TN 47 (08-96)

DI 42586.095 Exhibits -- Stieberger

Exhibit 1 - Potential Class Member Notice

Exhibit 2 - Court Case Reply Form

Exhibit 3 - Acknowledgments

Exhibit 4 - Screening Sheet

Exhibit 5 - Non-entitlement to Reopening

Exhibit 6 - Stieberger Folder Request

Exhibit 7 - Folder Retrieval Worksheet

Exhibit 8 - Attachment 1 ( Stieberger Settlement Teletype Instructions)

Exhibit 9 - DEVELOPMENT/PAYMENT PERIOD Worksheet

Exhibit 10 - 48-Month Chart

Exhibit 11 - Stieberger Supplement

Exhibit 12 - Request for Court Case Review/Change of Address Worksheet

Exhibit 13 - Corroboration Checklist

Exhibit 1 - Potential Class Member Notice

 

SOCIAL SECURITY ADMINISTRATION

Important Information

 

NameST Date:
Address  Claim Number:
City, State, ZipDOC:  

 

We have good news for you about your past claim for disability benefits. We are writing to you about a court case that may affect you. Because of this court case you may be entitled to money from Social Security. Please read this letter carefully.

 

INFORMATION ABOUT THE COURT CASE

You may be entitled to Social Security or Supplemental Security Income disability payments based on a past claim you filed. In a recent court case called Stieberger v. Sullivan, we agreed to look again at certain claims that were denied or where payments were stopped. We believe that your claim may be one of those that we agreed to look at again.

HOW TO ASK FOR A REVIEW

We will not look at your claim again unless you ask us to do so. If you want us to do this, fill out the enclosed reply form that came with this letter and mail it right away in the enclosed envelope. You have 180 days from the day you received this letter to ask us to look at your claim again, but don't wait. If you don't send the form back, we will not look at your claim again. We will write to you when we receive your reply form.

IF YOU NOW GET MONEY FROM SOCIAL SECURITY

Even if you get money from Social Security, we may still owe you more money. Return the reply form in this letter within 180 days to ask us to look at your past claim again.

PROTECTING YOUR RIGHTS

Sending in the enclosed reply form does not protect your rights on any other claim for benefits. If you have a claim for benefits that we are still considering or that we recently denied and you disagree with our decision, you must follow the guidelines that we tell you about in the notice on that claim.

IF YOU HAVE ANY QUESTIONS

If you have any questions, you may contact any Social Security office. The address and phone number of your local Social Security office are printed at the top of this letter. If you call or visit an office, please take this letter with you. It will help us answer your questions.

FOR HELP

Additionally, if you have someone helping you with your claim, you should contact him/her. You also may contact one of the following offices to obtain a legal representative, or you may contact the lawyers in this case. These offices are listed below.

OFFICES THAT WILL REFER YOU TO ORGANIZATIONS THAT PROVIDE FREE LEGAL REPRESENTATION

  • New York City Area:

    Legal Services for New York City, (212) 431-7200 or
    The Legal Aid Society, (718) 722-3100.

    The Rest of New York State:

    Greater Upstate Law Project, (800) 724-0490, or (800) 635-0355.

OFFICE THAT WILL REFER YOU TO AN ATTORNEY WHO WILL CHARGE A FEE FOR REPRESENTATION

  • Throughout New York State:

    National Organization of Social Security Claimants'
    Representatives, (800) 431-2804, or (914) 735-8812.

OFFICES OF THE LAWYERS THAT REPRESENTED CLAIMANTS IN THIS LAWSUIT

  • The Legal Aid Society of New York
    Civil Division, Civil Appeals & Law Reform Unit
    11 Park Place, Room 1805
    New York, New York 10007
    (212) 406-0745

    Legal Services for the Elderly
    130 W. 42nd Street, 17th Floor
    New York, New York 10036-7803
    (212) 391-0120

    MFY Legal Services
    35 Avenue A
    New York, New York 10009
    (212) 475-8000

     

     

Enclosure:

Reply form and envelope

Exhibit 2 - Court Case Reply Form

G-SSA-23-SM

Printer Friendly Version

Exhibit 3 - Acknowledgments

 

SOCIAL SECURITY ADMINISTRATION

Important Information

 

Ms. Jane DoeMay xx, 1993
123 Elm Street 
New York, NY 12345Claim Number: XXX-00-XXXXDI

 

  1. We are writing to tell you that we received your request asking for a review of our earlier decision that you were not or no longer disabled.

