TN 1 (11-00)

DI 32548.035 Miscellaneous Procedure

Procedure

1. Lost files

If queries indicate that the claimant is eligible for Hyatt III relief (see DI 32548.010B.3.b.) and the PC is unable to locate a Hyatt III claims file, the FO will initiate folder reconstruction. After completing its development, the FO will forward the file to the DDS. The DDS will:

  1. Reconstruct the evidence for the reopening or redetermination period following DI 20502.030.

  2. Conduct Hyatt III review based on the reconstructed file.

    If the file cannot be reconstructed:

    • Adjudicate the claim based on current evidence.

    • In the absence of substantial contrary evidence such as contrary medical judgment, a traumatic onset, or new impairment, infer that the class member was disabled as of the earliest date upon which all other requirements for disability benefits, including the filing of a claim, were met within the class period if the class member has been found disabled on a subsequent claim.

      In addition, if the class member has not been found disabled on a subsequent disability claim and if evidence of the past condition is not readily available, presume that the class member"s past condition and impairments were as they are currently if such a presumption is reasonably based on the nature of the impairment.

2. Whereabouts unknown

If the claimant"s whereabouts become unknown anytime during the adjudication process and:

  • the redetermination or reopening is unfavorable, request FO assistance to locate claimant. (See DI 23005.001.) If the FO cannot provide a better address, prepare an SSA-831-U3 and personalized notice. Send the notice to the class member"s last known address, make systems input per DI 32548.005B.3., and send the folder to the servicing FO to retain during the appeal period.

    NOTE: If the claimant is not located, the personalized notice prepared in any unfavorable determination should contain a description of the attempts made to locate the claimant.

  • a favorable redetermination or reopening is possible, request FO assistance to locate the claimant. If the claimant is not located, complete any development not requiring claimant participation and prepare a determination based on the evidence in file. (See DI 23005.001.)

3. Deceased class member

When a class member dies prior to adjudication, apply the following procedure.

  1. Contact the FO to locate survivors or a qualified substitute party and a death certificate. Do not send the folder to the FO unless the FO requests it to assist in locating survivors. Once a survivor or substitute party has been located, proceed with the adjudication process.

  2. Prepare a determination for title II cases, even if there are no benefits payable to auxiliaries because an underpayment may be due to the individual"s legal heirs or the legal representative of the estate. (See DI 23510.001.)

  3. Prepare a redetermination for title XVI cases, only if:

    • there is a surviving spouse (eligible or ineligible) who was living in the same household at the time of death or any time in the preceding 6 months, or

    • the deceased was a disabled or blind child living with parent(s) at the time of death or any time in the preceding 6 months, or

    • a determination is needed for Medicaid eligibility purposes.

      Telephone the FO to ascertain if any of the above conditions exist. To insure that the Class Action Tracking System (CATS) is updated, prepare a SSA-559 and forward to OPB, LS (See DI 32548.015A.2.b. for the address).

4. Failure to cooperate

In failure to cooperate situations follow DI 23010.005 - DI 23010.025.


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http://policy.ssa.gov/poms.nsf/lnx/0432548035
DI 32548.035