TN 60 (08-96)

DI 32586.055 Readjudication Notices -- Stieberger

A. Policy

The claimant and any representative will be notified of any determination. If a Spanish notice is required, follow DI 28095.030. See DI 32586.085 for special notice language where all of a Second Circuit decision is not applied.

B. Procedure -- affirmation of prior denial

In addition to the language required by the following subsections, add the following sentence to notices involving claims in which an onset has been established as a consequence of the Stieberger review: “We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had not applied the special Stieberger rules.”

1. Title II only

Send an SSA-L951-U2/C2, (Social Security Notice Letterhead) add third line heading “IMPORTANT INFORMATION” and include the following:

  1. Introductory statement that reads:

    “A court order in the Stieberger v. Sullivan class action lawsuit required the Social Security Administration to look at your case again to determine whether our prior determination in your case was correct. Because of the court order, we looked at the evidence in your file covering (period of time for which disability was considered) again to see if you were disabled.

    “We have completed this review and we still find that the determination in your case is proper and in accordance with the law. Therefore, the prior denial of your application remains unchangeda.”

  2. If the claimant is in current pay, add the following language:

    “This determination does not affect the checks that you are getting now based on your later application for benefits.”

  3. Paragraph 4041 (Delete if merged text format is used.).

  4. A discussion of the evidence containing the elements in accordance with DI 26530.020.

  5. Paragraph 140. In the second sentence, substitute “if you still believe" for "if you believe.”

  6. In addition include:

    “You have the right to file a new application at any time, but filing a new application is not the same as appealing this decision. If you disagree with this decision and you file a new application instead of appealing:

    • You might lose some benefits, or not qualify for any benefits, and

    • we could deny the new application using this determination if the facts and issues are the same.

    If you disagree with this determination, you should file an appeal within 60 days.”

  7. Paragraph MG20.

  8. Enclosures:

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

    • SSA Pub. No. 70-10281

2. Title XVI only

Send notice on SSA-L8052-U2/C2, add third line heading “IMPORTANT INFORMATION,” and include the following:

  1. Follow B.1.a. - e. above.

  2. “You have the right to file a new application at any time, but filing a new application is not the same as appealing this decision. If you disagree with this decision and you file a new application instead of appealing, you might lose some benefits, or not qualify for any benefits. If you disagree with this decision, you should file an appeal within 60 days.”

  3. Paragraph 1481.

  4. B.1.h. above.

3. Concurrent cases

  1. title II - Follow B.1. above, but add disclaimer paragraph 842.

  2. title XVI - Follow B.2. above, but add disclaimer paragraph 841.

C. Procedure -- revision to partially favorable allowance

In addition to the language required by the following subsections, add the following sentence to notices involving claims in which an onset has been established as a consequence of the Stieberger review: “We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had not applied the special Stieberger rules.”

1. Title II only

Send interim notice on SSA-L951-U2/C2, add third line heading “IMPORTANT INFORMATION,” and include:

  1. An introductory statement as follows:

    • Onset established later than the earliest possible Stieberger onset:

      “A court order in the Stieberger v. Sullivan class action lawsuit required the Social Security Administration to look at your case again to determine whether our prior determination in your case was correct.

      “We have completed this review and we find that you meet the medical requirements for disability benefits on  (onset date)  but you do not meet these requirements prior to that date. You must meet certain medical and non-medical requirements to be entitled to disability benefits. Attached to this notice is an explanation of the decision that we made on your claim and how we arrived at it.” (Delete last sentence if merged text format is used.)

    • Closed period established

      “A court order in the Stieberger v. Sullivan class action lawsuit required the Social Security Administration to look at your case again to determine whether our prior determination in your case was correct. According to the court order, we looked at the evidence in your file covering  (period of time for which disability was considered)  again to see if you were disabled.

      “We have completed this review and we find that you meet the medical requirements for disability benefits from  (onset date)  to   (cessation date)  .

      You must meet certain medical and non-medical requirements to be entitled to disability benefits. Attached to this notice is an explanation of the decision that we made in your claim and how we arrived at it.” (Delete the last sentence if merged text format is used.)

      If the class member is not in current pay, add:

      “If you believe that our decision is wrong, you may appeal this determination. You may also file a new claim.”