  2. We expect to receive many requests for review and it may take several months before we look at your file.

    When we start our review, we will decide if you are a member of the “class” of people entitled to reopening included in the suit.

    1. If you are a member of the class entitled to a review of our earlier decision that you were not or no longer disabled, your local Social Security office will contact you when it is time for you to come in to submit additional evidence (if you have any). You should begin now to collect any evidence you may have that you feel will be pertinent to your review. BUT, PLEASE DO NOT SUBMIT THE EVIDENCE UNTIL WE CONTACT YOU.

    2. If you are not a member of the class entitled to reopening we will send you a notice telling you why and advising you of any further right you may have.

  3. If you have questions you may contact your local Social Security office. If you phone, please call 1-800-772-1213. If you visit a Social Security office, please bring this letter with you. It will help us answer your questions.

Exhibit 4 - Screening Sheet

 

STIEBERGER
SCREENING SHEET

IMPORTANT: A separate screening sheet must be prepared for each claim number and the applications screened must be identified. See IV below.

CLASS ACTION CODE: S T

1. CLAIMANT'S SSN:        -       -             

2. CLAIMANT'S NAME:                                     

(Please Print)  (Last)          (First)

3. DATE OF BIRTH:     /       /           

                           (MM/DD/YYYY)

4. CLAIM #:        -       -             -       

                                                                           (BIC/ID)

5. DATE OF SCREENING:     /       /           

                                   (MM/DD/YYYY)

6. SCREENING RESULT:

MEMBER:
REQUIRES

   REVIEW (J)

NON-MEMBER:
DOES NOT REQUIRE

   REVIEW (F)

SCREENOUT CODE

     
(see II. for codes)

I. CLASS MEMBERSHIP REOPENING ENTITLEMENT DETERMINATION

7.

Does the Stieberger alert package indicate that no claim for disability benefits was ever filed on the SSN provided?

  Yes   No
(If yes: Stop here! Check block 7 follow II below.)
(If no : Go to 8.)

8.

Does the Stieberger alert package indicate that the claimant was not a New York state resident at the time all claim(s) were finally decided?
  
NOTE: If the final decision on the claim(s) was based upon the res judicata effect being given to an earlier New York decision, do not screen out the Stieberger claim(s). The individual may still be eligible for Stieberger reopening.

  Yes   No
(If yes: Stop here! Check block 8 and follow II below.)
(If no: Go to 9.)

9.

Were all claims for disability benefits finally denied or ceased for some reason(s) other than medical or vocational reasons? The reason(s) was

             .

  Yes   N o
(If yes: Stop here! Check block 9 and follow II below.)
(If no: Go to 10.)

10.

Were the remaining claims for disability benefits finally denied/ceased, at any level, between October 1, 1981 and October 17, 1985, inclusive; or, between October 18, 1985 and July 2, 1992, inclusive, at the hearings or Appeals Council levels of review.

  Yes   No
(If yes: Go to 11.)
(If no: Stop here! Check block 10 and follow II below.)

11.

Did the claimant receive a subsequent decision review after October 17, 1985 under P.L. 98-460 that covered a prior cessation within the Stieberger period and was that decision review appealed to an ALJ?

  Yes   No
(If yes: Stop here! Check block 11 and follow II below.)
(If no: Go to 12.)

12.

Did the remaining claim(s) receive a non-New York final decision(s), at any time, that covered the entire time period covered by the Stieberger claim(s).

