TN 62 (02-97)

DI 32521.015 Reopening Class Claims

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 404.1520-1524, 416.920-924, including the current severity regulations, 20 C.F.R. Sections 404.1520(c), 416.920(c), Social Security Ruling 85-28, and the other policies and procedures of SSA. The readjudication will be a reopening at the reconsideration level unless consolidated at the OHA level.

2. Subsequent allowance

For class members subsequently entitled based on a subsequent disability application, the Dixon reopening will not proceed past the date of onset covered by any subsequent allowance (e.g., alleged onset date (AOD) in later onset date cases and established onset date (EOD) in all other situations or date of filing (DOF) in title XVI cases), regardless of whether the subsequent allowance is continuing, ceased or was a closed period (see B. below).

However, any earlier period of potential entitlement must be reopened and developed (see B. below).

3. Subsequent denial

If the class member received a final medical/vocational denial for any reason after July 19, 1983, or for any reason other than not severe on or before July 19, 1983, the Dixon reopening will not proceed past the AOD (or DOF in title XVI cases) of that denial (see B. below).

Preclusive effect is given to the period covered by a denial for any reason after July 19, 1983, or for any reason other than not severe on or before July 19, 1983, (e.g., if the Dixon review results in a finding that the individual was disabled, the disability would cease as of the AOD (or DOF in title XVI cases) in a subsequent denial), unless there are grounds for reopening and revising the subsequent denial under the rules of administrative finality (DI 27510.005).

4. Multiple determinations

If there are multiple determinations within the court ordered timeframe, only a single determination is needed to replace the prior determinations. (Use the earliest filing date which results in class membership).

5. 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 to an administrative law judge (ALJ).

6. 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.

7. 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.

8. 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.

9. Review jurisdiction

Normally the New York ODD will perform the Dixon review, even if the individual has left New York, unless there is a claim pending or stored in OHA (see DI 32502.001 ff. and DI 32521.020 for exceptions).

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

B. Procedure - general

1. Development

Refer to the Dixon alert for the period to be developed that the Dixon screener has annotated on the alert and develop as follows.

  1. If no subsequent applications have been filed, develop the Dixon claim(s) from the earliest date based on the application(s) which results in class membership up to the present (or in title II cases in which the claimant is no longer insured, through the date last insured (DLI). If disability can be established prior to DLI, develop to the present.) See b. and c. below for exceptions.

When readjudicating the Dixon claim(s), 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). (See B.2.c. below regarding subsequent impairments.)

  1. If the class member was allowed based on a subsequent application, develop only the period from the earliest Dixon claim which results in class membership up to the onset covered by the subsequent allowance (AOD in later onset date cases and EOD in all other situations or DOF in title XVI cases), regardless of whether the subsequent allowance is continuing, ceased or was a closed period (see B.2.c. below regarding subsequent impairments).

    If evidence received during the development of the Dixon claim(s) raises a question of continuing disability, process the Dixon claim(s) to conclusion and then return the folder to the FO to conduct a face-to-face continuing disability review (CDR) interview.

  2. If the class member received a final medical/vocational denial, develop only the period from the earliest Dixon claim which results in class membership up to the AOD (or DOF in title XVI cases) of the claim that is denied for any reason after July 19, 1983, or for a reason other than not severe on or before July 19, 1983 (see B.2.c. below regarding subsequent impairments).

  3. Develop the medical record, using treating sources whenever possible and employing consultative examiners when necessary.

    Contact only those doctors, hospitals, etc., identified by the class member. DO NOT reconstruct the names of doctors, medical centers, etc., that a claimant may have visited when the claimant is now unable to recall that information.

    If no response is received from the initial request, make one follow-up by letter (or phone call) (see DI 22505.001). If the evidence received from the treating source(s) or other medical source(s) is insufficient for adjudication, recontact the source(s) for additional information. DO NOT obtain a consultative exam if the request for information is unsuccessful.

  4. Develop the entire period being reopened even if it involves intervening periods of SGA (see exceptions in b. and c. above).

  5. Develop work and/or medical evidence through a servicing FO, as appropriate.

2. Evaluation

  1. Apply existing policies and procedures for:

  2. Consider the earliest AOD (or DOF in title XVI cases) found in the Dixon claim(s).

  3. Review the evidence in the file and assess disability. If the evidence indicates that the Dixon impairment(s) has not continued and a subsequent impairment(s) unrelated to the Dixon impairment(s) arises, deny the Dixon claim(s) and have the FO obtain a new application unless the subsequent impairment(s) was dealt with in a subsequent application.

    If the Dixon impairment(s) continues and a subsequent impairment(s) arises, consider the combined effects of all impairments in determining disability.

  4. Prepare a new determination covering the entire period being reopened (see B.3. and 4. below). Annotate prior determinations in the Remarks section of the Form SSA-831/832/833-U3, as appropriate, with “Superseded by Dixon Review Determination of (Date of Dixon Determination).”

  5. Route adjudicated claim to servicing FO. If work activity is discovered during DDS development, advise FO that SGA development is necessary.

3. Fully and partially favorable determinations

For fully and partially favorable determinations:

  1. Prepare an SSA-831/832/833-U3, as appropriate per DI 32521.025B.2.

  2. If undeveloped work activity is involved, annotate the Remarks section with “File Contains Work Activity to be Developed by the FO.”

    Request the FO to develop all work activity and make an SGA determination for all periods of work whether they were previously identified or developed by the FO or identified by the DDS during development.

    Prepare an SSA-5002 (Report of Contact) for the file and list all periods of work activity the FO needs to adjudicate before the final determination.

  3. Prepare an open period allowance unless medical improvement subsequently occurred or there is a subsequent determination that must be given preclusive effect per B.1.b. and c. above.

  4. Consider a closed period of disability if medical improvement is indicated,

    • Apply the guides in DI 28005.001 ff. in determining whether the claimant's disability had ended.

  5. See DI 32521.040, DI 32521.045, DI 32521.055 and DI 32521.060 for notice instructions.

  6. Route folder to the servicing FO (or DQB if selected for PER or QA).

4. Fully unfavorable determination

For fully unfavorable determinations:

  1. Prepare an SSA-831/832/833-U3, as appropriate (see DI 32521.025B.1.)

    Annotate prior determination(s) in the Remarks section of the Form SSA-831 /832/833-U3 as appropriate, with “Superseded by Dixon Review Determination of (Date of Dixon Determination).”

  2. Prepare and mail a notice to the claimant and any representative (see DI 32521.035 and DI 32521.050).

  3. Send the folder to the FO to hold for the appeals period. (The next level of appeal is to the ALJ.) If folder is selected for review, follow standard DQB procedures.

5. New claim filed (or pending)

If a new claim is filed (or pending), consolidate the new claim with the Dixon claim in accordance with DI 32502.001.

NOTE: The NY ODD should retrieve the pending claim from any out of state DDSs.

6. Subsequent claim adjudicated

Where the subsequent claim is no longer pending:

  1. Reopen the prior Dixon claim(s) and develop from the earliest date based on the application 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). (See B.2.c. above regarding subsequent impairments.)

  2. If the subsequent fully favorable determination established the earliest possible AOD (or DOF in title XVI cases) but full retroactive benefits were not paid because the earliest application was not reopened:

    • Prepare a new SSA-831-U3;

    • Send the folder to the FO for development of work activity; and

    • Annotate the route slip “Fully Favorable Medical Decision Made on MMDDYY. Retroactive Benefits Due Based on Reopening of Dixon Application of MMDDYY. Priority Action Required.”