TN 26 (08-93)

DI 42502.001 Court-Ordered Reviews -- Jurisdiction

A. Introduction

As a result of class action court decisions, SSA is at times required to readjudicate its past determinations. The special review criteria required by a court's order are not generally well known in areas outside of the State(s) affected by that order.

This becomes a problem if a claimant has moved out of the area affected by the court's order since DDS/FO personnel in the new State may not be familiar with the pertinent review criteria.

B. Policy

1. Jurisdiction

Court-ordered reviews of class members' claims are generally the jurisdiction of the DDS which made the determination to be reviewed.

This is true even if the claimant has moved out of that DDS's usual area of jurisdiction.

Exceptions are:

  1. The State in which the claimant now lives will have jurisdiction if the court order also is applicable in that State (e.g., in nationwide, region-wide or circuit-wide classes).

  2. If a face-to-face review is appropriate (cessation cases), the “resident” DDS will have jurisdiction.

  3. If the court order requires otherwise (e.g., review by the resident DDS is mandated).

2. Work/Medical development

Development of work activity and/or medical evidence will be coordinated with resident FOs and DDSs, as appropriate.

3. QA reviews

Selection of claims for QA reviews will be unaffected (unless a change is mandated in the court order).

4. Appeals

Appeal requests will be the jurisdiction of a DHU or OHA hearing office servicing the claimant's residence, as per usual procedures.

5. Initial payment

Both preceding and following court-ordered reviews, any benefits which can be paid (e.g., on partially favorable determinations) will be, prior to the processing of any appeal requests, etc.

6. Subsequent (current) claims pending

If there is a subsequent (current) claim involving common issues pending in:

  1. The State (DDS or DHU) which has court case jurisdiction (see DI 42502.001B.1., in this section), this State will process on a priority basis (to the extent possible) a determination or determinations covering both the court-ordered review and the subsequent (current) claim.

  2. Another State (DDS, DHU, or FO):

    • The subsequent (current) claim will be sent to the State having jurisdiction of the court case for association with the class action claim. (If OHA has jurisdiction, see d.). Prior to referral of the subsequent claim, if they are in a position to do so (i.e., they have sufficient evidence), the other State will adjudicate the subsequent (current) claim and refer it for payment (if applicable). If this is to be done, notify the State with court case review jurisdiction (or OHA) of the reason for the delay. Additionally, customary processing of the subsequent (current) claim should never be delayed in anticipation of a class action alert.

    • If a subsequent (current) claim is referred by a DDS or FO for association with a class action claim, the claimant will be notified by the referring DDS, DHU, or FO using appropriate language. For example:

      “We have sent your new (disability/Supplemental Security Income/ Social Security disability and Supplemental Security Income) claim(s) to the ( name of new State DDS) to review your disability under the ( name of class action) class action court case. (Name of new DDS) has responsibility for your claim.

      The review may cover the same period and issues raised by your earlier application. The (DDS) will process your claims and they will contact you.”

    • A determination covering both the subsequent (current) claim and the court-ordered review will be processed by the State with review jurisdiction (see DI 42502.001B.1.). If the subsequent claim is unadjudicated, processing should be on a priority basis (to the extent possible).

EXCEPTION: If a subsequent terminal illness case (i.e., TERI or potential TERI case) is filed or pending adjudication, the resident DDS has jurisdiction for both that claim and the court-ordered review. If another subsequent claim or court-ordered review case is pending at OHA or a court, contact OHA's court case coordinator to discuss processing.

  1. OHA: Class members' (or potential class members') claims folders will be sent for association with the OHA claim (see DI 42502.001B.7., in this section).

    After screening the case for class membership, OHA will:

    • Prepare and mail a non-member notice; or

    • Combine the claims and render an all-inclusive decision(s); or

    • Dismiss the request for hearing on the subsequent claim and return both claims to the DDS having jurisdiction of the court case for combined processing; or

    • Decide not to combine the claims. The approp