and Order in
Small, the Commissioner will readjudicate the title
II and title XVI disability claims of those individuals who: 1) respond to
notice informing them of the opportunity to request relief or do not
receive notice but otherwise self-identify and request relief
(“walk-ins”); and 2) are determined to be class members
entitled to relief (see Parts IV. and V.
below).
Under the terms of the Stipulation, SSA's Office of Disability and
International Operations (ODIO) or the Great Lakes Program Service Center
(GLPSC) will retrieve the claim file for each responder or walk-in who had
a hearing before the subject ALJ during the time frame for relief and ship
it to the St. Louis HO. The St. Louis HO will notify class counsel of its
availability for review. The settlement agreement provides that class
counsel will perform the initial review of the claim file in the process
of determining whether an individual is entitled to relief. Class counsel
will have 60 days from the date of the notice to review the claim file for
evidence of the conduct specified in
Part V.C. and to provide written notice
of the certification to the St. Louis HO and the Office of the General
Counsel (OGC).
Class counsel may avoid review of the file for certain responders if
available systems data establishes that vocational expert testimony was
received at the hearing. SSA will provide a list of such individuals based
on available systems data to class counsel, who may certify any individual
on this list under Part V.B.4. without
reviewing the claim file. For each individual that class counsel certifies
pursuant to Part V.B.4., class counsel
will mail a certification to the St. Louis HO and OGC within 60 days from
the date of notification that the claim file is available for
review.
The St. Louis HO will review class counsels' certification and, if
appropriate, send class counsel a written rebuttal of the certification or
notice that the individual is not otherwise entitled to relief within 60
days of the date class counsel mails the certification. If the individual
is not otherwise entitled to relief, the St. Louis HO will send class
counsel a notice describing why the individual is not entitled to receive
relief under the Small Stipulation. If, within 60
days after the date of mailing of the certification, the St. Louis HO does
not rebut the certification or send notice to class counsel that the
individual is not otherwise entitled to relief, the individual will become
entitled to relief.
With the exception of cases consolidated with a current claim pending at
the Appeals Council (AC) level to expedite a favorable decision (see
Part VI. below), class members who are
entitled to relief will receive the opportunity for a new hearing decision
from an ALJ other than the subject ALJ. The type of review to be conducted
will be a “redetermination”
(see Part VI. below). In most cases, the
HO nearest to the claimant's residence will perform the required
readjudications. Individuals entitled to relief who receive adverse
decisions upon readjudication of their claims may appeal to the AC.
Any action by the AC on these claims will be binding and not subject to further review.
IV. Definition of Class
The parties' June 7, 1996 Stipulation and Order revised the original class
definition, set forth in the district court's September 21, 1992 Order, to
include any individual who filed a claim for disability benefits pursuant
to title II or title XVI of the Social Security Act; and
•
had a request for hearing dismissed by the subject ALJ on or after
September 28, 1986, but on or before June 15, 1995 (the date of the
court's preliminary approval of the settlement); or
•
had a hearing conducted by the subject ALJ on or after September 28, 1986,
but on or before June 15, 1995, and who received a less than fully
favorable decision from the subject ALJ which was not reversed on appeal
or remand from an appeal; and
•
did not file a federal civil action in which the issue of the subject
ALJ's alleged predisposition to deny claims was addressed and
determined.
However, class members entitled to relief
include only those class members
•
who had a hearing or hearings conducted by the subject ALJ on or after
September 28, 1986, but before January 22, 1992; and
•
who are determined to be entitled to relief based on class counsels'
unrebutted certification that the claim file contains evidence of conduct
by the subject ALJ that meets the specific requirements of
Part V.C. below; and
•
whom SSA determines are otherwise entitled to relief after
screening.
A person is not a class member entitled to relief if the individual
received a decision from an ALJ other than the subject ALJ (whether
favorable or unfavorable) after a de
novo hearing on the potential class
member claim, or on a subsequent claim that covered the entire period at
issue in the class member claim(s).
V. Determination of Class Membership and Entitlement to Relief and
Preadjudication Actions
A. Pre-Certification — General
1.
Notification of Individuals Potentially Entitled to Relief
a.
On April 10, 1996, Litigation Staff mailed notices to 1824 individuals who
had been identified by its computer systems as potential class members.
Such individuals had 60 days (from the date of the notice) to request that
SSA readjudicate their claims under the terms of the
Small Stipulation and Order.
b.
ODIO will send untimely responses to the servicing field office (FO) (i.e.
district or branch office) to develop for possible evidence of good cause
for the untimely response. Good cause determinations will be based on the
standards in 20 CFR
§§ 404.911 and
416.1411. If good
cause is established, the FO will forward the good cause determination,
and any folders currently in the FO, to ODIO (title II and concurrent
claims) or the GLPSC (title XVI only claims) for any additional folder
retrieval action that may be necessary and for routing to OHA.
c.
An individual who did not receive written notice of the settlement could
have, nonetheless, requested relief under the Stipulation by filing a
written request with SSA by October 7, 1996, which is 180 days from the
date (April 10, 1996) that SSA mailed the written notices to the
systems-identified potential class members. The written request must have
included the individual's social security number, claim number, date of
birth, and request to receive relief under the
Small Stipulation. The Stipulation does not provide
for consideration of good cause for untimely responses by walk-ins
received after October 7, 1996.
2.
Identification of Individuals Entitled to Relief
Litigation Staff shall generate alerts and review its available systems
data to determine whether individuals who requested relief as specified in
Part V.A.1., above, had a hearing
conducted by the subject ALJ during the time frame for relief (on or after
September 28, 1986, but before January 22, 1992). For those individuals
who had a hearing during the time frame for relief, SSA (ODIO or GLPSC)
will retrieve and/or reconstruct the appropriate claim folder(s) and
forward them to the St. Louis HO for class counsels' review. For those
individuals who did not have a hearing during the time frame for relief,
Litigation Staff will forward the alert and query package to the St. Louis
HO.
3.
Alert and Folder Retrieval Process
All response forms should be returned to ODIO so that the information can
be entered into the Civil Actions Tracking System (CATS). CATS will
generate folder alerts to the current claim file location for all
potential class members who had a hearing before the subject ALJ during
the time frame for relief. See Attachment 2 for a sample
Small alert.
ODIO will associate the computer-generated alerts with available title II
and concurrent title II and title XVI claim file(s) for potential class
members who had a hearing before the subject ALJ during the time frame for
relief. For title XVI only claims, the GLPSC will retrieve available files
for potential class members who had a hearing before the subject ALJ
during the time frame for relief. Once the claim files and alerts have
been associated, ODIO or the GLPSC will forward the alert and claim files
directly to the St. Louis HO, unless there is another claim pending, for
further processing.
If ODIO or the GLPSC determines that a potential class member's claim file
or a subsequent claim file is pending or stored at OHA Headquarters, ODIO
or the GLPSC will send the alert, along with any prior claim file(s) not
in OHA's possession, to the OAO Class Action Coordinator for association
with the pending or stored claim file. If ODIO or the GLPSC determines
that the potential class member's claim file (either current or prior
Small claim file) is pending or stored in an OHA
HO, ODIO or the GLPSC will send the alert, along with any prior claim
file(s) not in OHA's possession, to the HO which has the pending or stored
claim file. Since all certification and screening actions will be
conducted in the St. Louis HO, the OHA component receiving the alert must
forward all current and prior files to the St. Louis HO for processing. If
the pending or stored claim file cannot be released, a photocopy of that
file should be forwarded to the St. Louis HO as provided in
Parts V.E.3. and
V.E.4. below.
The OAO Class Action Coordinator is responsible for controlling and
reconciling the disposition of class alerts shipped to OHA Headquarters.
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 reconciliation for individuals entitled to
relief.
4.
Ensuring Folder Is Ready for Review
The St. Louis HO will review the file to determine whether the individual
was represented at the hearing(s) held by the subject ALJ during the time
frame for relief. If the individual was unrepresented, and a transcript or
cassette recording of the Small hearing(s) is not
present in the file, the St. Louis HO will complete a Cassette Tape
Request Form (Attachment 3) and forward it to the Computer Cassette
Library (CCL) located in OHA Headquarters at the following address:
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Office of Hearings and Appeals
Office
of Appellate Operations
Computer Cassette Library (CCL)
One
Skyline Tower, Suite 803
5107 Leesburg Pike
Falls
Church, VA 22041-3200
Attn: Branch Chief
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The CCL will retrieve available transcripts or hearing tapes, and forward
them to the St. Louis HO for association with the claim file.
5.
Folder Reconstruction
a.
SSA shall make good faith efforts to reconstruct missing claim files of
individuals who had a hearing during the time frame for relief. SSA will
reconstruct these files to the best of its ability under existing SSA
procedures. ODIO will initiate any necessary reconstruction of prior claim
files for title II and concurrent cases, and the GLPSC will initiate claim
file reconstruction for title XVI cases.
b.
The HO or OAO will not delay action on a current claim when a prior
Small claim file is being reconstructed for class
counsels' review and certification. When the HO or OAO completes action on
the current claim, the HO or OAO, as appropriate, will forward a copy of
the action on the current claim to the St. Louis HO for association with
the reconstructed file.
c.
Upon receipt of a reconstructed file, the St. Louis HO will review the
file to determine whether the individual was represented at the hearing(s)
held by the subject ALJ during the time frame for relief. If the
individual was unrepresented, and a transcript or cassette recording of
the Small hearing(s) is not present in the file,
the HO will follow the procedures in
Part V.A.4. above.
B. Certification by Class Counsel — General
Class counsel will review the retrieved (or reconstructed) claim files to
determine whether the files contain evidence of the conduct specified in
Part V.C. below, by the subject
ALJ.
1.
Notification of Class Counsel that the Folder Is Available for
Review
After receiving a claim file for a potential class member and ensuring
that the file is ready for review pursuant to
Part V.A.4. above, the St. Louis HO will
send class counsel a notice (Attachment 4) that the file is available for
review. The notice will be sent to class counsel at the following
address:
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A. Robert Kassin
Attorney
At Law
P.O. Box 425
Edwardsville, IL 62025
Attn: Small court case
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2.
Completion of Certification Form
Within 60 days after the St. Louis HO sends notification to class counsel
that an individual's claim file is available for review, if class counsel
reviews the file and finds that any of the conduct by the subject ALJ
specified in Part V.C. below, is
evidenced in that file, class counsel shall mail a completed certification
form (Attachment 5) to the St. Louis HO at the following address:
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Office of Hearings and Appeals
Old
Post Office Building, Room 220
815 Olive Street
St.
Louis, Missouri 63101-9933
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A copy will be sent to OGC at the following address:
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Office of the General Counsel
Altmeyer
Bldg., Rm. 600
6401 Security Blvd.
Baltimore,
MD 21235
Attn: Small Attorney
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If class counsel does not certify the case within the 60 day time frame,
the potential class member will not receive relief.
3.
Rebuttal of Certification/Notice that Individual Is Not Otherwise Entitled
to Relief
Class counsels' certification will become the final determination of
entitlement to relief unless the St. Louis HO provides a rebuttal or
notice to class counsel that the individual is otherwise not entitled to
relief within 60 days of the date that class counsel mails the
certification to the St. Louis HO (see
Parts V.D. and V.E. below). In the event
that SSA mails class counsel a rebuttal or notice that the individual is
otherwise not entitled to relief, class counsel may dispute that
determination by raising an appeal to the Department of Health and Human
Services' Departmental Appeals Board (DAB) pursuant to
Part V.G. below. The DAB's decision on
whether an individual is or is not a member of the class entitled to
relief will be binding and not subject to further review.
4.
Certification Based on Available Systems Data
Prior to retrieving claim files, SSA shall review its available systems
data to determine whether a vocational expert testified at the hearing of
any individual responder who had a hearing conducted by the subject ALJ
during the time frame for relief (on or after September 28, 1986, but
before January 22, 1992). SSA will create a list of those individuals and
will provide a copy of such list to class counsel. Class counsel may
certify the claim of any individual on this list without reviewing the
claim file by mailing a completed certification form (Attachment 5) to the
St. Louis HO and OGC at the addresses in
Part V.B.2. above, within 60 days from
the date the St. Louis HO mails class counsel a notice that an
individual's claim file is available for review. For each individual so
certified, class counsel will annotate item 2 on Attachment 5 to indicate
that the certification is based on systems data provided by SSA.
