TN 1 (11-00)

DI 32548.045 Notice Instructions - Affirmation of Prior Denial

Citations:

Regulations No. 4 - Secs. 404.904, 404.1715, 416.1404, 416.1515

A. Policy - primary and settlement subclass claims

In Primary and Settlement Subclass claims the claimant, his/her representative, if any, and class counsel must be notified of any determination which is wholly or partially unfavorable. (See NL 00601.003 for signature requirement).

Class counsel"s copy of the notice is sent to:

North Carolina Justice and Community Center

P. O. Box 28068

224 South Dawson St.

Raleigh, North Carolina 27611-8068

Telephone: 1(800) 299-8619

B. Procedure

1. Title II only

For title II only cases, use an SSA-L951-U2/C2; add the third line heading “IMPORTANT INFORMATION”; and include:

  1. An introductory statement which reads:

    “We have completed the review you requested as a result of the Hyatt III court order. Based on our review, we still find that the determination in your case is proper and in accordance with the law. Therefore, the denial of your application remains unchanged.”

    For cases involving a consolidated determination (i.e., a Hyatt III claim and initial claim) add: “This notice includes our decision on both the Hyatt III case review and the new application filed on (date of new application).”

  2. An optional paragraph to be used if the earliest claim(s) within the Hyatt III period is not a Hyatt III eligible claim,

    “We did not review your claim(s) filed on (fill in date of claim(s) ineligible for Hyatt III review) because (fill-in reason claim(s) was not eligible for Hyatt III review ). We reviewed your claim(s) filed after that date.”

  3. An optional paragraph to be used if claimant is in current pay:

    “This review does not affect the checks you are getting now based on your later application.”

  4. Paragraph 4041 - (delete if merged text format is used.)

  5. A discussion of the evidence containing the elements in DI 26530.020.

  6. Paragraph 4107- in the second sentence substitute “if you still believe” for “if you believe.”

    For Settlement Subclass members, replace all but the first sentence of paragraph 4107 with:

    “If you disagree with this determination, you may request a review by an administrative law judge if you provide us with “new and material” information about your condition. You must ask for this review no later than 60 days from the date you receive this notice.

    You must submit the “new and material” information to us within 105 days of the date that you receive this notice. You may submit the “new and material” information to us along with your request for hearing, or you may mail the information directly to the hearing office. If you do not provide us with “new and material” information, there will be no further review of this determination, and this determination will become final and not subject to further review.

    Information is “new and material” if:

    • It was not considered by the person who made the determination in your claim; and

    • The new evidence, by itself or with the other evidence that will be reviewed, would cause us to change our determination.

    New and material evidence could include an oral or written statement from you about your condition.”

    On cases returned from OHA for consolidation (or one of several Hyatt III claims that were appealed to the ALJ hearing level (DI 32548.015B.1.)), replace all but the first sentence of paragraph 140 with “Since you previously had requested a hearing on your case, we will automatically return your case to the Office of Hearings and Appeals for a hearing before an administrative law judge.”

  7. Paragraph REF 003 on LSF

  8. Enclosures:

    • Explanation of Determination (Delete if merged text is used.)

    • SSA Pub. No. 70-10281 (Do not send this publication to Settlement Subclass Members. This publication is only sent to individuals whose class claims are reopened.)

2. Title XVI only

For title XVI only cases, use an SSA-L8052-U2/SSA-L8052-C2; add the third line heading “IMPORTANT INFORMATION”; and inclu