      If the class member is in current pay, add:

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

  2. Language from B.1.f. above.

  3. A discussion of the evidence containing the elements in accordance with DI 26530.020.

  4. Last three paragraphs from SSA-1157-U2 DI. (If onset is established as later than alleged, add “as of the date that we have now found that you meet the medical requirements for disability benefits” after “requirements” in first sentence of third paragraph from SSA-1157-U2 DI - see DI 31515.270.) “We have found that you do not meet the medical requirements for disability from  (earliest Stieberger onset date)  through  (day before the established onset)  .”

  5. Route folder to servicing FO (or to DQB if selected for PER or QA).

2. Title XVI only

Send interim notice on SSA-L8052-U2/C2, add third line heading, “IMPORTANT INFORMATION,” and include the following:

  1. Follow C.1.a. and C.1.c. above.

  2. Last three paragraphs from SSA-L1157-U2 SI. (If Stieberger onset date is established later than alleged, add: “as of the date that we have now found that you meet the medical requirements for disability benefits” after “requirements” in the first sentence of third paragraph from SSA-L1157-U2 SI - (see DI 31515.275.)

  3. Follow B.2.b and B.2.c. above.

3. Concurrent cases

  1. title II - Follow C.1. above, but add disclaimer paragraph 842.

  2. title XVI - Follow C.2. above, but add disclaimer paragraph 841.

D. Procedure -- revision to a fully favorable allowance

If the class member is disabled throughout the DEVELOPMENT PERIOD, and he/ she remains disabled, find that the allowance/continuance is fully favorable for Stieberger purposes. This is true even though the onset is later than the original AOD.

Also, in addition to the language required by the following subsections, add the following sentence to notices involving claims in which an onset has been established as a consequence of the Stieberger review: “We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had not applied the special Stieberger rules.”

1. Title II only

  1. Enter “ODO/DL-S” in item 29 of SSA-831.

  2. Indicate SSA-L30-C1 as notice on attachment and include following paragraph:

    “This determination is based on a review of your claim as ordered by the court in the case of Stieberger v. Sullivan . Based on the Stieberger court order, we looked at the evidence in your file covering  (period of time for which disability was considered)  again to see if you were disabled. After reviewing the evidence, we have established that you are disabled beginning  (date)  . This is the earliest date under the Stieberger court order that disability can be established.”

2. Title XVI only

  1. Indicate DO/DL-S as notice on SSA-831.

  2. On attachment, show SSA-8025-U2: (SSI Payment Decision)

    • Lead-in sentence:

      “This determination is based on a review of your claim as ordered by the court in the case of Stieberger v. Sullivan. Based on the Stieberger court order, we looked at the evidence in your file covering  (period of time for which disability was considered)  to see if you were disabled. After reviewing the evidence, we have established that you are disabled beginning (date). This is the earliest date under the Stieberger court order that disability can be established.”

    • Paragraph 1029

    • Paragraph 1414, 1415, 1424, or 1425, as appropriate.

3. Concurrent cases

Follow above instructions for each case.

E. Procedure -- revision to continuance

1. Title II only

  1. Enter “ODO/DL-S” in item 29 of SSA-833.

  2. Prepare modified SSA-L1013 (SS Notice of Continued Disability). Add the following to the bottom of the notice:

    “This determination is based on a review of your claim as ordered by the court in Stieberger v. Sullivan . After examining the new and old evidence, we find that you are still disabled.”

  3. Indicate SSA Pub. No. 70-10282 as an enclosure.

  4. Forward claim to the PSC for processing under cover of an SSA-408 annotated “ Stieberger Class Action Cases - Process per DI 42586.001.”

2. Title XVI only

  1. Indicate DO/DL-S as notice on SSA-833.

  2. On attachment, show SSA-L8100-U2, followed by: Lead-in sentence:

    “This determination is based on a review of your claim as ordered by the court in Stieberger v. Sullivan.”

    • Decision paragraph:

      “After examining the new and old evidence, we find that you are still disabled.”

    • Numbered (e.g., 1391, 1412, 1413) or dictated paragraphs to give appropriate information contained on front of SSA-L1014.

  3. Forward claim to FO for processing under cover of an SSA-408 annotated “ Stieberger Class Action Cases - Process per DI 12586.001.”

3. Concurrent cases

Follow above instructions for each case.

F. Procedure -- affirmation of cessation

1. General

Do not offer benefit continuation.

2. Specific

  1. In addition to standard language, include introductory paragraph from DI 32586.040 B.1.a. Replace last sentence with the following: “Therefore, the decision that your disability ended remains unchanged.”