The St. Louis HO will place a copy of the certification in the claim file.
The certification will become the final determination of entitlement to
relief unless the St. Louis HO mails a rebuttal or notice that the
individual is otherwise not entitled to relief within 60 days of the date
class counsel mails the certification.
C. Conduct Specified in Paragraph V(B) of Small
Stipulation and Order
The Stipulation provides that class counsel will mail SSA a certification
form if any of the conduct described below is evidenced in the
individual's claim file:
1.
The subject ALJ obtained a consultative examination, whether pre-hearing
or post-hearing, and the claim file includes no documentation that the
subject ALJ first requested the treating physician to conduct the
examination;
2.
An expert witness testified at the hearing at the request of SSA;
3.
The subject ALJ obtained post-hearing development and the claim file
includes no documentation that the subject ALJ provided the individual or
the individual's representative an opportunity to examine and comment on,
to object to, or to refute the post-hearing evidence;
4.
The subject ALJ sent an interrogatory to an expert witness and the claim
file includes no documentation that the interrogatory was proffered to the
individual or the individual's representative (before being propounded to
the expert) with the opportunity to object to the use of the
interrogatory, to object to the substance of the interrogatory, or to
propose additional interrogatories;
5.
The subject ALJ sent an interrogatory to an expert witness that was not
modified or supplemented as requested by the individual or the
individual's representative unless the requested modification or
supplementation was not material to the issue of disability;
6.
The subject ALJ sent an interrogatory to an expert witness that was
modified or supplemented as requested by the individual or the
individual's representative and the claim file includes no documentation
that the interrogatory as modified or supplemented was proffered to the
individual or the individual's representative for further comment (before
being propounded to the expert) with the opportunity to object to the use
of the interrogatory, to object to the substance of the interrogatory, or
to propose additional interrogatories;
7.
The subject ALJ received a response to an interrogatory to an expert
witness and the claim file includes no documentation that the response to
the interrogatory was proffered to the individual or the individual's
representative;
8.
The subject ALJ communicated ex parte with a
treating source, consultative examiner, or a medical or vocational
expert;
9.
With respect to an individual who was unrepresented at the time of the
hearing:
a.
The claim file includes documentation that additional, specific medical
records relevant to the claim existed and the claim file includes no
documentation that the subject ALJ requested such records; or
b.
The subject ALJ did not obtain a consultative examination when such an
examination would have been required under the standards currently set
forth in 20 CFR
§§ 404.1519 and
416.919; or
c.
The subject ALJ did not obtain expert evidence on vocational issues and
the claim file includes documentation that the individual had a severe
nonexertional impairment and the claim was denied at the fourth or fifth
step of the sequential evaluation process;
10.
With respect to an individual who was unrepresented at the time of the
hearing, the tape recording or transcript of the hearing (if available)
documents that:
a.
The subject ALJ did not advise the individual of the right to
representation, including an explanation of the manner in which an
attorney can aid in the proceedings, the possibility of free counsel or a
contingency arrangement, and the limitation on attorney's fees to
twenty-five percent of past-due benefits plus required Agency approval of
the fees; or
b.
The subject ALJ did not elicit testimony from the individual regarding an
issue that was relevant to the claim, or the ALJ's inquiry regarding the
issue was wholly inadequate to support a finding on the issue; or
11.
If SSA reconstructed the individual's claim file pursuant to
Part V.A.5. above, the claim file
includes insufficient information to determine whether any of the
above-specified conduct may have occurred.
D. Rebuttal of Class Counsels' Certification
The St. Louis HO is the only component that will review the claim file(s)
and class counsels' certifications for possible rebuttal. Within 60 days
after class counsel mails a certification that indicates that the conduct
specified in Part V.C. above occurred,
the St. Louis HO will review the file for evidence that supports or
contradicts class counsels' certification and may rebut the certification
by mailing written notice to class counsel that the specified conduct did
not occur (Attachment 6). Class counsel may dispute the rebuttal pursuant
to Part V.G. below.
E. Post-Certification Action/Determination that an Individual is Not
Entitled to Relief
The St. Louis HO is the only component that will review the claim file(s)
of those individuals whose claims are certified to determine whether all
other requirements for relief are met. Within 60 days after class counsel
mails a certification that the conduct specified in
Part V.C. above occurred, the St. Louis
HO will complete a screening sheet (Attachment 8), as provided in
Part V.E.2. below, to determine whether
the other requirements for relief specified in
Part I.V. and Attachment 8. If the St.
Louis HO determines that the individual is otherwise not entitled to
relief, the HO will mail a non-entitlement to relief notice (Attachment 7)
to class counsel. Class counsel may dispute the determination pursuant to
Part V.G. below.
1.
Jurisdiction for Review/Pre-Screening Actions
All claims will be screened at the OHA level by the St. Louis HO. The St.
Louis HO will ensure that a timely certification has been received for the
individual pursuant to Part V.B. above
prior to screening for entitlement to relief.
2.
General Screening Instructions
In cases where class counsel mails a timely certification, the St. Louis
HO will associate the alert and any prior claim file(s) with the claim
file(s) in its possession and complete a screening sheet (Attachment 8) as
follows.
•
Consider all applications that fall within the
Small time frame;
•
Follow the screening sheet instructions when completing the screening
sheet; and
•
Sign and date the original screening sheet and place it in the claim file
(on the top right side of the file).
3.
Special Instructions - Current Claim is Pending at OHA
If a current claim is before the AC, the OAO Class Action Coordinator will
forward the alert, a photocopy of the
current claim file and the prior claim file(s) (or a photocopy of the
prior file if it is needed to adjudicate the current claim) to the St.
Louis HO using Attachment 9 for review by class counsel. The Coordinator
will place a notation in the current claim file regarding the
Small claim because the adjudicating component must
notify the St. Louis HO when processing of the current claim is completed.
The St. Louis HO will notify the OAO branch if the individual is
subsequently determined to be entitled to relief under
Small.
If a current claim is pending in an HO other than the St. Louis HO, the HO
will forward the alert, a photocopy of
the current claim file and the prior claim file(s) (or a photocopy of the
prior file if it is needed to adjudicate the current claim) to the St.
Louis HO using Attachment 9 for review by class counsel. The St. Louis HO
will notify the HO if the individual is subsequently determined to be
entitled to relief under Small.
4.
Special Instructions - Claim at OHA But No Current Action Pending
If a claim file (either on a Small claim or another
claim) is located in OHA Headquarters but there is no claim actively
pending administrative review, i.e., Headquarters is holding the file(s)
awaiting potential receipt of a request for review or notification that a
civil action has been filed, the OAO Class Action Coordinator will forward
the alert and a photocopy of the file(s)
at OHA headquarters to the St. Louis HO using Attachment 9.
5.
Special Screening Instructions if a Civil Action Is Involved
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 a copy of any
accompanying claim file(s) to the St. Louis HO for review by class
counsel. The route slip to the HO should indicate that there is a civil
action pending. The Coordinator will also notify the appropriate OAO Court
Case Preparation and Review Branch (CCPRB) of the potential
Small claim.
If a civil action is involved, after screening, the St. Louis HO will
forward the file(s) to the CCPRB for appropriate action. The screening
determination will dictate the appropriate post-screening action.
•
If the claim pending in court is the potential class member claim, the
CCPRB will immediately notify OGC so that OGC can notify the claimant of
the option to have the case remanded for readjudication under
Small.
•
If the claim pending in court is a subsequent claim and resolved all
Small issues, the claimant is not a
Small class member entitled to relief. The St.
Louis HO staff will follow the instructions in
Part V.F.1. below, for processing such
claims.
•
If the claim pending in court is a subsequent claim and did not resolve
all Small issues, e.g., there is a prior (inactive)
claim and the current claim did not adjudicate the entire period covered
by the Small claim, the CCPRB will forward the
Small claim to the appropriate HO for separate
review. The CCPRB will use the case flag in Attachment 11 to indicate that
the pending court case does not resolve all Small
issues and that the Small class member claim is
being forwarded for separate processing. The CCPRB will notify the Class
Action Coordinator of this action.
•
If the final administrative decision on the claim pending in court was not
adjudicated in accordance with the Small settlement
or is legally insufficient for other reasons, the CCPRB may wish to
initiate voluntary remand proceedings and consolidate the claims.
1.
Screened-Out Cases
If the St. Louis HO determines that the individual is not a class member
entitled to relief, the St. Louis HO will:
•
notify class counsel of that determination using Attachment 7 (modified as
necessary to fit the circumstances and posture of the case when there is a
current claim);
•
retain a copy of the notice in the claim file;
Include the date and claim number at the top of Attachment 7 in the spaces
indicated.
•
retain the claim file(s) (or copy of the file(s)) for 90 days pending a
possible dispute regarding entitlement to relief; and
•
if class counsel does not, in a timely manner (see
Part V.G. below), dispute the rebuttal or
screening determination, return the file(s) (or copy of the file(s)) to
the appropriate storage location at the expiration of the 90-day retention
period.
2.
Cases Determined to Be Class Members Entitled to Relief
If SSA does not rebut class counsels' certification or notify class
counsel that the individual is otherwise not entitled to relief within the
60-day time frame (see Part V.B.4.
above), then the individual shall receive relief.
If the claimant's current residence is outside the jurisdiction of the St.
Louis HO, the St. Louis HO will forward the claim file to the appropriate
HO to perform the readjudication using Attachment 13.
The readjudicating HO will review the file to determine whether a fully
favorable decision can be issued on the current record. If necessary the
HO will forward the folder via the Small folder
flag (Attachment 10) to the appropriate FO for needed development. Medical
development will be limited to updating the medical evidence of record
where the HO is prepared to find that the claimant became disabled during
the redetermination period or that the individual's disability did not
cease. The HO will then proceed with processing in accordance with the
instructions in Part VI. below.
G. Third Party Resolution of Disputes Concerning Entitlement to
Relief
Within 35 days after the St. Louis HO mails rebuttal documentation or
notice that the individual otherwise is not entitled to relief, class
counsel may file an original and two copies of a request for final
resolution of the dispute with the DAB. Copies of the review request shall
also be sent to the St. Louis HO and OGC. Within 15 days of class
counsels' filing of a review request with the DAB, OGC shall mail to the
DAB an original and two copies of all documents and arguments that OGC
will submit which identify the specific reasons why OGC believes that the
individual is not a class member entitled to relief.
The DAB will assign each review request to a Third Party Review Panel
drawn from the DAB's professional staff. The Panel's resolution of the
matter will be final and not subject to further review.
H. Case Tracking Requirements
The St. Louis HO and the OAO Class Action Coordinator share responsibility
for maintaining a personal computer-based record of OHA implementation
activity. This information is necessary to respond to inquiries and to
complete reconciliation (see
Part VIII.).
1.
The St. Louis HO is responsible for keeping a record of alerts and files
received, hearing tape and transcripts received (for unrepresented
claimants), notification of class counsel that the file is available for
review, whether certification by class counsel is timely, ensuring a
timely screening determination and, if appropriate, the timely mailing of
rebuttal of class counsels' certification or notice that an individual is
not otherwise entitled to relief. The St. Louis HO is also responsible for
updating OHA records with any case transfers made to other hearing offices
for readjudication.
2.
The OAO Class Action Coordinator is responsible for controlling and
reconciling the disposition of class alerts shipped to OHA Headquarters.
The Coordinator will maintain a record of all alerts received and the
location, if any, to which they are transferred, as well as folder
movement where there is a current claim pending or stored in OHA
Headquarters.
VI. Processing and Adjudication
A. OHA Adjudication of Claims
All individuals entitled to relief will receive the opportunity for a new
hearing decision on their claim from an ALJ other than the subject ALJ.
All of the Small readjudications will be conducted
at the OHA level.
In consolidation cases, the Small readjudication will be performed at the hearing level or the AC level.
The conditions under which the AC would perform the readjudication are
limited to cases where an ALJ decision is not required because the AC will
issue a favorable decision. Most consolidations at the AC level would
involve fully favorable dispositions, however, the AC may issue a
partially favorable decision as long as it is fully favorable with respect
to the Small claim. Individuals who receive adverse
readjudication determinations of their Small claims
will be able to appeal the determinations to the AC.
Any decision by the Appeals Council will be binding and not subject to further review.
Except as noted herein, HOs and OHA Headquarters will process
Small claims according to all other current
practices and procedures including coding, developing evidence, routing,
etc.
