TN 53 (08-95)

DI 32521.020 Court Ordered Presumptions

Policy

1. General

The Dixon court order establishes certain presumptions to be applied (see 2. and 3. below), prior to any reconstruction efforts, to the claim(s) of class members whose class claim(s) cannot be located.

ODIO and/or NEPSC will attempt to apply the court-ordered presumptions in 2. and 3. below when the class claim(s) is screened-in and is determined to be lost or destroyed.

If ODIO and/or NEPSC cannot adjudicate the entire class claim(s) based on the court-ordered presumptions, ODIO and/or NEPSC will initiate reconstruction.

2. Presumption of disability

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

  • absent evidence to the contrary, a class member was 55 years of age or older at the time of the administrative determination which results in class membership.

If these presumptions 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 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 claim regardless of whether the subsequent allowance is continuing, ceased or was a closed period.

3. Presumption of not disabled

Absent evidence to the contrary, there will be 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 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) indicate that:

    the individual had a period of employment longer than six months following the denial or termination that forms the basis of class membership; and

    the earnings are in excess of the minimum monthly amounts prescribed in 20 C.F.R. Sections 404.1574 and 416.974; 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 3. above, ODIO and/or NEPSC will send a denial notice (see DI 32521.095, Exhibit 8). 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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0432521020
DI 32521.020 - Court Ordered Presumptions - 02/20/2013
Batch run: 02/20/2013
Rev:02/20/2013