TN 57 (02-97)

DI 12521.015 Relief Under the Court Order

A. Policy

1. General

If the Dixon class claim(s) has been retrieved or reconstructed and the individual is a class member entitled to relief, the NY ODD (or the appropriate DDS) will evaluate the claim(s) in accordance with the Social Security Act, the sequential evaluation process set forth at 20 C.F.R. Sections 404.1520 through 1524, 416.920 through 924 , including the current severity regulations, 20 C.F.R. Sections 404.1520(c), 416.920(c), Social Security Ruling 85-28, and other policies and procedures of SSA. The readjudication will be a reopening at the reconsideration level unless consolidated at the OHA level.

2. Appeal Rights

Class members whose claims are readjudicated under the Dixon review standard at the reconsideration level have full appeal rights and may appeal their claim(s) to an administrative law judge (ALJ).

3. Folder Consolidation

If a class member has more than one Dixon claim subject to reopening and readjudication, SSA may, at its option, consolidate all such claims and readjudicate them at the same time.

4. SGA Development

The FO must develop SGA if it began within 12 months of onset and continued throughout the Dixon period to be developed. All other work activity will be developed by the FO after DDS adjudication.

NOTE: The class membership in the Dixon court case begins with decisions made as far back as 1976. Some class members may, therefore, be due many years of retroactive payments. Tolerances have been established for developing work activity in both title II and title XVI initial claims and in title II work issue continuing disability reviews.

5. Administrative Finality

Dixon class claims will be reviewed outside the normal time limits of administrative finality, if doing so is necessary to comply with the court order.

B. Process

Dixon class claims are identified and reviewed under the following process.

1. General

  • CO generates alerts for each individual who requests Dixon review. The alerts are released to ODIO and/or NEPSC. ODIO and/or NEPSC retrieves folders, where possible, reviews the Dixon alert, related queries (FACT, SSIRD, etc.) and/or claims file(s) and determines when a claim(s) is lost or destroyed.

  • If ODIO and/or NEPSC declares that the claim(s) has been lost or destroyed, ODIO and/or NEPSC determines if the claim(s) may be screened-out solely on the basis of information shown on the queries.

    If the lost or destroyed claim(s) is screened-in, ODIO and/or NEPSC attempts to apply the presumptions in DI 12521.015B.5.

  • If the lost or destroyed claim(s) cannot be readjudicated on the basis of the presumptions, ODIO and/or NEPSC initiates folder reconstruction (see DI 12521.015B.6.).

  • ODIO and/or NEPSC forwards screened-in folders to the FO for folder update or reconstruction, as appropriate. Once the FO development is completed, the folder(s) is sent to the appropriate DDS for Dixon review. (In most cases, this will be the New York ODD.)

2. Screening

In most cases, ODIO and/or NEPSC screens the claims of potential Dixon class members. However, if a claim(s) is pending or stored in OHA, OHA will perform the screening. The component that screens (see DI 12521.095, Exhibit 5) the Dixon claim(s) sends the non-class membership notice (see DI 12521.095, Exhibit 7).

3. Jurisdiction

Normally the New York ODD performs the Dixon review, even if the individual has left New York, unless there is a claim pending or stored in OHA (see DI 12502.001 ff. and DI 12521.015B.5. for exceptions).

If a claim is pending or stored in OHA, the ALJ or AC may consolidate a class member's Dixon claim and a subsequent claim at the OHA level.

NOTE: If a current claim is pending in another DDS, the New York ODD will retrieve the claim from the other DDS and consolidate with the Dixon claim(s).

4. Folder(s) Located

When the claim(s) is located and the individual is a class member entitled to relief, the NY ODD (or the appropriate DDS) reopens and develops the Dixon claim(s) from the earliest date based on the application(s) which results in class membership up to the:

  1. alleged onset date (AOD) (including AOD in later onset date allowance cases or date of filing (DOF) in title XVI cases), covered by any subsequent claim(s) that is denied for any reason after July 19, 1983, or for a reason other than not severe on or before July 19, 1983, or established onset date (EOD) in a subsequent allowance (regardless of whether the subsequent allowance is continuing, ceased or was a closed period), or

  2. present where no subsequent applications have been filed.

When readjudicating the Dixon claim(s), SSA will ONLY consider subsequent impairment(s) that can reasonably be said to be related to the impairment(s) which provided the basis for the determination in the Dixon claim(s).

5. Unable To Locate Prior Claim - Presumptions

When a class member's claim(s) cannot be located, ODIO and/or NEPSC attempts to apply the following presumptions.