1.
Type of Review and Period to Be Considered
a.
Pursuant to the Small 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. Normal OHA policy and
standard operating procedures apply to the scheduling and notice of the
Small hearing. The new hearing decision will be
based on the claim and period that were at issue in the hearing that led
to class membership and entitlement to relief. The readjudication shall be
a de
novo evaluation of the individual's
entitlement to benefits based on all evidence in his or her file including
any new evidence relevant to the period at issue.
b.
If the redetermination will result in a favorable decision (in whole or in
part), the ALJ shall determine pursuant to
20 CFR §§
404.1588 -
404.1599 and
416.988 - 416.998, whether the individual's disability continues as of the
date of the new decision. However, if the individual is already within a
period of disability (20
CFR § 404.321) or is eligible for Supplemental Security Income
based on a disability (20
CFR § 416.202), the ALJ shall only consider whether the
individual's disability continued up to, but not including, the date on
which the individual's disability was found to have begun.
2.
Individual Is Deceased
If an individual entitled to relief is deceased, the usual survivor and
substitute party provisions and existing procedures for determining
distribution of any potential underpayment apply.
3.
Releasing Instructions
The new hearing decision should be accompanied by a special notice of
Small Class Action Readjudication (See Attachment
14 — Sample Notice of Unfavorable Decision) rather than a standard
notice of unfavorable decision. Likewise, at the AC level, denials of
requests for review of Small claims should utilize
a modified notice (See Attachment 15 — Sample Denial of Request for
Review of Small Readjudication). For a favorable or
partially favorable decision at the AC level, the standard notices should
be tailored to the circumstances of the particular case using the language
contained in Attachments 14 and 15 as a guide.
B. Processing and Adjudicating Small Claims in
Conjunction with Current Claims (Consolidation Procedures)
1.
General
If an individual has a current claim pending at the OHA level and
consolidation is warranted according to the guidelines below, the
appropriate component will consolidate all Small
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 individual 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 not consolidate the
Small case with the appeal on the current claim.
If 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 individual
entitled to relief under Small, the ALJ will
consolidate the claims and issue a favorable decision.
If the claims are consolidated, follow
Part VI.B.2.c. below. If the claims are
not consolidated, follow Part VI.B.2.d.
below.
b.
Hearing Not Scheduled
Except as noted below, if an individual has an initial request for hearing
pending on a current claim and the HO has not yet scheduled a hearing, the
ALJ will consolidate the Small claim and the
current claim (see Part VI.B.2.d.
below).
The ALJ will not consolidate the claims if
•
the current claim and the Small 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; or
•
consolidation will unreasonably delay action on either the current claim
or the Small claim.
If the claims are consolidated, follow
Part VI.B.2.c. below. If the claims are
not consolidated, follow Part VI.B.2.d.
below.
c.
Actions If Claims Consolidated
When consolidating a Small claim with any current
claim, and when 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 the date the individual attains age 65 (or through the date
the claimant last met the insured status requirements or the prescribed
period requirements, if applicable and earlier). Accordingly,
consolidation will result in a reopening of the
Small claim through the time period at issue in the
current claim. However, if the period at issue in the current claim does
not overlap the period to be adjudicated in the
Small claim, the two claims should be considered
separately.
Nevertheless, if the claimant is found to be disabled within the time
frame of the Small claim, the claim will be
reopened through the date at issue in the current claim. If the current
claim and the Small claim are consolidated, 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 Small claim raises any additional issue(s) not
raised by the current claim;
•
issue one decision that addresses both the issues raised by the current
request for hearing and those raised by the Small
claim (the ALJ's decision will clearly indicate that the ALJ considered
the Small claim pursuant to the
Small Stipulation and Order);
•
indicate in the decision which findings are subject to court review and
which are not because there are no court appeal rights with respect to
Small readjudications; and
•
modify the sample notice (Attachment 14), as appropriate to fit the
circumstances of the particular case.
d.
Action If Claims Not Consolidated
If the ALJ decides not to consolidate the current claim with the
Small claim because 1) the claims do not have any
issues in common, or 2) there is a court-ordered time limit, or 3)
consolidation would unreasonably delay action on either the current claim
or the Small claim, the ALJ will:
•
take the necessary action to complete the record and issue a decision on
the current claim; and
•
schedule a hearing and issue a separate decision on the
Small claim.
3.
Current Claim Pending at the AC
If there is a current claim pending at the AC, the St. Louis HO will
forward the claim file(s) and the completed screening sheet to the
appropriate OAO disability review branch. The action the AC takes on the
current claim determines the disposition of the
Small claim. Therefore, OAO must keep the claim
files together until it completes its action on the current claim. The
following sections identify possible AC actions on the current claim and
the corresponding action on the Small claim.
a.
AC Intends to Dismiss, Deny Review or Issue a Denial Decision on the
Current Claim — Small Issue(s) Will Remain
Unresolved.
This will usually arise when the current claim does not duplicate the
Small claim, e.g., the current claim raises the
issue of disability but does not cover the entire period adjudicated in
the Small claim. For example, the
Small claim raises the issue of disability for a
period prior to the period adjudicated in the current claim. In this
instance, the AC will proceed with its intended action on the current
claim.
OAO staff will attach a Small case flag (Attachment
12) to the Small claim, immediately forward the
Small claim to the appropriate HO for action, and
retain a copy of Attachment 12 in the current claim file. However, the
current claim should not be forwarded with the
Small claim unless the appeal period for the
current claim has expired. OAO will indicate on Attachment 12 that the
AC's action on the current claim does not resolve all
Small issues and that the
Small claim is being forwarded for separate
processing. OAO staff will include copies of the ALJ's or AC'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 AC's decision.
b.
AC Intends to Issue a Favorable Decision on the Current Claim — No
Small Issue(s) Will Remain Unresolved.
If the AC intends to issue a 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 an individual entitled to
relief under Small, the AC should proceed with its
intended action. In this instance, the AC will consolidate the claims,
reopen the final decision on the Small claim and
issue a decision that adjudicates both applications. The AC's decision
will clearly indicate that the AC considered the
Small claim pursuant to the
Small Stipulation and Order.
c.
AC Intends to Issue a Favorable Decision on the Current Claim —
Small Issue(s) Will Remain Unresolved.
If the AC 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 Small claim, the AC will proceed with
its intended action. In this situation, the AC will request the
effectuating component to forward the claim files to the appropriate HO,
after the AC's decision is effectuated. The HO will assign the
Small claim to an ALJ other than the subject ALJ
for a new hearing. OAO staff will include the following language on the
transmittal sheet used to forward the case for effectuation:
"Small court case review needed — following
effectuation forward the attached combined folders to the designated HO
for further action."
d.
AC Intends to Remand the Current Claim to an Administrative Law
Judge.
If the AC intends to remand the current claim to an ALJ, it will proceed
with its intended action unless one of the exceptions below applies. In
its remand order, the AC will direct the ALJ to consolidate the
Small claim with the action on the current claim
pursuant to the instructions in
Part VI.B.2.a. above.
The AC will not direct the ALJ to consolidate the claim if
•
the current claim and the Small 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
Small claim to the HO for separate review. The case
flag in Attachment 12 should be used to indicate that the AC is forwarding
the Small 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.B.2. 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.” To identify individuals entitled to relief in
HOTS, HO personnel will code “SM” 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 OHA components to
reconcile their disposition of class member claims with information
available on CATS. Within OHA, the OAO Class Action Coordinator and St.
Louis HO share responsibility 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). See
Part V.H. and
HALLEX
HA 01170.012 with respect
to reporting requirements.
IX. Inquiries
HO personnel should direct any questions to their Regional Office.
Regional Office personnel should contact the Division of Field Practices
and Procedures in the Office of the Chief Administrative Law Judge at
(703) 305-0022. OHA headquarters personnel should contact the Division of
Litigation Analysis and Implementation at 305-0721.
Attachment 1. -
Joint Motion for Preliminary Approval of Settlement Agreement and Small Stipulation and Order; Approved by the U.S. District Court for the Southern District of Illinois on June 7, 1996.
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[DATE FILED 05/15/1995] |
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IN THE UNITED STATES DISTRICT COURT |
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FOR THE SOUTHERN DISTRICT OF ILLINOIS |
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CORENE SMALL, et. al. |
) |
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|
) |
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Plaintiffs, |
) |
|
|
|
) |
|
|
v. |
) |
Civil Action No. 89-CV-3700-WDS |
|
|
) |
(Stiehl, C.J.; Cohn, M.J.) |
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SHIRLEY S. CHATER, |
) |
|
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Commissioner, Social |
) |
|
|
Security Administration |
) |
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|
) |
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Defendant. |
) |
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_________________________________ |
) |
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JOINT MOTION FOR PRELIMINARY APPROVAL |
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OF SETTLEMENT AGREEMENT |
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The plaintiff class and defendant, by their respective counsel, hereby
request the Court, pursuant to the terms of their settlement agreement and
Fed. R. Civ. P. 23(e), to approve preliminarily the Stipulation and Order
attached at Tab A.
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Respectfully submitted, |
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____________/s/____________
RICHARD
CHASE
JOAN SPIEGEL
Land of Lincoln Legal
Assistance
Foundation, Inc.
327 Missouri Avenue, Suite 605
East
St. Louis, IL 62201
Telephone: (618) 271-2476
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Attorneys for the Plaintiff Class |
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Date: May 15, 1995 |
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FRANK W. HUNGER
Assistant
Attorney General
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W. CHARLES GRACE
United
States Attorney
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LAURA J. JONES
Assistant
United States Attorney
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OF COUNSEL: |
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Randolph
W. Gaines
Acting Principal Deputy
General
Counsel
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____________/s/____________
BRIAN
G. KENNEDY
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|
A.
George Lowe
Acting Associate General
Counsel,
Litigation Division
Dean Landis
Attorney
Office
of the General
Counsel
Social Security
Administration
|
____________/s/____________
FELICIA
L. CHAMBERS
U. S. Department of Justice
Civil
Division
Federal Programs Branch
P.O. Box 883
Ben
Franklin Station
Washington, D. C. 20044
Telephone:
(202) 514-3259
Attorneys for Defendant
Date:
May 12, 1995
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IN THE UNITED STATES DISTRICT COURT |
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FOR THE SOUTHERN DISTRICT OF ILLINOIS |
|
|
|
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|
CORENE SMALL, et. al. |
) |
|
|
|
) |
|
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Plaintiffs, |
) |
|
|
|
) |
|
|
v. |
) |
Civil Action No. 89-CV-3700-WDS |
|
|
) |
(Stiehl, C.J.; Cohn, M.J.) |
|
SHIRLEY S. CHATER, |
) |
|
|
Commissioner, Social |
) |
|
|
Security Administration |
) |
|
|
|
) |
|
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Defendant. |
) |
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_________________________________ |
) |
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The parties, by and through their respective counsel, hereby agree to the
full and final settlement of this class action on the following
basis.
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I — DESCRIPTION OF THE CAUSE |
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On September 13, 1989, this class action seeking declaratory and
injunctive relief was filed against the Secretary of Health and Human
Services. On September 21, 1992, the District Court issued a Memorandum
and Order denying the Secretary's Motion to Dismiss and granting
Plaintiffs' Motion for Class Certification, Small v.
Sullivan, 820 F. Supp. 1098 (S.D. Ill. 1992).
The class definition as stated in the Court's September 21, 1992 Order is
amended, as follows, to include any individual:
A.
Who filed a claim for disability benefits pursuant to Title II or XVI of
the Social Security Act;
B.
1. Who requested a hearing on the claim and had the request dismissed by
the Administrative Law Judge (ALJ) whose conduct was the subject of this
action (subject ALJ) on or after September 28, 1986, but on or before the
date of preliminary approval of this Stipulation and Order (Stipulation)
by the Court pursuant to ¶ IV(A) below, or
2. Who had a hearing on the claim conducted by the subject ALJ on or after
September 28, 1986, but on or before the date of preliminary approval of
this Stipulation by the Court pursuant to ¶ IV(A) below, and who
received a less than fully favorable decision by the subject ALJ which was
not reversed upon appeal or remand from an appeal; and
C.
Who did not file a federal civil action in which the issue of the subject
ALJ's alleged predisposition to deny claims was addressed and
determined.