NOTE: If a subsequent non-New York claim that encompassed the Stieberger timeframe was denied based upon the res judicata effect being given to an earlier New York decision, do not screen out the Stieberger claim(s). The individual may still be eligible for Stieberger reopening.

  Yes   No
(If yes: Stop here! Check block 12 and follow II below.)
(If no: Go to 13.)

13.

Was the remaining claim(s) decided under any other New York class action order, e.g., State of New York, Dixon, or Hill; and, if so, did the decision cover the same period as the Stieberger claim(s)?

NOTE: The criteria for readjudications may be different for each class action. Therefore, if you screen out the Stieberger claim because the individual received a decision based upon a readjudication under another class action, you must be sure that the period of time covered by the readjudication in the other class action, both with respect to development and payment, is at least as broad as the development and payment periods in the potential Stieberger readjudication.

  Yes   No
(If yes: Stop here! Check block 14 and follow II below.)
(If no: Go to 15.)

14.

Did the remaining claim(s) receive a Federal court decision on the merits or did the claimant choose Federal court review instead of Stieberger review on the remaining claim(s) within the Stieberger period?

  Yes   No
(If yes: Stop here! Check block 15 and follow II below.)
(If no: Go to 16.)

15.

Did the remaining claim(s) receive a determination/decision, after July 2, 1992 that covered the same timeframe and issues covered in the Stieberger claim(s)?

  Yes   No
(If yes: Stop here! Check block 16 and follow II below.)
(If no: Follow III below.)

II.

Individuals Not Entitled To Reopening

If you checked block 07, 08, 09, 10, 11, 12, 13, 14, or 15, and if all claims within the Stieberger period have been screened out, the claimant is not entitled to reopening. Check “NON-MEMBER” (F) in item 6 on page 1, fill in the screen-out code (07, 08, 09, 10, 11, 12, 13, 14, 15 or 16). NOTE: In multiple claims situtations, fill in, at item 6, page 1, the screen-out code of the last claim screened.

III.

Class Members Entitled to Reopening

If you have no blocks checked, the claimant is a class member entitled to reopening. Check “MEMBER” (J) in item 6 on page 1.

IV.

On the lines below, please enter the date of the application(s) and final decision(s) considered in the screening process. Also indicate the administrative level at which the final decision was made (i.e., initial, recon, ALJ, AC). If claims are screened out when proceeding through the screening sheet, indicate the screenout code at which each claim is eliminated from Stieberger reopening.

 

Date of
Application(s)
Date of Decision(s)Level of Final
Decision
Screenout Code

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

               

 

 

BEFORE SIGNING, PLEASE BE SURE TO COMPLETE ITEM 4 on PAGE 1.

                                                             
Print name and phone number          Signature

Stieberger Screening Sheet Instructions

General Instructions: It is expected that most screening will be completed based on related queries (FACT, SSIRD, STALE, earnings query extract, OHA query extract, etc.) which are part of the alert package. If the folder is available, use the folder to complete the screening sheet. Since the answer to some of these questions is not readily apparent from queries only, if the claim file is not available, assume the claim is not screened out and go on to the next question. If a conclusive class membership determination cannot be made from the information available, the claimant should be screened in.

A SEPARATE screening sheet must be prepared for each claim number. Make sure the claim number, BIC/ID and SSN, are the same as on the STIEBERGER Case Flag Alert to ensure proper case clearance. Consider all Title II and Title XVI claims (denials/cessations) decided at any level of administrative review (initial, reconsideration or ODAR) during the period of October 1, 1981 and October 17, 1985, inclusive; or, at the ALJ or Appeals Council level between October 18, 1985 and July 2, 1992, inclusive.

Question 1:

Please fill in the claimant's SSN from BOAN/PAN field on alert.

Question 2:

Print the claimant's name (last name, and first name).

Question 3:

Fill in the claimant's date of birth (2-digit month, 2- digit day, 4-digit year).

Question 4:

Fill in the claim number(s) (social security number) under which this claim is being processed. Include the BIC (Title II)/ID (Title XVI).

Question 5:

Complete the screening date using 2-digit month, 2-digit day, and 4-digit year.

