TN 1 (11-00)

DI 12548.020 Field Office (FO) Responsibilities Before Adjudication

A. Policy - General

The scope of the FO's responsibility before the class claim receives a substantive DDS determination depends on which subclass the claim belongs to.

  1. Primary Subclass claims are reopened and may require a FO interview prior to DDS action. OCO forwards Primary Subclass claims to the FO if it is reasonable to interpret claimant's earnings to be at SGA levels within 12 months of the AOD of the earliest Hyatt III claim through the present.

  2. Settlement Subclass claims will have disability redetermined based on the evidence that is already in file and any evidence submitted by the class member supporting the class claim.

B. Procedure - Primary Subclass Claims

Take the following steps to develop Primary Subclass claims, which are forwarded to the FO from OCO.

  1. Contact the class member and inform him/her that SSA is reviewing their prior claim under Hyatt III even if they received a prior notice telling them they did not qualify for this review. If contact is in writing, include the following language in the contact notice: “We are currently looking at your case as the result of a class action court case in North Carolina called Hyatt. Your case will be reviewed even if we looked at it earlier and sent you a letter saying you were not entitled to a review.”  Ascertain whether the class member has a representative. If the class member has a representative, obtain an SSA-1696 and make further contacts through the representative unless the representative gives written permission to contact the claimant directly.

  2. Update the claimant's medical condition to the present via an SSA-3441-F6 (Reconsideration Disability Report) and obtain an SSA-827 (Authorization for Source to Release Information to the Social Security Administration) for each source listed by the claimant plus two extras.

  3. Complete an SSA-820-F4 or SSA-821-F4 covering all periods of work activity before sending folder to DDS for adjudication. (Do not do full documentation of work activity until after DDS adjudication unless it appears as SGA denial if is appropriate.) (See DI 10501.025.)

  4. If development shows that an SGA denial is appropriate (i.e., SGA resumed within 12 months of earliest alleged onset of the earliest Hyatt III eligible claim and continues uninterrupted to the present), take the following action:

    • Prepare an SSA-831-U3 and deny claim.

    • Annotate “Hyatt Case” in Remarks

    • If the earliest application filed within the Hyatt III period is not a Hyatt III eligible claim, include the optional paragraph found in DI 12548.025A.1.

    • Release the notice to claimant, claimant's representative, if any, class counsel at the address below, and Litigation Staff. Otherwise, proceed to next step.

      Carlene McNulty
      North Carolina Justice and Community Development Center
      P. O. Box 28068
      224 South Dawson St.
      Raleigh, North Carolina 27611-8068
  5. If an SGA denial is not appropriate,

    • Route folder to NCDDS for substantive review.

    • Do not make systems input - DDS will control through NDDSS when folder received in DDS.

C. Procedure - Settlement Subclass Claims

1. General

Since the adjudication is a redetermination and not a reopening, do not request an FO interview before adjudication unless the DDS or PC (reconstruction cases) requests assistance. (See DI 12548.010B.2. for reconstruction cases.)

Exception: If it is reasonable to interpret claimant's earnings to be at SGA levels within 12 months of the AOD through the date of the determination/decision on the Hyatt III claim, develop for SGA. If SGA denial is appropriate, prepare an SSA-831-U3 and deny claim. (See DI 12548.020B.4.) See additional language in DI 12548.020B.1. that must be included in the SGA denial notice.

2. Securing Additional Evidence

If the DDS finds that the evidence in file is insufficient to assess RFC, the DDS may ask the FO assistance.

NOTE: The DDS advises potential Settlement Subclass members that they have the right to submit additional evidence supporting the class claim.

3. DDS Requests Assistance

If the DDS requests assistance via an SSA-883-U3, take the following actions.

  • Contact the claimant/claimant's representative, if there is one, and inform him/her that SSA is reviewing their prior claim under Hyatt III even if they already received a notice that they did not qualify for this review. If contact is in writing see DI 12548.020B.1. for required notice language. Update the claimant's medical condition and medical sources.

  • Use an SSA-3441-F6 (Reconsideration Disability Report) to obtain the updated information.

  • Obtain an SSA-827 (Authorization for Source to Release Information to the Social Security Administration) for each source listed by the claimant.

  • Initiate work activity development. Follow DI 10501.025A.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412548020
DI 12548.020 - Field Office (FO) Responsibilities Before Adjudication - 06/26/2012
Batch run: 06/26/2012
Rev:06/26/2012