TN 55 (08-96)
DI 12586.015 Stieberger Reopenings
A. Types of Cases
1. Pipeline Cases
There are two types of Stieberger reopenings, pipeline cases and non-pipeline cases.
A Stieberger claim is a “pipeline” case if, as of the date of request for Stieberger review, either:
an administrative or judicial review had been requested on the Stieberger claim but no determination or decision had been issued on that request, or;
a request for such an administrative or judicial review would still have been timely if filed.
These cases will be processed per the guides in DI 12586.025B. Favorable decisions will be processed under all normal claims processing rules. The special Stieberger rules in this transmittal do not apply.
2. Non-Pipeline Cases
All other denials/cessations meeting the Stieberger reopening criteria in DI 12586.001 are non-pipeline cases. The New York DDS will usually process Stieberger non-pipeline cases under the Stieberger criteria.
B. Procedure -- Responder Fails to Cooperate
If at any point the class member fails to cooperate, try to obtain his/her cooperation employing the guidelines in DI 13015.001C. Document the file with your attempts to secure the class member's cooperation. If the class member fails to cooperate, annotate the comment “Stieberger Failure to Cooperate Case” and the date on the flag/alert (DI 12586.095, Exhibit 9). Send a copy of the annotated alert to ODIO at the address shown in DI 12586.005D.2.b. Hold the original alert, documentation, and green jacket for 180 days. If there has been no further activity, destroy the green jacket and queries, and route other material according to normal procedures.
C. Procedure -- Whereabouts Unknown/Failure to Pursue
If the class member's whereabouts become unknown or the class member does not wish to pursue his/her request for Stieberger relief:
Follow DI 11010.045 and DI 11055.085.
Annotate the alert (Exhibit 9, DI 12586.095) to show either “Whereabouts Unknown” or “Failure to Pursue,” and the date. Send a copy of the annotated alert to ODIO at the address shown in DI 12586.005 D.2.b. Hold the original alert, documentation, and green jacket for 180 days. If there has been no further activity, destroy the green jacket and queries, and route other material according to normal procedures.
D. Policy -- Readjudicating Stieberger Cessations
Readjudicating Stieberger cessations (title II/XVI) requires the following special handling because of the limitations on development and payment (see DI 12586.020):
Adjudication of the DEVELOPMENT PERIOD (DI 12586.035) generally is completed without the prior file using initial disability standards. However, if the DEVELOPMENT PERIOD extends back to the date of cessation in the Stieberger claim, special processing is needed (such as getting the prior file, use of the medical improvement standard (MIRS), and deciding whether to use an SSA-831 or SSA-833). See DI 32586.020, item 6.
If all or part of the DEVELOPMENT PERIOD cannot be allowed, the claimant is deemed to meet section 10(e)(5) of the settlement criteria (DI 12586.035D.2.), and the case is developed back to the date of cessation using the prior folder and applying the MIRS standard.
If the case is developed back to the date of cessation and claimant is found to have a continuing disability, either a continuance or a new allowance determination is prepared, depending on whether the start of the PAYMENT PERIOD is during the termination month in the Stieberger claim or is later.
If a claim is not continued or allowed based on MIRS, the possibility of a later allowance sometime during the reopened period is considered.
Whether the DDS uses the MIRS will depend on whether the DDS is required to develop all the way back to the month of cessation.
Whether an SSA-831 or an SSA-832/833 (which means having offered a face-to-face hearing) is prepared by the DDS depends on whether the determination is based on MIRS, and also on whether the 48-month limit on payments prior to 12/1/91 (DI 12586.001, item 8.) prevents resumption of benefits in the month benefits were terminated by the Stieberger cessation.