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III — CLASS MEMBERS ENTITLED TO RELIEF |
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Class members entitled to relief under this Stipulation shall include any
class member:
A.
Who had a hearing conducted by the subject ALJ on or after September 28,
1986, but before January 22, 1992; and
B.
Who is determined to be entitled to relief pursuant to ¶ V(E)
below.
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IV — COURT APPROVAL OF STIPULATION AND REQUESTS FOR RELIEF |
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A.
Preliminary Approval of Stipulation
Following execution, the parties shall promptly move the Court to enter
this Stipulation as an Order by endorsing it following the signature of
counsel. Such entry by the Court constitutes preliminary approval of the
proposed settlement.
B.
Identification of Class Members
Following preliminary approval of the Stipulation, the Social Security
Administration (SSA) shall, as soon as practicable, use its available data
processing systems to identify the names, Social Security numbers, claim
numbers and last known addresses of class members.
C.
Scheduling of Rule 23(e) Hearing
Following identification of class members, the parties shall request the
Court to schedule a hearing (Rule 23(e) hearing) to consider final
approval of the Stipulation pursuant to Rule 23(e) of the Federal Rules of
Civil Procedure.
D.
Notice of Rule 23(e) Hearing and Entitlement to Relief
Following scheduling of the Rule 23(e) hearing, SSA shall send a copy of
the notice attached as Exhibit 1, together with a review request form
attached as Exhibit 2 and a postage-paid return envelope, by first class
mail to class members, identified pursuant to ¶ IV(B) above, at their
last known addresses. The notice shall advise each individual of the
opportunity to object to approval of this Stipulation and of the
possibility of relief under this Stipulation but shall not mention the
subject ALJ by name. SSA shall bear the cost of this notice.
E.
Rule 23(e) Hearing
Any class member may comment on the terms of this Stipulation by
submitting written comments to class counsel postmarked no later than 30
days prior to the Rule 23(e) hearing and signed by the class member or
representative. Class counsel shall forward to defendant's counsel and
file with the Court copies of all comments immediately upon receipt and no
later than 21 days prior to the Rule 23(e) hearing. Any class member who
submits such timely written comments may testify at the Rule 23(e) hearing
and object to final approval of this Stipulation. Any such testimony by a
class member shall be limited to matters addressed in the class member's
timely written comments. At the Rule 23(e) hearing, the parties shall
request the Court to enter a final order granting final approval of this
Stipulation, dismissing this action with prejudice, and expressly
retaining jurisdiction for the limited purpose of enforcing the terms and
conditions of this Stipulation.
F.
Request for Relief
1.
Any individual who receives the notice of Rule 23(e) hearing and
entitlement to relief and who wishes to receive relief under this
Stipulation must mail a completed review request form to SSA within 60
days of the date SSA sent the notice to the individual. No individual who
receives the notice and whose review request form is not timely received
by SSA shall receive relief under this Stipulation unless the individual
demonstrates good cause (as defined in
20 C.F.R. §§
404.911 and
416.1411) for the
untimeliness. A determination by SSA concerning good cause shall be
binding and not subject to further review.
2.
Any individual who does not receive the notice of Rule 23(e) hearing and
entitlement to relief but who wishes to receive relief under this
Stipulation must notify SSA in writing of the individual's Social Security
number, the individual's claim number, the individual's date of birth, and
the individual's request to receive relief under this Stipulation. The
individual must notify SSA within 180 days after SSA mails the notices
pursuant to ¶ IV(D) above. If the individual fails to do so, then
that individual shall not receive relief.
3.
SSA shall provide copies of the requests received under ¶¶
IV(F)(1) and (2) to class counsel.
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V — DETERMINATION OF ENTITLEMENT TO RELIEF |
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A.
Retrieval of Claim Files
1.
As soon as practicable, for each individual who requests relief in
compliance with ¶ IV(F) above, SSA shall make good faith efforts to
retrieve the claim file for that individual and shall forward it to the
St. Louis, Missouri, hearing office (hearing office). With respect to an
individual who was unrepresented at the time of the hearing, SSA shall
also make good faith efforts to retrieve and forward the tape recording or
transcript of the hearing (if available).
2.
If SSA cannot retrieve the claim file for any individual who requests
relief in compliance with ¶ IV(F) above, then SSA shall reconstruct
the claim file under existing SSA procedures and shall forward the
reconstructed claim file to the hearing office.
3.
Upon receiving claim files, the hearing office will notify class counsel
in writing that they are available for review for the purpose of making a
certification pursuant to ¶ V(B) below.
B.
Certification by Class Counsel
Within 60 days after the hearing office sends notification to class
counsel that an individual's claim file is available for review pursuant
to ¶ V(A)(3) above, class counsel shall mail to SSA (i.e., the
hearing office and the Office of the General Counsel, Room 600, Altmeyer
Building, 6401 Security Boulevard, Baltimore, MD 21235) a certification
form (attached as Exhibit 3) only if any of the conduct described below is
evidenced in the individual's claim file:
1.
The ALJ obtained a consultative examination, whether pre-hearing or
post-hearing, and the claim file includes no documentation that he first
requested the treating physician to conduct the examination;
2.
An expert witness testified at the hearing at the request of SSA;
3.
The ALJ obtained post-hearing development and the claim file includes no
documentation that he provided the individual or individual's
representative an opportunity to examine and comment on, to object to, or
to refute the post-hearing evidence;
4.
The ALJ sent an interrogatory to an expert witness and the claim file
includes no documentation that the interrogatory was proffered to the
individual or the individual's representative (before being propounded to
the expert) with the opportunity to object to the use of the
interrogatory, to object to the substance of the interrogatory, or to
propose additional interrogatories;
5.
The ALJ sent an interrogatory to an expert witness that was not modified
or supplemented as requested by the individual or the individual's
representative unless the requested modification or supplementation was
not material to the issue of disability;
6.
The ALJ sent an interrogatory to an expert witness that was modified or
supplemented as requested by the individual or the individual's
representative and the claim file includes no documentation that the
interrogatory as modified or supplemented was proffered to the individual
or the individual's representative for further comment (before being
propounded to the expert) with the opportunity to object to the use of the
interrogatory, to object to the substance of the interrogatory, or to
propose additional interrogatories;
7.
The ALJ received a response to an interrogatory to an expert witness and
the claim file includes no documentation that the response to the
interrogatory was proffered to the individual or the individual's
representative;
8.
The ALJ communicated ex parte with a treating source, consultative
examiner, or a medical or vocational expert;
9.
With respect to an individual who was unrepresented at the time of the
hearing:
a.
The claim file includes documentation that additional, specific medical
records relevant to the claim existed and the claim file includes no
documentation that the ALJ requested such records;
b.
The ALJ did not obtain a consultative examination when such an
examination would have been required under the standards currently set
forth in 20 C.F.R.
§§ 404.1519 and
416.919; or
c.
The ALJ did not obtain expert evidence on vocational issues and the claim
file includes documentation that the individual had a severe
non-exertional impairment and the claim was denied at the fourth or fifth
step of the sequential evaluation process;
10.
With respect to an individual who was unrepresented at the time of the
hearing, the tape recording or transcript of the hearing (if available)
documents that:
a.
The ALJ did not advise the individual of the right to representation,
including an explanation of the manner in which an attorney can aid in the
proceedings, the possibility of free counsel or a contingency arrangement,
and the limitation on attorneys' fees to twenty-five percent of past-due
benefits plus required agency approval of the fees; or
b.
The ALJ did not elicit testimony from the individual regarding an issue
that was relevant to the claim, or the ALJ's inquiry regarding the issue
was wholly inadequate to support a finding on the issue; or
11.
If SSA reconstructed the individual's claim file pursuant to ¶
V(A)(2) above, the claim file includes insufficient information to
determine whether the conduct identified in ¶ V(B)(1) - (10) above
may have occurred.
C.
SSA Rebuttals
Within 60 days after class counsel mails a certification, SSA may rebut
the certification by mailing to class counsel written documentation that
the conduct did not occur. Within the same time limit, SSA may mail a
notice to class counsel that the individual otherwise is not a member of
the class entitled to relief under this Stipulation.
D.
Third Party Resolution
1.
Within 35 days after SSA mails rebuttal documentation or notice that the
individual otherwise is not a member of the class entitled to relief under
this Stipulation, class counsel may file an original and two copies of a
request for review by mail with the designated third party, the
Departmental Appeals Board of the Department of Health and Human Services
(Room 637-D Humphrey Building, 200 Independence Avenue, S.W., Washington,
D.C. 20201 — (202) 690-5863 (telecopier)), for final resolution.
Copies of the request for review shall be sent simultaneously to SSA
(i.e., the hearing office and the Office of the General Counsel, Room 600,
Altmeyer Building, 6401 Security Boulevard, Baltimore, MD 21235).
2.
Within 15 days of the filing of the request for review, class counsel
shall mail to the Departmental Appeals Board an original and two copies
(with an additional copy to SSA) of all documents and arguments that class
counsel will submit. These papers shall:
a.
Identify the specific reasons class counsel believes that the individual
is a member of the class entitled to relief and why SSA's determination is
incorrect; and
b.
Include all relevant documents, including a copy of the notice or other
documentation referred to in ¶ V(C) above and any attachments.
3.
Within 15 days of class counsel's filing of a request for review, SSA
shall mail to the Departmental Appeals Board an original and two copies
(with an additional copy to class counsel) of all documents and arguments
that SSA will submit. These papers shall:
a.
Identify the specific reasons SSA believes that the individual is not a
member of the class entitled to relief and why SSA's determination is
correct; and
b.
Include all relevant documents.
SSA shall advise the Departmental Appeals Board within five days of
receipt of the request for review if it will not be making a
submission.
4.
Each request for review will be assigned for final decision to a Third
Party Review Panel, drawn from the professional staff of the Departmental
Review Board, under the authority of
45 C.F.R. §§
16.4 and
16.13. The Panel
will promptly notify class counsel and SSA of the receipt of the request
for review and name a Panel contact for questions about case status and
procedure. The Panel may grant brief extensions of time for good cause
shown (as explained in 45
C.F.R. § 16.15). While the Panel may grant an extension for
the submission of documentation in support of the parties' respective
positions regarding class membership, the Panel will not grant an
extension for receipt of the request for review itself. The Panel may take
such actions as the Panel deems necessary to develop a sound record,
including, inter alia, requesting a
party to file a response to the other party's submission and holding a
telephone conference (which will be recorded or transcribed). Within 30
calendar days following completion of the record as determined by the
Panel (or as soon thereafter as is practicable), the Panel will issue a
written decision explaining why the individual is or is not a member of
the class entitled to relief. The Panel's decision on whether an
individual is or is not a member of the class entitled to relief will be
binding and not subject to further review.
E.
Entitlement to Relief
If SSA does not rebut class counsel's certification or notify class
counsel that the individual otherwise is not a member of the class
entitled to relief under this Stipulation, or if the third party finds
that SSA has not adequately rebutted class counsel's certification and
that the individual otherwise is a member of the class entitled to relief
under this Stipulation, then the individual shall receive relief under
this Stipulation.
A.
Nature of Relief
A class member entitled to relief under this Stipulation shall receive an
opportunity for a new hearing decision based on the claim and period that
were at issue in the hearing that led to membership in the class and
entitlement to relief.
B.
Supplementation of Record
The class member entitled to relief may supplement the record concerning
the claim at issue with evidence that relates to the period at issue in
the hearing that led to membership in the class and entitlement to
relief.
C.
Hearing Office Procedure
1.
The hearing office shall assign the case of a class member entitled to
relief to an ALJ (other than the subject ALJ), chosen by the normal method
of assignment, and shall notify the class member of the assignment.
2.
The hearing office shall review the record, including any supplemental
evidence submitted by the class member relating to the period at issue, to
determine whether the record supports a fully favorable decision on the
claim at issue. If so, the ALJ shall reopen the previous determination on
the claim and shall issue a fully favorable decision.
3.
If the hearing office determines that the record does not support a fully
favorable decision on the claim at issue, then the ALJ may offer the class
member the opportunity for a pre-hearing conference pursuant to
20 C.F.R. §§
404.961 and
416.1461.
4.
If the ALJ cannot make a fully favorable decision on the claim at issue
after any pre-hearing conference, then the ALJ shall offer the class
member the opportunity for a hearing on the claim. The ALJ shall
thereafter make any appropriate decision on the claim, which may include
reopening the previous determination on the claim, without regard to any
prior decision by the subject ALJ in the case.
