TN 2 (08-04)

DI 32548.095 Exhibits

Exhibit 1 - Priority Flag for Pending Hyatt III Class Claims

Exhibit 2 - Folder Alert

Exhibit 3 - Screening Sheet - Deleted

Exhibit 4 - Notice of Non-Entitlement to Relief – (Previously “Class Membership Denial Notice”) - Revised

Exhibit 5 - Prior Default Notice - Deleted

Exhibit 6 - Notice of Right to Submit Additional Evidence -- Settlement Subclass - Revised

Exhibit 7 - Alternate Class Membership Denial Notice - Deleted

Exhibit 8 – Folder Flag -- At Least One Claim Screened In and One Claim Screened Out - Deleted

Exhibit 9 – Priority Flag for Pending Hyatt III Class Claims

Exhibit 10 – Hyatt III - Notice of No Benefits Due - New

Exhibit 11 – Hyatt III Favorable Determination/Decision Worksheet & Transmittal - New

Exhibit 1 - Priority Flag for Pending Hyatt IIIClass Claims

Claim No:          

PENDING HYATT CLASS CLAIM

 

 

PROCESS ON A PRIORITY BASIS

Exhibit 2 – Folder Alert

999755 00000

CTWALT01                                         HYATT III COURT CASE FLAG/ALERT

REVIEW   PC    DOC    TOE    ALERT DATE     RESPONSE DATE      OLD BOAN/PAN

OFFICE

1340

SSN (BOAN OR PAN)        NAME                              BIRTH DATE                  REFERENCE #

FOLDER LOCATION INFORMATION

CAN/HUN                    BIC/MFT            CATG    TITLE    CFL CFL DATE ACN

PAYEE ADDRESS

SHIP TO ADDRESS

SSA

Disability Determination Services

Division of Social Services

3301 Terminal Drive

P.O. Box 243

Raleigh, NC 27602

If claim is pending in OHA, then ship folder to:

Office of Hearings and Appeals

Office of Appellate Operations

One Skyline Tower, Suite 701

5107 Leesburg Pike

Falls Church, VA 22041-3200

Exhibit 4 –Notice of Non-Entitlement to Relief

SOCIAL SECURITY ADMINISTRATION

IMPORTANT INFORMATION

Date:

Claim Number:

Dear               :

We looked at your case as the result of a class action court case in North Carolina called Hyatt. We looked at your case even if we looked at it earlier and sent you a letter saying you were not entitled to a Hyatt review.

As a result of reviewing your case, we found that you are not entitled to a Hyatt review. This means we will not review your old disability case again. The reason you are not entitled to this review is explained below.

IF YOU DISAGREE

You, or your representative, have 120 days from the date you receive this notice to write to Social Security to request review of this decision.

If you want Social Security to review this decision, please write to:

     Social Security Administration

     Office of the General Counsel

     Room 617 Altmeyer

     6401 Security Blvd.

     Baltimore, MD 21235-6401

THE REASON YOU ARE NOT ENTITLED TO HYATT REVIEW IS BECAUSE:

We have no evidence that you ever filed an application for social security disability insurance benefits under either title II or title XVI of the Social Security Act. Your application was for ­________________________________________________________________________________________________ _________________________­­­­­­­_____.

You did not receive a less than fully favorable determination/decision (choose one) by a North Carolina adjudicator on or after July 7, 1981 and before November 14, 1991. The final determination/decision (choose one) on your claim was

(fill in the reason the claimant does not qualify for Hyatt review)                             

______________________________________________________________________

You did not receive a medical denial/determination. The final determination decision was based on ________________________________________________________.

Remember that you only have 120 days to ask us to review this decision. If you do not contact us within 120 days this decision will become final.

IF YOU NEED HELP

If you have questions or want help, you should contact:

  1. Your lawyer or representative; or

  2. The lawyers for the Hyatt class:

Hyatt Attorney

North Carolina Justice and Community Development Center

P.O. Box 28068

224 South Dawson Street

Raleigh, NC 27611-8068

1 (800) 299-8619

INFORMATION ABOUT FILING A NEW APPLICATION

If you think you are disabled now, you may file a new application. A new application is not the same as asking us to review your claim under Hyatt. In the new application, you may not be able to receive disability benefits for the period of time you asked for in your prior claim. If you decide to file a new application, contact any Social Security office.

cc:
Claimant"s Representative
Hyatt Attorney

Exhibit 6 - Notice of Right to Submit Additional Evidence - Settlement Subclass

 

NOTICE OF RIGHT TO SUBMIT EVIDENCE -- SETTLEMENT SUBCLASS

                                                    North Carolina Disability

                                                     Determination Service

                                                      3301 Terminal Drive

                                                Raleigh, North Carolina 27604

                                                                     Date:

                                                             Claim Number:

Dear

We are currently looking at your case as the result of a class action court case in North Carolina called Hyatt. Your case will be reviewed even if we looked at it earlier and sent you a letter saying you were not entitled to a review. We will review your file and issue a new decision on your Hyatt claim. You have the right to give us any additional information relating to this earlier claim that was not previously considered.

