TN 60 (08-96)

DI 32586.020 Readjudication Policy -- Stieberger

Procedure

1. No current claim pending

SSA will usually reopen Stieberger claims at the reconsideration level (see 2., below). Claims reopened at the reconsideration level will have appeal rights to the Administrative Law Judge (ALJ) level. If the Stieberger claim was a cessation, the DDS will offer the claimant the opportunity to have a face-to-face hearing if an SSA-833 would be appropriate per 6., below.

2. Current claim pending

If the class member has an active disability claim pending, at any administrative level, at the time of the FO interview, SSA may, unless the class member objects, consolidate the Stieberger reopening with the active claim (see DI 12502.001):

  • in OHA if the active claim is pending in OHA; or

  • at the reconsideration level, if the active disability claim is pending at the initial or reconsideration level.

Any claimant who objects to consolidation is informed that processing of the Stieberger claim will resume after the pending claim is finally adjudicated. If the claimant does object to consolidation, a signed statement to that effect is obtained.

NOTE: Cases remanded from court are considered to be active pending claims. Such cases will generally be adjudicated at the hearing level.

A claimant may request Stieberger reopening in conjunction with action on a current claim. However, no Stieberger reopening is done unless the claim has been alerted for review by CO. The FO will request a CATS query from the Disability Programs Branch in the Regional Office to ascertain whether an alert has been generated.

If the claim has not been alerted for review by CO, the FO informs the claimant and/or any representative, that any Stieberger reopening will be processed separately from the current claim.

3. Civil action pending

The following criteria apply to cases where a civil action is pending:

  1. a. 

    Responders who had civil actions pending in, or on appeal from, one of the four Federal district courts in New York State at the time of the settlement were notified that they have the option of proceeding with either their litigation or reopening under the class settlement.

  2. b. 

    Those proceeding with litigation waived any right to Stieberger reopening of the subject claim.

  3. c. 

    Those waiving the right to Stieberger reopening on one claim retain the right to reopening on other claims.

4. Stieberger processing of subsequent claims

Full Stieberger development may not be necessary where one or more subsequent claims were filed.

a. Subsequent unfavorable decision review

Where a Stieberger cessation had an unfavorable Decision Review by a DDS other than the New York DDS, at any time, or by the New York DDS after July 2, 1992, no Stieberger reopening is necessary.

b. Subsequent disability allowance at any level

Where the established onset coincides with or is earlier than the Stieberger onset and additional payment is possible based on the Stieberger claim, the Stieberger Workgroup will send the subsequent allowance folder along with the green jacket to the FO. The FO will adopt the subsequent allowance decision by preparing an SSA-831-U3 annotated “ Stieberger reopening. This adopts the SSA 831 dated       ”.

c. Subsequent allowance at any level

Where the established onset is later than Stieberger onset, the Stieberger Workgroup will include the subsequent file with the green jacket. FO forwards them, with medical sources and authorizations covering the medical DEVELOPMENT PERIOD, to the DDS. After reviewing the package, including the subsequent allowance the DDS may, absent evidence to the contrary, (e.g., traumatic onset, new impairment), presume continuous disability and establish the Stieberger onset date. (See DI 32586.001, item 10).

d. Subsequent disability denial issued by a state other than New York, or by New York after July 2, 1992.

No Stieberger reopening is necessary if a subsequent denial issued by a state other than New York or by New York after July 2, 1992, covered the same period and issues as the earlier denial.

5. Closed periods

If the DDS finds a closed period of disability that ends prior to 12/1/91, the PAYMENT PERIOD will consist of the months of actual disability (up to 48) immediately prior to 12/91. In the event of multiple closed periods, the PAYMENT PERIOD will be adjusted, if necessary, to fit within the closed period(s).

The PAYMENT PERIOD will not exceed the number of months the individual was disabled prior to 12/1/91, less any necessary title II waiting period, up to a maximum of 48 months.

In addition to the normal factors that cause a closed period, in Stieberger , there also is the effect of non-New York denials. If a claimant was denied disability while residing in another state, the period covered by that denial is not reopened under Stieberger .

6. Cessations

Readjudicating Stieberger cessations (see DI 32586.070C.) requires the following special handling because of the limitations on development and payment (see DI 32586.001):

  1. a. 

    The DEVELOPMENT PERIOD (DI 32586.035) generally is adjudicated without the prior file using initial disability standards. However, if it extends back to the date of cessation in the Stieberger claim, special processing is needed (use of the medical improvement standard - MIRS, getting the prior folder, and deciding whether to use an SSA-831 or SSA-833).

  2. b. 

    If all or part of the DEVELOPMENT PERIOD cannot be allowed, the claimant is deemed to meet 10(e)(5) criteria (DI 32586.035C.2.), and the case is adjudicated back to the date of cessation using the prior folder, developing back to the comparison point, and applying the MIRS standard (see DI 28010.105).

  3. c. 

    If the case is adjudicated back to the date of cessation and claimant is found to have a continuing disability, either a continuance or a new allowance determination is prepared, depending on whether the start of the PAYMENT PERIOD is during the termination month in the Stieberger claim or is later.

  4. d. 

    If a claim is not continued or allowed based on MIRS, the possibility of a later allowance sometime during the reopened period is considered.

Whether the DDS uses the MIRS will depend on whether the DDS is required to adjudicate all the way back to the month of cessation.

Whether an SSA-831 or an SSA-833 (which means having offered a face-to-face hearing) is prepared depends on whether the determination is based on MIRS, and also on whether the 48-month limit on payments prior to 12/1/91 (DI 32586.001, item 8.) prevents resumption of benefits in the month benefits were terminated by the Stieberger cessation.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0432586020
DI 32586.020 - Readjudication Policy -- <Italic> Stieberger</Italic> - 03/15/1997
Batch run: 04/14/2014
Rev:03/15/1997