TN 31 (08-93)

DI 12502.001 Court-Ordered Reviews -- Jurisdiction

A. Introduction

As a result of class action court decisions, SSA is at times required to readjudicate its past determinations. The special review criteria required by a court's order are not generally well known in areas outside of the State(s) affected by that order.

This becomes a problem if a claimant has moved out of the area affected by the court's order since DDS/FO personnel in the new State may not be familiar with the pertinent review criteria.

B. Policy

1. Jurisdiction

Court-ordered reviews of class members' claims are generally the jurisdiction of the DDS which made the determination to be reviewed.

This is true even if the claimant has moved out of that DDS's usual area of jurisdiction.

Exceptions are:

  1. The State in which the claimant now lives will have jurisdiction if the court order also is applicable in that State (e.g., in nationwide, region-wide or circuit-wide classes).

  2. If a face-to-face review is appropriate (cessation cases), the "resident" DDS will have jurisdiction.

  3. If the court order requires otherwise (e.g., review by the resident DDS is mandated).

2. Work/Medical Development

Development of work activity and/or medical evidence will be coordinated with resident FOs and DDSs, as appropriate.

3. Subsequent (Current) Claim Pending in an FO

If a class member has a subsequent (current) claim involving common issues pending in an FO, the FO will:

  • send it for association with the class action claim (for processing by the DDS, DHU, or OHA);

  • use language such as that in 4., below, to notify claimants of referrals to a DDS or DHU;

  • use language such as that in 5., below, to notify claimants of referrals to OHA.

4. Subsequent (Current) Claims Pending in DDS

  1. If the subsequent (current) claim is pending in the State having jurisdiction for the court-ordered review (see B.1.), the claims will be combined there for concurrent processing on a priority basis, to the extent possible.

  2. If the subsequent (current) claim is in another State:

    • the State with the pending claim will refer that claim for association with the court-ordered review claim. Prior to this, however, the referring State will notify the State with review jurisdiction (see B.1.) that it will complete its adjudication of the subsequent claim (if it is in a position to do so; i.e., it has sufficient evidence, etc.). If this results in a favorable finding, the subsequent claim will be sent for payment actions prior to referral to the State with review jurisdiction. Customary processing of a subsequent claim should never be delayed in anticipation of a class action alert.

      The referring State will notify the claimant of the transfer of unadjudicated pending claims using the appropriate language. For example:

      “We have sent your new (disability/Supplemental Security Income/ Social Security disability and Supplemental Security Income) claim(s) to the ( name of new State DDS) to review your disability under the ( name of class action) class action court case. (Name of new DDS) has responsibility for your claim.

      The review may cover the same period and issues raised by your earlier application. The (DDS) will process your claims and they will contact you.”

    • the State having review jurisdiction will combine the claims for adjudication. If the subsequent claim is unadjudicated when it is sent for association with the court-ordered review claim, the cases will be processed on a priority basis (to the extent possible).

5. Subsequent (Current) Claim Referred to OHA

When an FO or DDS forwards a subsequent (current) claim to OHA for association with a court-ordered review case, the claimant will be notified by the FO (or DDS) using appropriate language. For example:

“We are sending the (disability/Supplemental Security Income/Social Security disability and Supplemental Security Income) claim(s) you filed on ( date of filing(s)) to the (name of hearing office), which has responsibility for your claim, to review it under the (name of class action) class action court case.

The review may cover the same period and issues as your earlier claim.

The Hearing Office may process your claims at the same time. They will contact you.”

6. Subsequent (Current) Claim is a TERI Case

If a subsequent terminal illness case (i.e., TERI or potential TERI case) is filed or pending adjudication, the resident DDS will have jurisdiction for both the class action court case review and the TERI case. If another subsequent claim or court-ordered review case is pending at OHA or in court, contact OHA's court case coordinator to discuss processing.

7. Class Action Claim Referred to OHA

Where an FO is transferring a class action claim to OHA (e.g., because a current claim is pending there) and the claimant knows that his or her claim is in the FO, the claimant must be notified of the transfer by the FO using the appropriate language. For example:

“We are sending the (disability/Supplemental Security Income/Social Security disability and Supplemental Security Income) claim(s) you filed on ( date of original filing) to the (name of hearing office). We are doing this because you asked us to review your disability under the ( name of class action ) class action court case.

The review may cover the same period and issues involved in the claim you recently filed. That claim is pending in the (name of hearing office).

The Hearing Office may process your claims at the same time. They will contact you.”

8. QA Reviews

Selection of claims for QA reviews will be unaffected (unless a change is mandated in the court order).

9. Appeals

Appeal requests will be the jurisdiction of a DHU or OHA hearing office servicing the claimant's residence, as usual.

10. Initiating Payment Prior to Referral

Both preceding and following court-ordered reviews, any benefits which can be paid (e.g., on partially favorable determinations) will be, prior to the processing of any appeal requests, etc. This is also true in the case of subsequent (current) claim referrals (see 4.).

C. References

Since the processing criteria in court-ordered reviews vary, procedures specific to each class action will be in the individual FO POMS for that class action.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412502001
DI 12502.001 - Court-Ordered Reviews -- Jurisdiction - 06/26/2012
Batch run: 06/26/2012
Rev:06/26/2012