Question 6:

Complete this information last. Do not fill in until the screening process has been completed.

Question 7:

If the Stieberger alert package indicates that no claim for disability benefits was filed under the claim number given, obtain an MBR or SSR under the beneficiary's own social security number if it is different from the claim number given. If there is still no evidence that a disability claim was filed, check block 7 and follow II.

Question 8:

Screen for residency as of the date of the final determination(s)/decision(s), not date of application. If there is a SSIRD in file check for claimant's past address(es). If there is an OHA query extract in file check for hearing office code as follows: 5024, 5200, 5308, 5023, 5310, 5102, 5020, 5021, 5110, 5135. If there is only an MBR in package, check claimant's address. If the claimant was not a resident of New York at the time any claims were finally decided within the Stieberger period, those claims are not entitled to Stieberger reopening. Continue to screen any remaining claims in which the claimant was a resident of New York and go to question 9. NOTE: If a non-New York denial decision within the Stieberger timeframe was due to the res judicata effect being given to a New York decision, move on to question 9. If not check block 8 and follow II.

Question 9:

Review the query package and/or folder to determine if the claimant was denied for medical or vocational reasons as opposed to technical reasons (insured status, engaging in SGA, excess income and resources) on any claim. Look for basis denial codes for title II of: E1, E2, E3, E4, F1, F2, G1, G2, H1, H2, J1, J2, K1, K2, L1, L2, M5, M6. For Title XVI look for: N30, N31, N32, N34, N35, N36, N37, N39, N40, N41, N42, N43, N45, N46, N47, N48, N51. If claimant was denied for other than medical reasons, state the reason on the line provided. If any claims were finally denied for non-medical/vocational reasons within the Stieberger period, those claims are not entitled to Stieberger reopening. Check block 9 and follow II. Continue to screen any remaining claims in which there are medical/vocational determinations and go to question 10.

Question 10:

Review queries to determine dates of all disability applications denied/ceased. If claimant's application(s) for disability benefits were not denied/ceased between October 1, 1981 and October 17, 1985, inclusive, at any level of administrative review, or, between October 18, 1985 and July 2, 1992, inclusive, at the ALJ or Appeals Council levels of review, those claims are not entitled to Stieberger reopening. Check block 10 and follow II. Continue to screen any remaining claims which meet the date criteria and go to question 11.

Question 11:

If the post-October 17, 1985 determination by the NYDDS was a decision review under P.L. 98-460 of a prior cessation, the claimant is not entitled to Stieberger reopening on either the prior cessation determination or the decision review completed under P.L. 98-460. Check block 11 and follow II. Continue to screen any remaining claims in which the claimant did not receive a decision review or in which the claimant did receive a decision review and appealed it to an ALJ and go to question 12.

Question 12:

If the claimant received a final decision which was rendered by a non-New York jurisdiction on a claim(s) which covered the entire Stieberger period, claimant is not entitled to Stieberger reopening on this claim. Check block 12 and follow II. Continue to screen any remaining claims within the Stieberger period. NOTE: If the non-New York denial decision was due to the res judicata effect being given to a New York decision, move on to question 13.

Question 13:

If the claimant received a decision on a claim(s) under any other New York class action order which covered the entire Stieberger period, e.g., State of New York, Dixon or Hill, that reopened the claim, the claimant is not entitled to Stieberger reopening of this claim. Check block 13 and follow II. Obtain a DDSQ to determine if the claimant received a favorable decision under the above-referenced court cases. If claim was last decided at the ODAR level, you will have to contact the DPB of your Regional Office. They will obtain a CATS query to determine if the claimant has received a court decision. Continue to screen any remaining claims within the Stieberger period which were not covered by any other New York class action. NOTE: The criteria for readjudications may be different for each class action. For example, if the claimant received a decision under State of New York, but that decision provided only a limited redetermination of the claim, the claimant is eligible for review under Stieberger on that claim. However, if the relief under the other class action is as broad as what the claimant would receive under Stieberger, that claim is not eligible for Stieberger review.