  1. The class member will be found disabled if he/she received a favorable decision awarding benefits for any subsequent period of disability; and

    • the medical evidence relevant to that determination demonstrates that, given the class member's condition at the time of the favorable determination, it is reasonable to presume that he/she was disabled as of the date of the prior administrative determination which resulted in class membership (i.e., earliest Dixon claim); or

    • absent evidence to the contrary which suggests that the class member was not disabled, a class member was 55 years of age or older at the time of the administrative determination which resulted in class membership.

  2. If the presumptions outlined in DI 12521.015B.5.a., above, are not overcome by evidence to the contrary and the class member will be found to be disabled as a result, he/she will be found to be disabled from the earliest date based on the application(s) which results in class membership up to the date of onset established by the subsequent allowance regardless of whether the subsequent allowance is continuing, ceased or was a closed period.

    NOTE: In title II claims, the onset established is that alleged on the earliest Dixon claim. In title XVI claims, disability is established as the DOF of the earliest Dixon claim.

  3. Absent evidence to the contrary, there is a rebuttable presumption that a class member is not disabled if:

    • he/she received a denial or termination of benefits for any reason after July 19, 1983, or for a reason other than not severe on or before July 19, 1983, on a disability claim subsequent to the one that forms the basis of class membership; or

    • employment records available to SSA (e.g., earnings record or SEQY) indicate (1) a period of employment longer than 6 months following the denial or termination that forms the basis of class membership and (2) the earnings from that period are in excess of the minimum monthly amounts prescribed in 20 C.F.R. Sections 404.1574 and 416.974 (see DI 10501.015); or

    • he/she had a claim reviewed under Stieberger v. Sullivan which was denied.

    When ODIO and/or NEPSC determines that a class member is not disabled based on the presumptions in DI 12521.015B.5.c. above, ODIO and/or NEPSC sends a denial notice (see DI 12521.095, Exhibit 12). The notice will inform the class member that he/she has 60 days from receipt of the notice to request a hearing and to submit any evidence to rebut the presumptions of non-disability. Existing evidence of record must be considered in the light most favorable to the class member.

6. Unable to Locate Prior Claim - Presumptions Do Not Apply

When ODIO and/or NEPSC cannot locate the Dixon claim(s) and the presumptions in DI 12521.015B.5. above do not apply, ODIO and/or NEPSC requests the FO to initiate reconstruction. (See DI 12521.025B.4. for FO procedures on reconstructing lost claims.)

  1. If the class member's Dixon claim(s) cannot be located and the presumptions in DI 12521.015B.5. above do not apply, the class member must submit evidence pertaining to his/her condition during the period to be readjudicated. SSA will provide reasonable efforts to assist the class members in obtaining evidence.

    SSA IS NOT required to reconstruct the names of doctors or medical centers which the claimant visited when the claimant is now unable to recall that information. SSA IS required to contact ONLY those medical sources identified by the claimant. If SSA writes to a source requesting a report and no response is received, SSA will make one follow-up by letter (or phone call). If the evidence received from the treating source(s) or other medical source(s) is insufficient for adjudication, SSA will recontact the source(s) for additional information. SSA will not obtain a consultative exam if the request for information is unsuccessful.

  2. After the FO completes its development, the NY ODD (or the appropriate DDS) reopens and develops the Dixon claim(s) from the earliest date based on the application(s) which results in class membership up to the:

    • AOD (including AOD in later onset date allowance cases or DOF in title XVI cases), covered by any subsequent claim(s) that is denied for any reason after July 19, 1983, or for a reason other than not severe on or before July 19, 1983, or EOD in a subsequent allowance (regardless of whether the subsequent allowance is continuing, ceased or was a closed period), or

    • present where no subsequent applications have been filed.

    When readjudicating the Dixon claim(s), SSA will ONLY consider subsequent impairments that can reasonably be said to be related to the impairment(s) which provided the basis for the determination in the Dixon claim(s).

7. Development

  1. Development in Cases of Allowances on a Subsequent Claim or After Benefits From a Prior Allowance Have Been Ceased

    Absent evidence to the contrary, SSA adjudicators assume that the favorable determination or decision on the subsequent claim is correct and limit development and readjudication to the period up to the date of onset covered by any subsequent claim (e.g., AOD (or DOF in title XVI cases) in later onset date and EOD in all other situations), regardless of whether the subsequent allowance is continuing, ceased or a closed period.

  2. Development in Cases Where New Evidence Submitted or Developed in Connection with the Dixon Claim Raises a Question of Continuing Disability

    SSA adjudicators are not barred from considering and deciding the issue under the normal continuing disability review (CDR) procedures and standard. However, the favorable decision on a subsequent claim is considered correct, absent any evidence to the contrary.


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http://policy.ssa.gov/poms.nsf/lnx/0412521015
DI 12521.015 - Relief Under the Court Order - 07/30/2013
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