You have 10 days from the day you receive this letter, to tell us if you plan to give us any additional information. You can call us at 1-800-          to give us the information about your Hyatt claim or to tell us that you plan to give us something in writing. You will have two weeks from when we hear from you to get the information to us. You may send the information to us by using our toll-free fax number, which is 1-800-          or you may mail it to:

     North Carolina Disability Determination Service

     3301 Terminal Drive

     Raleigh, NC 27604

If you have additional information but cannot get it to us within the above time limits, you must let us know. If we do not hear from you within 10 days after you receive this letter, we will make our new decision based on the information that is in your file now. We will consider any information you give us if we receive it prior to making our new decision.

If you have questions or want help you should contact your lawyer or your representative immediately.

Exhibit 9 - Priority Flag for Pending Hyatt IIIClass Claims

 

Claim No:          

PENDING HYATT CLASS CLAIM

 

 

PROCESS ON A PRIORITY BASIS

Exhibit 10 - Hyatt III – Notice of No Benefits Due

SOCIAL SECURITY ADMINISTRATION

Claimant's Name                            H3                     SSN

Address                                                                                 DOC

We have reviewed your prior claim(s) because of the class action court case called Hyatt. Your case was reviewed even if we looked at it earlier and sent you a letter saying you were not entitled to a review.

We found that you were disabled beginning (fill in established onset date). This means that the earliest your benefits can start is

  1. (fill in MM/YY for Social Security disability) (and/or)

  2. (fill in MM/YY for Supplemental Security Income).

[For title II only claims select 1,

for title XVI only claims select 2,

for concurrent claims complete both].

Since you already received these benefits, we do not owe you any more money because of this review.

If you believe that this determination is not correct, you may request that your case be reexamined. If you want this reconsideration, you must request it not later than 60 days from the date you receive this notice. You should make your request through any Social Security office. If additional evidence is available, you should submit it with your request.

If you have any questions about your claim, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you do visit an office, please take this notice with you.

cc:

Hyatt Attorney

North Carolina Justice and Community Development Center

224 South Dawson Street

P.O. Box 28068

Raleigh, NC 27611

Telephone: 1-800-299-8619

Claimant's Representative

Litigation Staff

Exhibit 11 - Hyatt III Favorable Determination/Decision Worksheet & Transmittal

G-DI_32548.095

Printer Friendly Version

NOTE: Please do not forward completed folders to The Class Action Section (CAS) located in Balti-more, Maryland. Upon completion of a case, the folder should be forwarded to the appropriate storage facil-ity (PSC, WBDOC, ODO). CAS does not house completed folders.

Exhibit 12 Hyatt (H3) Class Action – Reopening Reviews for Settlement Subclass Cases

A. Background

There are two separate subclasses of claimants that are entitled to relief under the March 1994 Hyatt Settlement Order, i.e., they are the primary and settlement subclasses.

1. Primary subclass

The primary subclass, subject to certain very limited exclusions, consists of all individuals whose disability claims, which included allegations of pain, were finally denied or terminated on or after July 7, 1981 and before August 6, 1990. Primary subclass members have their claims reopened and receive full appeal rights. See DI 12548.001B.1., DI 32548.001B.1., DI 42548.001B.1., HALLEX I-5-404IV.B.1.

2. Settlement Subclass

The settlement subclass, subject to certain very limited exclusions, consists of all individuals whose disability claims, which included allegations of pain, were finally denied or terminated by the North Carolina DDS on or after August 6, 1990 and before November 14, 1991. Settlement subclass members receive a disability redetermination with limited appeal rights. See DI 12548.001B.2., DI 32548.001B.2., DI 42548.001B.2., HALLEX I-5-404-IV.B.2-3.

B. New process

Effective immediately all settlement subclass members will prospectively have their claims reopened and will receive full appeal rights. The settlement subclass members' claims will have the same appeal rights as the primary subclass members.

C. References

Follow POMS DI 12548.020B., DI 32548.020, and DI 42548.009B. to process all HYATT H3 class member claims. The POMS and HALLEX are currently being revised and will be issued upon completion.

D. Contacts

Questions regarding the content of this message or about the HYATT case should be directed as follows:

  • SSA Offices, other than OHA, should contact the HYATT coordinator in their Regional Office.

  • Regional Coordinators should contact the Office of Acquiescence and Litigation Coordination (OALC).

  • OHA offices contact: The appropriate OHA Regional Office.

  • OHA Regional Office should contact the Chief Judge’s Office.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0432548095
DI 32548.095 - Exhibits - 02/21/2013
Batch run: 02/21/2013
Rev:02/21/2013