5.
If the new decision will be favorable (in whole or in part), then the ALJ
shall determine, pursuant to
20 C.F.R. §§
404.1588-99 and 416.988-98, whether the class member's disability
continues as of the date of the new decision. However, if, on the date of
the new decision, the class member is already within a period of
disability, 20 C.F.R.
§ 404.321, or is already eligible for Supplemental Security
Income on the basis of a disability,
20 C.F.R. §
416.202, then the ALJ shall only determine whether the class
member's disability continued up to, but not including, the date on which
the class member's disability had already been found to have begun.
6.
If the new decision is not fully favorable, then the class member may
appeal the decision to the Appeals Council. Any decision by the Appeals
Council will be binding and not subject to further review.
D.
Named Plaintiffs
1.
The claim of Plaintiff Corene Small will be remanded, pursuant to
sentence four of 42 U.S.C. § 405(g), for further administrative
proceedings. SSA will not make a decision that is less than fully
favorable without offering Plaintiff Corene Small the opportunity for a
new hearing (before an ALJ (other than the subject ALJ) chosen by the
normal method of assignment) on the claim and period that were at issue in
the hearing that led to membership in the class.
2.
The claim of Plaintiff Addie Liddell will be remanded, pursuant to
sentence four of 42 U.S.C. § 405(g), for further administrative
proceedings. SSA will not make a decision that is less than fully
favorable without offering Plaintiff Addie Liddell the opportunity for a
new hearing (before an ALJ (other than the subject ALJ) chosen by the
normal method of assignment) on the claim and period that were at issue in
the hearing that led to membership in the class.
SSA shall provide class counsel with two statistical reports concerning
hearings by the subject ALJ on disability claims showing the number of (A)
dispositions; (B) affirmances (decisions unfavorable to claimants); (C)
reversals (decisions favorable to claimants); and (D) dismissals. The
first report shall include information concerning the period ending with
the date of the Court's final approval of this Stipulation and following
the period included in response to Interrogatory Number 1 of Plaintiffs'
Third Set of Interrogatories. The second and final report shall include
information concerning the period ending with the date one year from the
date of the Court's final approval of this Stipulation and following the
period included in the first report.
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VIII — ATTORNEYS' FEES AND COSTS |
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Each party shall bear its own attorneys' fees, expenses and costs
resulting from this litigation.
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IX — PRIVACY ACT PROVISION |
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Any disclosures of information made under ¶¶ IV(F)(3) and V and
any other disclosures authorized under this Stipulation shall be permitted
pursuant to the Privacy Act, 5 U.S.C. § 552a(b)(11). Authorized
disclosures include, inter alia,
disclosures (pursuant to current written consent by individual class
members attached at Exhibit 4) made by class counsel to persons
representing individual class members (or to persons formerly representing
individual class members on the claim and period that were at issue in the
hearing that led to membership in the class) for the purpose of
effectuating the terms and conditions of this Stipulation. The Stipulated
Protective Order dated October 30, 1990, hereby incorporated by reference,
shall govern the disclosures of the claim files to class counsel for the
purpose of making certifications pursuant to ¶ V(B), the disclosures
of individuals' requests for relief under ¶ IV(F)(3), the treatment
of the certification forms described in ¶ V(B), disclosures of
information by class counsel to persons representing individual class
members (or to persons formerly representing individual class members on
the claim and period that were at issue in the hearing that led to
membership in the class), and any other disclosures authorized under this
Stipulation.
A.
Upon final approval by the Court of this Stipulation, the claims of all
class members are dismissed, with prejudice, subject to the retention of
jurisdiction for the limited purpose of enforcing the terms and conditions
of this Stipulation. This Stipulation represents the full and final
resolution of, and the full and exclusive remedy for, any and all
allegations, claims or causes of action, whether known or unknown, which
have been or could have been asserted in this action or in any other
proceeding of any kind, by reason of, with respect to, or in connection
with class members' claims.
B.
Defendant, her administrators or 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 or could have been asserted in this action, or administratively, by
reason of, with respect to, in connection with, or that arise out of, any
matters alleged in this action; provided, however, that nothing in this
paragraph shall relieve defendant of the duty to comply with this
Stipulation. Nothing in this Stipulation shall bind the defendant to take
any action that is contrary to law.
C.
This Stipulation does not constitute an admission by defendant of any
pattern or practice that violates or fails to comply with any law, rule,
or regulation dealing with any matter within the scope of the allegations
contained in the complaint or otherwise raised by plaintiffs in this
action. The parties agree that no admission with respect to any claim or
defense raised in this action shall be deemed in any subsequent proceeding
hereunder to constitute a waiver of any defense which otherwise might be
raised. This Stipulation shall not serve as precedent in any other
litigation.
D.
Neither this Stipulation nor any of its terms may be amended, modified,
changed, or abrogated except by written agreement executed by the parties
and approved by the Court. This Stipulation shall have no force or effect
if not finally approved by the Court in its entirety.
E.
Preliminary approval of this Stipulation shall be a condition precedent
to any obligation of any party pursuant to this Stipulation.
F.
Final judgment in accordance with Rules 54, 58 and 79(a) of the Federal
Rules of Civil Procedure shall be entered upon the Court's final approval
of this Stipulation. This Stipulation shall become effective on the 61st
day after such entry of final judgment; provided however, that this
Stipulation shall not be effective if an appeal of the Court's entry of
the Stipulation or the final judgment is filed, in which event the
Stipulation shall be effective only upon the expiration of all subsequent
appeal periods.
G.
If this Stipulation is finally disapproved by any court, or in the event
that it fails to become effective for any reason whatsoever, or it is
finally reversed or modified on appeal, then this Stipulation shall be
null and void, shall have no further force and effect, and shall not be
used in this action or in any other action or proceeding. If any of those
circumstances occur, then this Stipulation and all negotiations,
proceedings and statements made in connection with it shall be without
prejudice to any person or party, shall not be deemed or construed to be
an admission by any party of any fact, matter or proposition, and shall
not be used in any manner or for any purpose in any subsequent proceedings
in this action or in any other action, court or administrative
proceedings, except for the purpose of restoring the procedural posture of
this action to the status quo ante.
AGREED to by counsel representing the respective parties subject to
approval of the Court.
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____________/s/____________
RICHARD
CHASE
JOAN SPIEGEL
Land of Lincoln Legal
Assistance
Foundation, Inc.
327 Missouri Avenue, Suite 605
East
St. Louis, IL 62201
Telephone: (618) 271-2476
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Attorneys for the Plaintiff Class |
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Date: May 15, 1995 |
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FRANK W. HUNGER
Assistant
Attorney General
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W. CHARLES GRACE
United
States Attorney
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LAURA J. JONES
Assistant
United States Attorney
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OF COUNSEL: |
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Randolph
W. Gaines
Acting Principal Deputy
General
Counsel
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____________/s/____________
BRIAN
G. KENNEDY
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A.
George Lowe
Acting Associate General
Counsel,
Litigation Division
Dean Landis
Attorney
Office
of the General
Counsel
Social Security
Administration
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____________/s/____________
FELICIA
L. CHAMBERS
U. S. Department of Justice
Civil
Division
Federal Programs Branch
P.O. Box 883
Ben
Franklin Station
Washington, D. C. 20044
Telephone:
(202) 514-3259
Attorneys for Defendant
Date:
May 12, 1995
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PRELIMINARILY APPROVED AND ORDERED, pursuant
to ¶ IV(A) of the Stipulation and Order, Rule 23(e) of the Federal
Rules of Civil Procedure, and the Privacy Act, 5 U.S.C. §
552a(b)(11), this _____ day of ________________, 1995. The parties shall
forthwith implement the terms of this Stipulation and Order.
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_____________________________ |
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UNITED STATES DISTRICT JUDGE |
SOCIAL SECURITY ADMINISTRATION
______________________________________________________________________________
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[Name] |
DOC: |
DATE: |
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[Address] |
TA: |
Social Security Number: |
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[City State ZIP] |
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Key Code: |
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Reference Number: |
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Claim Numbers: |
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IMPORTANT NOTICE OF PROPOSED SETTLEMENT |
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— PLEASE READ CAREFULLY — |
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Our records show that you requested a hearing on a Social Security or
Supplemental Security Income (SSI) disability claim which was denied or
dismissed on or after September 28, 1986, but before [date of preliminary
approval of the settlement agreement]. This is a notice of a proposed
settlement of the lawsuit Small v. Chater, No.
89-CV-3700-WDS (S.D. Ill.), that may affect you.
The lawsuit was filed on September 13, 1989, in the United States District
Court for the Southern District of Illinois seeking declaratory and
injunctive relief against the Secretary of Health and Human Services. In
their Amended Complaint, the Plaintiffs alleged that an Administrative Law
Judge of the St. Louis, Missouri, Office of Hearings and Appeals was
generally biased against claimants for Social Security or Supplemental
Security Income (SSI) disability benefits. On September 21, 1992, the
Court issued a Memorandum and Order denying the Secretary's Motion to
Dismiss and granting Plaintiffs' Motion for Class Certification,
Small v. Sullivan, 820 F. Supp. 1098 (S.D. Ill.
1992). The proposed settlement was filed recently in the Court so that the
Court may decide if it is fair.
This notice describes the proposed settlement, how to get more information
about the proposed settlement, and how to tell the Court if you think it
is fair. This notice also describes what you must do if the proposed
settlement is approved by the Court and you want us to review your claim
again.
The proposed settlement includes the following main terms.
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People Who May Ask Us to Review Their Claims Again |
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Class members who had a hearing, in the St. Louis, Missouri, Office of
Hearings and Appeals, on a disability claim on or after September 28,
1986, but before January 22, 1992, may ask us to review their claims
again. People in this group who are entitled to have us review their
claims again and whose claims are approved may receive money.
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People Who May Not Ask Us to Review Their Claims Again |
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Class members who had a hearing on or after January 22, 1992, or whose
requests for hearing were dismissed, may not ask us to review their claims
again. People in this group and all other class members will be bound by
the proposed settlement, if the Court approves it. This means that class
members can no longer raise the issues that were raised in this
lawsuit.
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How to Object to the Proposed Settlement |
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You may tell the Court what you think about the proposed settlement. If
you think it is fair, you do not need to comment. To object to the
proposed settlement, you must write your objections, sign the letter (or
have it signed by your representative, if you have one), and send it to
Mr. Richard Chase, Land of Lincoln Legal Assistance Foundation, Inc., 327
Missouri Avenue, Suite 605, East St. Louis, IL 62201. Your letter must be
postmarked by [date 30 days prior to the date of the Rule 23(e) hearing].
District Court Judge William D. Stiehl will decide whether to approve the
settlement at a hearing on [date of the Rule 23(e) hearing] in [courtroom
address]. If you wish to testify at the hearing, your testimony will be
limited to the matters addressed in your written objections.
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What to Do If You Want Us to Review Your Claim Again |
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If you would like us to review your claim again (whether or not you
comment on the proposed settlement), you must complete the enclosed
“SMALL v. CHATER [mdash ] REVIEW REQUEST FORM” and send it to
us in the enclosed postage-paid envelope. YOU MUST SEND US THE FORM WITHIN
60 DAYS OR WE WILL NOT REVIEW YOUR CLAIM AGAIN. DO NOT WAIT OR YOU MAY
LOSE THE RIGHT TO HAVE YOUR CLAIM REVIEWED. Even if you now get money from
us, we may still owe you more.
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What We Will Do If You Ask Us to Review Your Claim Again |
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If you send us the “SMALL v. CHATER [mdash ] REVIEW REQUEST
FORM”, we and the legal assistance lawyers who worked on this
lawsuit will check to see if you are entitled to have us review your claim
again. If so, an Administrative Law Judge (ALJ) will make a new decision.
If the new decision is not fully favorable to you, then you may appeal
that decision to the Appeals Council. Any decision by the Appeals Council
will be binding and not subject to further review.
To get a copy of the proposed settlement, or for more information, write
Mr. Richard Chase, Land of Lincoln Legal Assistance Foundation, Inc., 327
Missouri Avenue, Suite 605, E. St. Louis, IL 62201, or call (618)
271-2476. If someone is helping you with your claim, you should contact
that person. You may also write or call your local Social Security office
for more information, or you may call us toll-free at 1-800-772-1213. Do
not contact Judge Stiehl or the Clerk of the Court about this proposed
settlement. They will not be able to assist you.
