TN 1 (11-00)

DI 12548.010 Determining if a Responder is Entitled to a Disability Review

A. Process

  • The Claimant is a class member eligible for relief unless, in the process of retrieving the folders or adjudicating the claim, the claimant obviously is not eligible for Hyatt III review. That is, there is no evidence a disability insurance benefits claim was filed; the claimant did not receive a determination/decision by a NC adjudicator; the determination/decision was based on fraud, insufficient quarters of coverage, SGA, etc. (See DI 12548.001B.3.b.)

  • If it is obvious that the claimant does not qualify for Hyatt III review, prepare an SSA-559 identifying why the claimant is ineligible for Hyatt III review. Forward the holder/folder to Litigation Staff. See DI 12548.005B.2.b. Litigation Staff will verify the claimant's ineligibility and prepare and release a notice to claimant, claimant's representative, if any, and class counsel informing them of claimant's ineligibility. Challenges to the ineligibility determination will be resolved between Litigation Staff, OGC, and Class Counsel.

  • Within 120 days of receiving the “Notice of Non-Entitlement to Review,” claimant, his/her representative, if any, or class counsel shall notify the Office of the General Counsel (OGC) of their wish to resolve any non-eligibility dispute. If a non-eligibility dispute is resolved in the claimant's favor, the claim(s) file is forwarded to the Disability Determination Services (DDS) or OHA for a substantive review. If claimant, his/her representative if any, or class counsel does not notify OGC that they disagree with the non-eligibility determination within 120 days of the date of receipt of the notice, that determination becomes final and is not subject to further appeal.

B. Procedure

1. Folder Retrieval

  1. a. 

    OCO Procedure:

    If the case control queries indicate that at least one Hyatt III folder is in the FO, forward the alert package to the FO.

  2. b. 

    FO Procedure:

Upon receipt of the alert package:

  • Review systems queries for other folder locations and attempt to retrieve the folder.

  • Associate the alert package with the Hyatt folder and send it to NCDDS/OHA for adjudication.

2. Lost Folders

If appropriate, initiate reconstruction for the period covered by the Hyatt claim. Forward reconstructed folder to DDS or OHA, as appropriate, after FO portion of reconstruction is completed.

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DI 12548.010 - Determining if a Responder is Entitled to a Disability Review - 05/15/2012
Batch run: 04/14/2014