TN 42 (08-95)

DI 42521.025 Court Ordered Presumptions

A. Policy

1. General

The Dixon court order establishes certain presumptions to be applied to the claim(s) of class members whose class claim(s) cannot be located.

ODIO and/or NEPSC will attempt to apply the court-ordered presumptions when the claim(s) is screened-in and is determined to be lost or destroyed. If ODIO and/or NEPSC cannot adjudicate the claim based on the presumptions, ODIO and/or NEPSC will initiate folder reconstruction.

2. Presumption of disability

A class member will be found disabled if he/she received a favorable decision awarding benefits for any subsequent period of disability; and

  • the medical evidence relevant to that determination or decision demonstrates that, given the class member's condition at the time of the favorable determination or decision, it is reasonable to presume that he/she was disabled as of the date of the prior administrative determination which resulted in class membership (i.e., the earliest Dixon claim); or

  • absent evidence to the contrary, a class member was 55 years of age or older at the time of the administrative determination which resulted in class membership.

If these presumptions are not overcome by evidence to the contrary and the class member will be found to be disabled as a result, he/she will be found disabled from the earliest date based on the application(s) which results in class membership up to the date of onset established by the subsequent allowance, regardless of whether the subsequent allowance is continuing, ceased or was a closed period.

3. Presumption of not disabled

Absent evidence to the contrary, there will be a rebuttable presumption that a class member is not disabled if:

  • he/she received a denial or termination of benefits for any reason after July 19, 1983, or for a reason other than not severe before July 19, 1983, on a disability claim subsequent to the one that forms the basis of class membership; or

  • employment records available to SSA (e.g., earnings record) indicate that:

    the individual had a period of employment longer than six months following the denial or termination that forms the basis of class membership; and

    the earnings are in excess of the minimum monthly amounts prescribed in 20 C.F.R. §§ 404.1574 and 416.974; or

  • he/she had a claim reviewed under Stieberger v. Sullivan which was denied.

When ODIO and/or NEPSC determines that the class member is not disabled based on the presumptions in A.3. above, ODIO and/or NEPSC will notify the class member of his/her right to request a hearing and to submit evidence to rebut the presumptions of non-disability (see B.2.c. below). Existing evidence of record must be considered in the light most favorable to the class member.

B. Procedure

1. Disabled based on presumptions

When a class member is found disabled based on the presumptions in A.2. above apply, take the following actions:

  1. Prepare Form SSA-831/832/833-U3, as appropriate. Include basic information such as SSN, name and address, filing date, onset date, etc. In the “Remarks” section show “Presumptive Dixon Determination Establishes Disability Through the Date of Onset of the Subsequent Allowance.”

  2. Prepare an SSA-4268-U4/C4 (Explanation of Determination) explaining the rationale of how the court-ordered presumptions apply to the missing Dixon claim(s) and the basis for the determination that the claimant is entitled to relief.

  3. Forward to the FO for non-medical development and award preparation. Annotate the route slip “Favorable Dixon Determination. FO Needs to Determine Filing Date of Earliest Dixon Claim. Process Per DI 12521.030.”

  4. NEPSC will send a copy of the SSA-831/832/833-U3, as appropriate, to ODIO, CAS at the address shown in DI 42521.010B. for entry into CATS.

2. Not disabled based on presumptions

When the class member is found not disabled based on the presumptions in A.3. above, take the following actions:

  1. Prepare an SSA-831/832/833-U3, as appropriate, and include basic information such as SSN, name and address, filing date, onset date, etc. Include in the “Remarks” section “Not Disabled Based on Presumptions.”

  2. Prepare an SSA-4268-U4/C4 explaining the rationale of how the court-ordered presumptions apply to the missing Dixon claim