Question 14:

Check the OHA query to determine court activity. If the claimant received a court decision on the merits that covered the entire period of the Stieberger claim, the claimant is not entitled Stieberger reopening of this claim. If the claim was last decided at ODAR level, you will have to contact the DPB of your Regional Office. They will obtain a CATS query to determine if claimant has received a court decision. In addition, any claim in which the claimant opted for court review instead of Stieberger reopening is not entitled further review on that claim. If either condition is satisfied, check block 14 and follow II. Continue to screen any remaining claims within the Stieberger period which were not covered by a court decision or option for court review.

NOTE: If the claimant's case was dismissed in court for a technical reason e.g., untimeliness, the claimant is eligible for Stieberger reopening on that claim.

Question 15:

Review the queries to determine if a subsequent claim was decided based on the earliest remaining claim(s) in the Stieberger period. An individual who has received a decision after July 2, 1992 on a later claim, which covered the entire timeframe and issues as in the Stieberger claim, has obtained all available relief under the Stieberger settlement.

If the claimant did not receive entitlement to all disability benefits that he/she would be entitled to under the Stieberger settlement, prepare an SSA-831-U3 annotated with “STIEBERGER reopening. This adopts the SSA-831 dated.” If necessary, forward to the FO for development of non-medical factors of entitlement.

If full payment has not been made on the post-July 2, 1992 claim, send the claim to a claims authorizer to pay any additional payment/benefit due.
If full payment has been made on the post-July 2, 1992 claim, check block 15 and follow II.

Return to screening sheet, sections II and III for screen in and screen out instructions.

Be sure to complete item IV. In multiple claims situations, when no claims remain that are eligible for Stieberger reopening, enter the screenout code in number 6 on page 1 of the final claim screened.

Exhibit 5 - Non-entitlement to Reopening

SOCIAL SECURITY ADMINISTRATION
Important Information

 

NameSTDate:
Address Claim Number:
City, State, ZipDOC: 

 

THIS NOTICE IS ABOUT YOUR SOCIAL SECURITY/SUPPLEMENTAL SECURITY INCOME BENEFITS.

PLEASE READ IT CAREFULLY!

  1. WE HAVE FOUND THAT YOU ARE NOT ENTITLED TO REOPENING UNDER STIEBERGER v. SULLIVAN.

    You asked us to review your case under the terms of the Stieberger court decision. We have looked at your case and decided that you are not a Stieberger class member entitled to reopening. This means that we will not review under the Stieberger class action our earlier decision to deny or cease your benefits. The reason you are not a class member entitled to reopening under the Stieberger court decision is checked below.

  2. WHY YOU ARE NOT A CLASS MEMBER ENTITLED TO REOPENING

    YOU ARE NOT A STIEBERGER CLASS MEMBER ENTITLED TO REOPENING BECAUSE:

1.

[  ]

You did not file a claim for disability benefits under the social security number provided.

2.

[  ]

You were not a New York state resident at the time your disability benefits were finally denied or ceased.

3.

[  ]

Your benefits were denied or ceased for some reason other than your medical condition. That reason was

                                                            .

4.

[  ]

Your benefits were not denied or ceased between October 1, 1981 and October 17, 1985, inclusive, at any administrative level; or, between October 18, 1985 and July 2, 1992, inclusive at the Administrative Law Judge or Appeals Council levels of review.

5.

[  ]

You received a decision review after October 17, 1985 under P.L. 98-460 that covered the same period as your Stieberger claim(s) and you did not appeal that decision to the hearing level.

6.

[  ]

You were found not disabled in a final decision by a non-New York adjudicator that covered the same period as your Stieberger claim(s).

7.

[  ]

You received a decision under another New York Court order such as the State of New York, Hill, or Dixon that covered the same period as your Stieberger claim(s).

8.

[  ]

You have received a Federal court decision(s) on the merits of your Stieberger claim or you opted for Federal district court review instead of Stieberger reopening.

9.