SOCIAL SECURITY ADMINISTRATION
______________________________________________________________________________
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SMALL v. CHATER — REVIEW REQUEST FORM |
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IMPORTANT |
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RETURN THIS FORM WITHIN 60 DAYS |
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IF YOU WANT US TO REVIEW YOUR CLAIM AGAIN |
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____________________________________________________________________________ |
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[Name] |
DOC: |
DATE: |
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[Address] |
TA: |
Social Security Number: |
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[City State ZIP] |
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Key Code: |
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Reference Number: |
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Claim Numbers: |
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IF YOU WANT US TO REVIEW YOUR CLAIM AGAIN, PLEASE SIGN AND DATE THIS FORM, AND RETURN IT IN THE ENCLOSED PRE-PAID ENVELOPE. |
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SIGNATURE _________________________ DATE __________________
Please write the area code and the telephone number where we can call
you.
AREA CODE __________ TELEPHONE NUMBER __________________
If your address is different from that shown above, please write your
correct address.
______________________________________________________________
ADDRESS
(Number and Street, Apartment Number, Post Office Box, or Rural
Route)
_____________________________________________________________
CITY
AND STATE ZIP CODE
If your Social Security Number is different from that shown above, please
write your correct Social Security Number.
_____________________________________
SOCIAL
SECURITY NUMBER
The Social Security Act (Sections 205(a) of title II, 702 of title VII,
1631 (e)(1)(A) and (B) of title XVI, and 1869(b)(1) and (c) of title
XVIII) allows us to collect the information on this form. We will use the
information to process your claim. You do not have to give us this
information, but without it we may not be able to process your claim.
Information may be disclosed to another person or to another governmental
agency for the administration of the Social Security program or for the
administration of programs requiring coordination with the Social Security
Administration. Explanations about these and other reasons why information
you provide us may be used or given out are available in Social Security
Offices. If you want to learn more about this, contact any Social Security
office.
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EXHIBIT 3 |
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IN THE UNITED STATES DISTRICT COURT |
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FOR THE SOUTHERN DISTRICT OF ILLINOIS |
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CORENE SMALL, et. al. |
) |
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) |
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Plaintiffs, |
) |
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) |
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v. |
) |
Civil Action No. 89-CV-3700-WDS |
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) |
(Stiehl, C.J.; Cohn, M.J.) |
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SHIRLEY S. CHATER, |
) |
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Commissioner, Social |
) |
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Security Administration |
) |
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) |
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Defendant. |
) |
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_________________________________ |
) |
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CERTIFICATION PURSUANT TO PARAGRAPH V(B) |
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OF STIPULATION AND ORDER |
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As one of the counsel for the plaintiff class, I have reviewed the claim
file of ____________________________ (Claim # ______________________)
regarding the Social Security or Supplemental Security Income disability
claim decided in the St. Louis, Missouri Hearing Office on
______________________. Pursuant to paragraph V(B) of the Stipulation and
Order, I certify that I am of the opinion that the claim file contains
evidence of the conduct indicated by checkmark below. The evidence of this
conduct in the claim file is also described below.
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___ |
1. The ALJ obtained a consultative examination, whether pre-hearing or post-hearing, and the claim file includes no documentation that he first requested the treating physician to conduct the examination. Rationale: |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___ |
2. An expert witness testified at the hearing at the request of SSA. Rationale: |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___ |
3. The ALJ obtained post-hearing development and the claim file includes no documentation that he provided the individual or individual's representative an opportunity to examine and comment on, to object to, or to refute the post-hearing evidence. Rationale: |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___ |
4. The ALJ sent an interrogatory to an expert witness and the claim file includes no documentation that the interrogatory was proffered to the individual or the individual's representative (before being propounded to the expert) with the opportunity to object to the use of the interrogatory, to object to the substance of the interrogatory, or to propose additional interrogatories. Rationale: |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___ |
5. The ALJ sent an interrogatory to an expert witness that was not modified or supplemented as requested by the individual or the individual's representative unless the requested modification or supplementation was not material to the issue of disability. Rationale: |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___ |
6. The ALJ sent an interrogatory to an expert witness that was modified or supplemented as requested by the individual or the individual's representative and the claim file includes no documentation that the interrogatory as modified or supplemented was proffered to the individual or the individual's representative for further comment (before being propounded to the expert) with the opportunity to object to the use of the interrogatory, to object to the substance of the interrogatory, or to propose additional interrogatories. Rationale: |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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7. The ALJ received a response to an interrogatory to an expert witness and the claim file includes no documentation that the response to the interrogatory was proffered to the individual or the individual's representative. Rationale: |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___ |
8. The ALJ communicated ex parte with a treating source, consultative examiner, or a medical or vocational expert. Rationale: |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___ |
9. With respect to an individual who was unrepresented at the time of the hearing:
a. The claim file includes documentation that additional, specific medical records relevant to the claim existed and the claim file includes no documentation that the ALJ requested such records;
b. The ALJ did not obtain a consultative examination when such an examination would have been required under the standards currently set forth in 20 C.F.R. §§ 404.1519 and 416.919; or
c. The ALJ did not obtain expert evidence on vocational issues and the claim file includes documentation that the individual had a severe non-exertional impairment and the claim was denied at the fourth or fifth step of the sequential evaluation process. Rationale:
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___ |
10. With respect to an individual who was unrepresented at the time of the hearing, the tape recording or transcript of the hearing (if available) documents that:
a. The ALJ did not advise the individual of the right to representation, including an explanation of the manner in which an attorney can aid in the proceedings, the possibility of free counsel or a contingency arrangement, and the limitation on attorneys' fees to twenty-five percent of past-due benefits plus required agency approval of the fees; or
b. The ALJ did not elicit testimony from the individual regarding an issue that was relevant to the claim, or the ALJ's inquiry regarding the issue was wholly inadequate to support a finding on the issue. Rationale:
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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___ |
11. If SSA reconstructed the individual's claim file pursuant to ¶ V(A)(2) of the Stipulation and Order, the claim file includes insufficient information to determine whether the conduct identified in (1) - (10) above may have occurred. Rationale:
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___________________________________________________________________ |
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___________________________________________________________________ |
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___________________________________________________________________ |
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_______________________________________
Signature
of Class Counsel
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EXHIBIT 4 |
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IN THE UNITED STATES DISTRICT COURT |
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FOR THE SOUTHERN DISTRICT OF ILLINOIS |
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CORENE SMALL, et. al. |
) |
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) |
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Plaintiffs, |
) |
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) |
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v. |
) |
Civil Action No. 89-CV-3700-WDS |
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) |
(Stiehl, C.J.; Cohn, M.J.) |
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SHIRLEY S. CHATER, |
) |
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Commissioner, Social |
) |
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|
Security Administration |
) |
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) |
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Defendant. |
) |
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_________________________________ |
) |
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CONSENT FOR DISCLOSURE OF SOCIAL SECURITY RECORDS |
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I, ______________________________, authorize
class counsel in the above-captioned case, Richard Chase, Joan Spiegel or
other attorney with the Land of Lincoln Legal Assistance Foundation, Inc.,
to disclose to ______________________________, my current/former
representative on a claim for disability benefits under Title II or XVI of
the Social Security Act, the following materials pertaining to me received
by class counsel from the Social Security Administration in order to
effectuate the terms and conditions of the Stipulation and Order entered
in settlement of this case:
•
the certification form prepared by class counsel; or
•
any other records or information necessary to effectuate the terms and
conditions of the settlement.
This consent for disclosure is valid for one
year from the date of my signature or until the requested records or
information are provided, whichever is earlier.
I am the individual to whom the record(s)
pertain. I understand that the knowing and willful request for, or
acquisition of, a record pertaining to an individual under false pretenses
is a criminal offense under the Privacy Act, 5 U.S.C.§ 552a, and is
subject to a $5,000 fine.
___________________________________ __________________
SIGNATURE
DATE
___________________________________ __________________________
PRINT
NAME OF CLAIMANT CLAIMANT'S SOCIAL SECURITY NUMBER
Attachment 2. - Small Court Case Flag/Alert
SM 999757
SM 00001
Small COURT
CASE FLAG/ALERT
REVIEW PSC
DOC TOE ALERT DATE RESPONSE DATE OLD BOAN/PAN
OFFICE
5067
Y 999 XXX 00/00/1997 00/00/1997 000-00-0000
SSN
(BOAN OR PAN) NAME BIRTH DATE REFERENCE #
123-45-6789
JANE M DOE 00/00/0000 980000009
FOLDER LOCATION INFORMATION
CAN/HUN BIC/MFT
CATG TITLE SITE COMP DATE ACN
123-45-6789
C1 1 II XXXX 01/02/92
XXXXXXXXXXXXX
234-56-7890
A 2 II PC7 MOD3 02/08/94
234-56-7890 DI
2 XVI XXXX 01/01/92
XVI L00
PAYEE
ADDRESS
JANE M DOE
XXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXX
12345
SHIP
TO ADDRESS:
OFFICE OF HEARINGS AND APPEALS
OLD POST OFFICE BLDG, ROOM 220
815 OLIVE STREET
ST LOUIS, MISSOURI 63101-9933
ATTN:
Small Court Case
(CASE LOCATOR CODE 5067)
IF UNABLE TO LOCATE THE CLAIM FILE(S), FORWARD A RECONSTRUCTION REQUEST TO
THE SERVICING FIELD OFFICE
*NOTE: A SEPARATE SCREENING SHEET MUST BE PREPARED FOR EACH CAN/HUN
PRINTED ABOVE.
Attachment 3. - Request for Cassette Tape Form
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Small Class Action Case |
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REQUEST FOR CASSETTE TAPE |
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DATE OF REQUEST: _____________________________________________ |
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REQUESTED BY: _____________________________________________ |
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OFFICE/COMPONENT:
OHA, St. Louis Hearing Office__________________
ADDRESS:
815 Olive Street, Rm. 220, St. Louis MO 63101-9933____________
CLAIMANT'S NAME:
______________________________________________
SSN: ________________________
XREF:
______________________
HEARING HELD DATE:
____________________________________________
DECISION DATE:
_________________________________________________
NUMBER OF CASSETTES: ____________________________________________
REMARKS:
______________________________________________________
___________________________________________________________________
___________________________________________________________________
*PROGRAM SERVICE CENTER INVOLVED: _____________________________
***************************************************************
THIS TAPE IS CERTIFIED AS LOST BY THE CASSETTE COMPUTER LIBRARY
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________________________________ |
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(SIGNATURE) |
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________________________________ |
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(PRINTED NAME) |
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________________________________ |
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(DATE) |
* IF MAMPSC IS INVOLVED, THE CONTAINER AND ACCESSION NUMBERS ARE
NEEDED.
Attachment 4. Notice that File Is Available for Review
SOCIAL
SECURITY Important Information
NOTICE
_____________________________________________________________
Social Security Administration
_____________________________________________________________
A.
Robert Kassin
Attorney At Law
P.O. Box 425
Edwardsville,
Illinois 62025
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DATE:___________________ |
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Dear Mr. Kassin:
This is to notify you, pursuant to ¶ V(A)(3) of the
Small Stipulation and Order, that the claim file
for (claimant name), SSN: ______________,
is available for your review in the St. Louis hearing office.
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Sincerely yours, |
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Staff Attorney (or other |
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designated staff person) |
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UNITED STATES DISTRICT COURT |
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FOR THE SOUTHERN DISTRICT OF ILLINOIS |
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CORENE SMALL, et al., |
) |
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Plaintiffs, |
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) Civ. No. 89-CV-3700-WDS |
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) (Stiehl, C.J.; Cohn, M.J.) |
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v. |
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SHIRLEY S. CHATER, |
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Commissioner, Social |
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Security Administration |
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Defendant. |
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__________________________________ |
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CERTIFICATION PURSUANT TO PARAGRAPH V(B) |
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OF STIPULATION AND ORDER |
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As one of the counsel for the plaintiff class, I have reviewed the claim
file of ___________________________________________________ (Claim #
_________________________) regarding the Social Security or Supplemental
Security Income disability claim decided in the St. Louis, Missouri
Hearing Office on _________________________. Pursuant to paragraph V(B) of
the Stipulation and Order, I certify that I am of the opinion that the
claim file contains evidence of the conduct indicated by check mark below.
