TN 47 (08-96)
DI 42586.030 Effectuation of Determinations and Appeals Process -- Stieberger
1. Favorable decisions
Where the file indicates the claimant is currently represented, a copy of the award notice must be sent to the claimant's representative.
a. Title II
The servicing PC receives favorable Title II decisions from the FO for effectuation of the SSA-101-U3 or resumption of benefits after all non-disability issues have been developed and resolved.
The PC is responsible for effectuating payment actions for cases in current payment status in which favorable readjudications are made.
b. Title XVI
Favorable decisions will be effectuated under existing guidelines by the FOs.
2. Unfavorable decisions
All cases with unfavorable decisions must be retained in the FO for the appeals period.
3. Appeals process
The next level of appeal on prior denial cases readjudicated by the DDS is the ALJ.
These cases are DOFA non-CAPS
Follow usual procedures to process cases reversed to allowance, except show “Stieberger Court Case” in item 11 of the SSA-101-U3.
Apply usual withholding procedures for medicare, overpayments, attorney fees, etc.
Note that SSI offset will apply in many cases.
Prepare and release the notice using the special language and notice designated by the DDS. Special payment rules apply to Stieberger reopenings, see DI 42586.001, item 7.
Include the following sentence in the award notice:
“Based on the Stieberger class action law suit, you are being awarded benefits for the period (first MOE) through (the last MOE or the present.”
For determinations made by the DDS, the first appeal is made to an ALJ. Substitute hearing language for reconsideration language.
3. Processing reversal of cessation to continuance
Follow usual procedures for reinstatement of benefits. Continuances will be subject to PER.