The evidence of this conduct in the claim file is also described
below.
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___ 1. |
The ALJ obtained a consultative examination, whether pre-hearing or post-hearing, and the claim file includes no documentation that he first requested the treating physician to conduct the examination. Rationale: ________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 2. |
An expert witness testified at the hearing at the request of SSA. Rationale: |
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 3. |
The ALJ obtained post-hearing development and the claim file includes no documentation that he provided the individual or the individual's representative an opportunity to examine and comment on, to object to, or to refute the post-hearing evidence. Rationale: _____________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 4. |
The ALJ sent an interrogatory to an expert witness and the claim file includes no documentation that the interrogatory was proffered to the individual or the individual's representative (before being propounded to the expert) with the opportunity to object to the use of the interrogatory, to object to the substance of the interrogatory, or to propose additional interrogatories. Rationale: ____ |
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 5. |
The ALJ sent an interrogatory to an expert witness that was not modified or supplemented as requested by the individual or the individual's representative unless the requested modification or supplementation was not material to the issue of disability. Rationale: ____________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 6. |
The ALJ sent an interrogatory to an expert witness that was modified or supplemented as requested by the individual or the individual's representative and the claim file includes no documentation that the interrogatory as modified or supplemented was proffered to the individual or the individual's representative for for further comment (before being propounded to the expert) with the opportunity to object to the use of the interrogatory, to object to the substance of the interrogatory, or to propose additional interrogatories. Rationale: __________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 7. |
The ALJ received a response to an interrogatory to an expert witness and the claim file includes no documentation that the response to the interrogatory was proffered to the individual or the individual's representative. Rationale: _____ |
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 8. |
The ALJ communicated ex parte with a treating source, consultative examiner, or a medical or vocational expert. Rationale: ________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 9. |
With respect to an individual who was unrepresented at the time of the hearing:
a. The claim file includes documentation that additional, specific medical records relevant to the claim existed and the claim file includes no documentation that the ALJ requested such records; b. The ALJ did not obtain a consultative examination when such an examination would have been required under the standards currently set forth in 20 C.F.R. §§ 404.1519 and 416.919; or c. The ALJ did not obtain expert evidence on vocational issues and the claim file includes documentation that the individual had a severe non-exertional impairment and the claim was denied at the fourth or fifth step of the sequential evaluation process. Rationale: __________________
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 10. |
With respect to an individual who was unrepresented at the time of the hearing, the tape recording or transcript of the hearing (if available) documents that:
a. The ALJ did not advise the individual of the right to representation, including an explanation of the manner in which an attorney can aid in the proceedings, the possibility of free counsel or a contingency arrangement, and the limitation on attorneys' fees to twenty-five percent of past-due benefits plus required agency approval of the fees; or b. The ALJ did not elicit testimony from the individual regarding an issue that was relevant to the claim, or the ALJ's inquiry regarding the issue was wholly inadequate to support a finding on the issue. Rationale: __
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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___ 11. |
If SSA reconstructed the individual's claim file pursuant to ¶ V(A)(2) of the Stipulation and Order, the claim file includes insufficient information to determine whether the conduct identified in (1) - (10) above may have occurred. Rationale: __________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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__________________________________________________________ |
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________________________________________ Date: _____________________ |
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Signature of Class Counsel |
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cc:
Office of the General Counsel
Altmeyer
Bldg., Rm. 600
6401
Security Blvd.
Baltimore
MD 21235
Attn:
Small Attorney
Attachment 6. Notice of Rebuttal (of Class Counsels' Certification)
SOCIAL
SECURITY Important Information
NOTICE
_____________________________________________________________
Social Security Administration
_____________________________________________________________
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A. Robert Kassin |
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Attorney At Law |
___________________________ |
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P.O. Box 425 |
Date |
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Edwardsville, Illinois 62025 |
___________________________ |
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Claimant's SSN |
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___________________________ |
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Date of Certification |
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On (date of certification), you certified
the above-referenced claim pursuant to ¶ V(B) of the Stipulation and
Order in Small v. Chater. You certified that the
file contained evidence of conduct described in ¶ V(B)
(enter appropriate subparagraph number(s) — 1 to 11)
of the Stipulation and Order. You found that
(enter a brief description of the conduct and evidence to support the allegation).
However, (choose 1 and/or 2)
1) the certification is untimely because it was mailed more than 60 days
after
(date of notice of file availability),
the date we sent you notice that the claim file was available for
review.
2) after a thorough review of the claim file and the points you raised in
your certification, we disagree with the conclusion the requisite conduct
has occurred. Specifically,
(Enter an explanation of why the alleged conduct did not occur)
The evidence to support our decision with respect to each allegation is
listed below.
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¶ V(B) sub ¶ # |
Conduct description |
Evidence |
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e.g., |
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(4) |
VE interrogs. |
Tr. 123 |
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not proffered |
Profert Letter |
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cc: Office of the General Counsel
Altmeyer
Bldg., Rm. 600
6401
Security Blvd.
Baltimore
MD 21235
Attn:
Small Attorney
Attachment 7. Non-Entitlement to Relief Notice
SOCIAL
SECURITY Important Information
NOTICE
_____________________________________________________________
Social Security Administration
_____________________________________________________________
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A. Robert Kassin |
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Attorney At Law |
___________________________ |
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P.O. Box 425 |
Date |
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Edwardsville, Illinois 62025 |
___________________________ |
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Claimant's SSN |
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___________________________ |
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Date of Certification |
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On (date of certification), you certified
the above-referenced claim with respect to the conduct described in ¶
V(B) of the Stipulation and Order in Small v.
Chater. However, after review of our systems data and the
claim file, we have determined that the claimant is an individual who is
otherwise not entitled to relief under ¶ V(C) of the Stipulation and
Order. The reason the claimant is not entitled to a new hearing decision
is checked below.
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____ |
The claimant did not file a disability claim under title II or title XVI of the Social Security Act or did not have a hearing before the ALJ whose conduct was the subject of the litigation (the “subject ALJ”). |
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____ |
The claimant's hearing before the subject ALJ was not held during the time frame specified for relief under the Small settlement (on or after September 28, 1986, but before January 22, 1992). |
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____ |
The claimant received an unfavorable decision after a hearing conducted by the subject ALJ on or after September 28, 1986, and before January 22, 1992, but the decision was changed to a fully favorable decision following appeal, remand or reopening. |
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____ |
The claimant received a fully favorable decision on another claim with entitlement commencing and benefits paid from the earliest possible month of entitlement on the potential Small claim. |
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____ |
The claimant filed a federal civil action on the potential Small claim in which the subject ALJ's alleged predisposition to deny claims was addressed and determined by the court. |
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____ |
The claimant received a decision from an ALJ other than the subject ALJ (whether favorable or unfavorable) after a de novo hearing on the potential class member claim, or on a subsequent claim that covered the entire period at issue in the class member claim |
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____ |
Other: |
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________________________________________________________. |
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cc: Office of the General Counsel
Altmeyer
Bldg., Rm. 600
6401
Security Blvd.
Baltimore
MD 21235
Attn:
Small court order
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CLASS ACTION CODE: S M |
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1. CLAIMANT'S SSN
___ ___ ___ - ___ ___ - ___ ___ ___ ___
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2. CLAIMANT'S NAME (Last, First)
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3. DATE OF BIRTH (Month, Day, Year)
___ ___ - ___ ___ - ___ ___ ___ ___
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4. WAGE EARNER'S SSN (if applicable)
___ ___ ___ - ___ ___ - ___ ___ ___ ___ - ___ ___
(BIC/ID)
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5. SCREENING DATE (Month, Day, Year)
___ ___ - ___ ___ - ___ ___ ___ ___
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a. SCREENING RESULTS
Member (J) Non-Member or Member (F)
Entitled to Relief Not Entitled to Relief
___ ___
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b. SCREENOUT CODE
___ ___
(see Item 13 for screenout codes)
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6. Was a timely certification by class counsel for the individual received by SSA?
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___ Yes ___ No
(if No, go to 13)
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7. Did the individual file a disability claim under title II or title XVI of the Social Security Act and have a hearing on that claim before the ALJ whose conduct was the subject of the Small litigation (ALJ Robert Ritter) on or after September 28, 1986, but before January 22, 1992? |
___ Yes ___ No
(if No, go to 13)
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8. Did the individual receive a less than fully favorable decision on the potential Small claim from the subject ALJ? |
___ Yes ___ No
(if No, go to 13)
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9. Was the less than fully favorable decision on the potential Small claim reversed on appeal, on remand from an appeal or upon reopening? |
___ Yes ___ No
(if Yes, go to 13)
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10. Did the individual receive a fully favorable determination/decision on another claim with entitlement commencing and benefits paid from the earliest possible month of entitlement on the potential Small claim? |
___ Yes ___ No
(if Yes, go to 13)
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11. Did the individual file a federal civil action on the potential Small claim in which the issue of the subject ALJ's alleged predisposition to deny claims was addressed and determined by the court? |
___ Yes ___ No
(if Yes, go to 13)
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12. Did the individual receive a decision from an ALJ other than the subject ALJ (whether favorable or unfavorable) after a de novo hearing on the potential class member claim, or on a subsequent claim that covered the entire period at issue in the Small claim? |
___ Yes ___ No
(If Yes, go to 13. If No, the claimant is a class member entitled to relief. Check “Member Entitled to Relief” block (J) in item 5a.)
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13.The individual is not a Small class member entitled to relief. Check the “Nonmember/Member Not Entitled to Relief” block (F) 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”.
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No other screenout code entry is appropriate
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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 or AC)
Date of Application(s) Date of Decision(s) Level of Final Decision
___________________ ___________________ ___________________
___________________ ___________________ ___________________
___________________ ___________________ ___________________
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15. IDENTIFICATION OF SCREENER:
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COMPONENT: |
DATE: |
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PHONE NUMBER: |
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16. SCREENER'S SIGNATURE:
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INSTRUCTIONS FOR COMPLETING SMALL SCREENING SHEET |
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Complete a screening sheet in cases where an individual has requested
relief and class counsel has provided a certification of the specified
conduct by ALJ Robert Ritter (subsequently referred to as the
“subject ALJ”) (see
HALLEX HA 01540.059 Part V.C.).
Under the terms of the Small settlement, screening,
rebuttal and mailing of notices to class counsel must be completed within
specific time frames (60 days from the
date class counsel mailed the certification form or 60 days from the date
the claim file was received in the St. Louis HO if the certification was
based on query information). If this review is not completed within the
required time frame, the individual is automatically entitled to relief
(see
HALLEX HA 01540.059 Parts V.D. and V.E.).
Items 1 - 4
You must consider all applications that fall within the period covered by
the court order when making the entitlement to relief determination. NOTE:
WHEN THERE ARE MULTIPLE CLAIM NUMBERS, A SEPARATE SCREENING SHEET MUST BE
PREPARED FOR EACH SSN. Multiple applications during the period covered by
the court order on the same account number should be screened using the
same screening sheet.
Fill in the identifying information as requested. Make sure the SSN,
BIC/ID and wage earner's SSN, if different from the claimant's, are
correct and legible. (If the claim is based on the wage earner's account,
copy the wage earner's SSN from BOAN/PAN field on alert).
Item 5
Complete this information last. Do not fill in the information in Item 5
until the screening process is completed.
Questions 6-12 and Items 13-16 — General
a.
In a case with multiple disability claims, begin screening with the
earliest disability claim in the Small period. Make
sure to check if claims outside the class time frame have awarded benefits
fully favorably with respect to the earliest Small
claim or accorded the individual all the relief to which he or she would
be entitled under the Small settlement (e.g., a new
hearing by another ALJ covering the entire time frame at issue in the
Small claim). A separate screening sheet must be
completed for claims on different account numbers.
(Check the XAN/XREF field on the OHAQ or MBR for claims on another
account.) Multiple claims covered by the court order under the same
account number should be screened using the same screening sheet.
b.
Check the notice of hearing and ALJ/AC decision to see if the subject ALJ
conducted a hearing and if the hearing was during the
Small time frame.
c.
If the notice of hearing and OHA decision are inconsistent, look further
into the file (hearing tape, transcript of hearing, etc.) to ensure the
subject ALJ held a hearing during the Small time
frame.
d.
If any one of questions 6-8 are answered “NO,” or any one of
questions 9-12 are answered “YES,” check the nonmember/member
not entitled to relief block (F) found in item 5.a. on the screening
sheet, then enter the appropriate screenout code in Item 5.b. as directed
in item 13 on the screening sheet.
e.
Remember to follow instructions for members entitled to relief and members
not entitled to relief/nonmembers.
Question 6
Determine whether class counsel completed a certification of specified
conduct by the subject ALJ (see
HA 01540.059 Part V.B.).
Make sure that the certification was filed within 60 days of notice that
the file was available for review.
Question 7
Review the file and case control queries to determine if the individual
filed a claim for Social Security or SSI disability benefits and
subsequently had a hearing before the subject ALJ during the time frame
for individuals who are entitled to relief, i.e., on or after September
28, 1986, but before January 22, 1992. Individuals whose disability claims
were dismissed without a hearing during the Small
time frame are not class members entitled to relief and should not be
screened in under question 7.
Question 8
Review the file and case control queries to determine if the individual
received a less than fully favorable decision on his or her claim(s) for
title II or title XVI disability benefits after a hearing from the subject
ALJ. If the information in the file indicates that the individual did not
have a hearing before the subject ALJ, the individual is not a class
member entitled to relief.
Question 9
Review the file, case control queries, and all subsequent administrative
and judicial determinations to determine if the less than fully favorable
decision referred to in Question 8 was changed to a fully favorable
decision. Make sure to review the file to determine whether benefits were
subsequently allowed or continued from the earliest possible entitlement
date.
Question 10
Review the file and case control queries. Determine if the individual
received a fully favorable decision on another claim that effectively was
the equivalent of a fully favorable decision on the potential class member
claim. This requirement would be met if the decision on the other claim
resulted in an award of benefits for the entire time period(s) at issue in
the potential class member claim.
NOTE: A claim cannot be screened out on the basis of Question 10
unless it is clear that the DDS, an
ALJ or the AC issued a fully favorable decision that adjudicated the
entire period covered by the Small claim back to
the earliest alleged onset/entitlement date. Therefore, in reviewing DDS
determinations, be aware that DDS adjudicators generally limit
consideration of subsequent claims to the period after the previously
adjudicated period. At the OHA level, ALJ and AC 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 11
Review all federal court orders/decisions to determine if allegations that
the subject ALJ was predisposed to deny claims were raised and if the
court made a determination concerning the validity of those
allegations.
Question 12
Review the file and case control queries to determine if the individual
received a new hearing decision (whether favorable or unfavorable), from
an ALJ other than the subject ALJ, on the potential class member claim or
on another claim, that considered the entire time period(s) at issue in
the class claim.
Item 13
Self-explanatory
Item 14
Fill in the dates of the applications, decisions and the level of
adjudication of the final decisions, that were reviewed in deciding
entitlement to relief for the claim number in item 4. Remember a separate
screening sheet must be prepared for claims on different account
numbers.
INSTRUCTIONS FOR MEMBERS
a.
Check the “MEMBER ENTITLED TO RELIEF” block (J) in item 5.a.
of the screening sheet.
b.
Sign the form and retain the original screening sheet in the claim
file.
INSTRUCTIONS FOR NONMEMBERS
a.
Check the “NONMEMBER/MEMBER NOT ENTITLED TO RELIEF” block (F)
in item 5.a. and enter the appropriate screenout code (i.e., the number of
the question that determined the individual is not a class member entitled
to relief, i.e., numbers 6-12, see item 13 on the screening sheet) in item
5.b.
b.
Sign the form and retain the original screening sheet in the claim
file.
c.
Prepare and send the non-entitlement to relief notice (Attachment 7) to
class counsel. Retain a copy of the denial letter in the claim file.
Forward the claim file(s) as indicated in
HALLEX HA 01540.059, Part V.F.
Attachment 9. - Route Slip or Case Flag for Certification/Screening
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Small Class Action Case |
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CERTIFICATION/ SCREENING NECESSARY |
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Claimant's Name: |
__________________________________ |
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SSN : |
__________________________________ |
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This claimant may be a Small class member entitled to relief. Accordingly, we are forwarding the attached alert, a copy of the current claim file and the prior claim file(s) (or a copy of the prior file(s)), if any, for certification of entitlement to relief and screening. |
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Please refer to HALLEX Temporary Instruction 5-4-59 for additional information and instructions. |
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TO: Office of Hearings and Appeals
St.
Louis Hearing Office
815
Olive Street, Rm. 220
St.
Louis MO 63101-9933
|
Attachment 10. Small Folder Flag for Hearing Office
Use
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ROUTING AND TRANSMITTAL SLIP |
DATE: |
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XX |
ACTION |
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FILE |
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NOTE AND RETURN |
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APPROVAL |
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FOR CLEARANCE |
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PER CONVERSATION |
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AS REQUESTED |
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FOR CORRECTION |
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PREPARE REPLY |
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CIRCULATE |
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FOR YOUR
INFORMATION |
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SEE ME |
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COMMENT |
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INVESTIGATE |
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SIGNATURE |
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COORDINATION |
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JUSTIFY |
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REMARKS |
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SMALL CASE |
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____ |
DISABILITY DEVELOPMENT NEEDED |
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____ |
NONDISABILITY DEVELOPMENT NEEDED |
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Claimant: ___________________________ |
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SSN: ________________________________ |
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This claimant is a Small class member entitled to relief. We are forwarding this file for the following: _________________________________________________________________ |
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_________________________________________________________________ |
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_________________________________________________________________ |
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_________________________________________________________________ |
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The FO should follow DI 12507.015. DDS personnel should follow DI 32507.020. Upon completion of medical development, the DDS will forward the file to the OHA Office noted below for readjudication. |
|
FROM:
Office
of Hearings and Appeals
Old Post Office Bldg., Room 220
815 Olive Street
St. Louis, MO 63101-9933
__________________________________________
|
SUITE/BUILDING |
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PHONE NUMBER |
Attachment 11. - Small Claim Flag for CCPRB Use
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Small Class Action Case |
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READJUDICATION NECESSARY |
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Claimant's Name: |
__________________________________ |
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SSN : |
__________________________________ |
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This claimant is a Small class member entitled to relief. The attached Small claim file was forwarded to the CCPRB because the claimant has a pending (or active) court case on another claim. |
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The claim pending in court will not resolve all the issues involved in the Small class member claim. Accordingly, we are forwarding the attached alert and the prior claim file(s) (or a copy of the prior file(s)) to your location for any necessary Small readjudication action. |
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We are sending the alert and prior file(s) to: |
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(Destination code: ) |
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Attachment 12. - Small Claim Flag for OAO Disability Branch
Use
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Small Class Action Case |
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READJUDICATION NECESSARY |
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Claimant's Name: |
__________________________________ |
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SSN : |
__________________________________ |
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This claimant is a Small class member entitled to relief. The attached Small claim file was forwarded to the Office of Appellate Operations, Disability Program Branch ____ because the claimant had a pending request for review on another claim at the Appeals Council. |
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The claim pending before the Appeals Council will not resolve all the issues involved in the Small class member claim. Accordingly, we are forwarding the attached alert and the prior claim file(s) (or a copy of the prior file(s)) to your location for any necessary Small readjudication action. |
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We are sending the alert and prior file(s) to: |
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(Destination code: ) |
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Attachment 13. - Route Slip or Case Flag for Readjudication
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Small Class Action Case |
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READJUDICATION NECESSARY |
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__________________________________ |
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__________________________________ |
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__________________________________ |
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__________________________________ |
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(Destination code: ) |
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Claimant's Name: |
__________________________________ |
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SSN : |
__________________________________ |
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This claimant is a Small class member entitled to relief. The claimant's current residence is within your jurisdiction. Accordingly, we are forwarding the attached alert and claim file(s) to your location for Small readjudication. See HALLEX HA 01540.059 for additional information and guidance. |
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Attachment 14. - Sample Notice of Unfavorable Decision on Small
Adjudication
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SOCIAL SECURITY |
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NOTICE OF DECISION — UNFAVORABLE |
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SMALL CLASS ACTION READJUDICATION |
Claimant's Name
Claimant's Address
I have made the enclosed decision in your case. Please read this notice
and the decision carefully.
If You Disagree With The Decision
If you do not agree with my decision, you may file an appeal with the
Appeals Council.
How To File An Appeal
To file an appeal you or your representative must request that the Appeals
Council review the decision. You must make the request in writing. You may
use a standard Request for Review form, HA-520, or write a letter.
You may file your request at any local Social Security office or a hearing
office. You may also mail your request to the Appeals Council, Office of
Hearings and Appeals, 5107 Leesburg Pike, Falls Church, VA 22041-3255.
Please put the Social Security number shown above on any appeal you
file.
Time To File An Appeal
To file an appeal, you must file your request for review
within 60 days from the date you receive
this notice.
The Appeals Council assumes you received the notice 5 days after the date
shown above unless you show you did not receive it within the 5-day
period. The Council will dismiss a late request unless you show you had
good cause for not filing it on time.
Time To Submit New Evidence
You should submit any new evidence that you wish to have the Appeals
Council consider with your request for
review.
How An Appeal Works
Our regulations state the rules the Appeals Council applies to decide when
and how to review a case. These rules appear in the Code of Federal
Regulations, Title 20, Chapter III, Part 404, Subpart J and Part 416,
Subpart N.
If you file an appeal, the Council will consider all of my decision, even
the parts with which you may agree. The Council may review your case for
any reason. It will review your case if
one of the reasons for review listed in the above-cited federal
regulations exists. Sections 404.970 and 416.1470 of the regulations list
the reasons.
Requesting review places the entire record of your case before the
Council. Review can make any part of my decision fully or partially
favorable or unfavorable to you.
On review, the Council may itself consider the issues and decide your
case. The Council may also send it back to an Administrative Law Judge for
a new decision.
The Appeals Council May Review The Decision On Its Own
The Appeals Council can review my decision even without your request to do
so. If it decides to do that, the Council will mail you a notice about its
review within 60 days from the date of this notice.
If No Appeal And No Appeals Council Review
If you do not appeal and the Council does not review my decision on its
own motion, my decision will be a binding decision that can be changed
only under special rules.
New Application
You have the right to file a new application at any time, but filing a new
application is not the same as appealing this decision. If you disagree
with my decision and you file a new application instead of appealing, you
might lose some benefits, or not qualify for any benefits. So, if you
disagree with this decision, you should file an appeal within 60
days.
If You Have Any Questions
If you have any questions, you may call, write or visit any Social
Security office. If you visit an office, please bring this notice and
decision with you. The telephone number of the local office that serves
your area is (xxx) xxx-xxxx. Its address is
_____________________________________________.
Enclosures
cc: (Claimant's representative)
Attachment 15. Sample Denial of Request for Review of Small
Readjudication
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SOCIAL SECURITY ADMINISTRATION |
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_________________________________________________________________________ |
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Refer to: |
Office of Hearings and Appeals |
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5107 Leesburg Pike |
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Falls Church, VA 22041-3255 |
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ACTION OF APPEALS COUNCIL ON REQUEST FOR REVIEW |
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OF SMALL CLASS ACTION READJUDICATION |
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Claimant's Name
Claimant's Address
Dear Mr./Mrs./Ms. _____________:
The Appeals Council has considered the request for review of the
Administrative Law Judge's decision issued on _________________.
Social Security Administration regulations provide that the Appeals
Council will grant a request for review where: (1) there appears to be an
abuse of discretion by the Administrative Law Judge; (2) there is an error
of law; (3) the Administrative Law Judge's action, findings, or
conclusions are not supported by substantial evidence; or (4) there is a
broad policy or procedural issue which may affect the general public
interest. The regulations also provide that where new and material
evidence is submitted with the request for review, the entire record will
be evaluated and review will be granted where the Appeals Council finds
that the Administrative Law Judge's actions, findings, or conclusion is
contrary to the weight of the evidence currently of record
(20 CFR
416.1470).
The Appeals Council has concluded that there is no basis under the above
regulations for granting your request for review. Accordingly, your
request is denied and, under the Small Stipulation
and Order, the Administrative Law Judge's decision stands as the binding
decision of the Commissioner of Social Security in your case. In reaching
this conclusion, the Appeals Council has considered the applicable
statutes, regulations, and rulings in effect as of the date of this
action.
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Sincerely yours, |
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Administrative Appeals Judge |
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cc: (Claimant's Representative)