[  ]

You received a subsequent determination/decision after July 2, 1992 that covered the same timeframe and issues as your Stieberger claim.

10.

[  ]

Other

                                                       .

  1. WE ARE NOT DECIDING WHETHER YOU ARE DISABLED

    It is important for you to know that this notice is not a decision about whether you are or were disabled. We are deciding only that you are not a Stieberger class member entitled to reopening.

  2. WHAT YOU MAY DO IF YOU DISAGREE WITH THIS DETERMINATION

    You have 60 days from the date you receive this notice to send your written disagreement directly to:

    The Office of the General Counsel
    Social Security Administration
    Rm. 617 Altmeyer Bldg.
    6401 Security Blvd.
    Baltimore, MD 21235
    Attn: The Stieberger Case Coordinator

    We will assume that you received this notice 5 days after the date of the notice unless you show us otherwise.

    You may ask to see the record on which we decided you were not a class member entitled to reopening. If you do ask to see it, you will have 45 days after we tell you that it is available for inspection at a mutually agreed upon Social Security office. You may also ask for your attorney or other representative to look at the record.

    When your written disagreement is received, the Office of the General Counsel will look at your case again, notify you of the final determination and advise you of any further appeal rights you may have.

  3. IF YOU HAVE A LEGAL REPRESENTATIVE OR WOULD LIKE TO OBTAIN ONE

    If you have a legal representative, you should show this notice to that person.

    If you would like to obtain a legal representative, you may contact one of the attorneys representing the Stieberger class at the following address:

    The Legal Aid Society of New York
    Stieberger Implementation Project
    841 Broadway, 3rd Floor
    New York, NY 10003
    (212) 477-5010

    If you would like a referral to an attorney who will charge a fee for representation, you may contact the National Organization of Social Security Claimants' Representatives by calling (800) 431-2804.

  4. YOU CONTINUE TO HAVE THE RIGHT TO FILE A NEW APPLICATION FOR BENEFITS. FILING A NEW APPLICATION IS NOT THE SAME AS CHALLENGING OUR CLASS MEMBERSHIP DECISION, AND OBTAINING A NEW DECISION ON A PAST APPLICATION.

    Si usted habla espanol y no entiende esta carta, favor de llevarla a la oficina de Seguro Social arriba mencionada para que se la expliquen.

Exhibit 6 - Stieberger Folder Request

 

STIEBERGER Folder Request Memo

 

 

STIEBERGER FOLDER REQUEST MEMO

Date                 

TO:

ODIO Stieberger Folder Retrieval Unit
P.O. Box 17369
Baltimore, MD. 21298-0050

FROM:

DDS               

Code               

 

FO               

Code               

SUBJECT:

Responder Name

Responder SSN

Title II Claim No.(s)

                                    

               

Please obtain the Title II and XVI claim file/medical evidence for the following Stieberger application(s) and forward to this office.

Date of ApplicationDate of Denial/Termination

               

               

               

               

               

               

               

               

               

               

               

               

                                                       
Requestor's Name               Requestor's Telephone No.

Attachment: Copy of Stieberger Alert-Query Package

Exhibit 7 - Folder Retrieval Worksheet

 

COURT CASE FOLDER RETRIEVAL WORKSHEET

 

1. Court Case Name                

Listing Code                

2. SSN (BOAN/PAN)                        

Date Search Began                

    Claimant's Name                            

3. a.

SOURCE/QUERY

RESPONSE*

DATE

SOURCE/QUERY

RESPONSE*

DATE

 

SSR/STALE

                 

provided

OHAQ

                   

provided

 

AR-25

                 

provided

DDSQ

                   

               

 

ODIO OVERNIGHT

                 

provided

BDIQ

                   

               

 

FACT

                 

provided

SSI2 CCTL

                   

               

   b.

ODIO SPEC SEARCH***

                 

               

   

   c.

PSC SPEC SEARCH***

                 

               

   

 4. LIST OF CLAIMS SEARCHED

 
CAN (BIC)/HUN (ID)

APPL
DATE**

ALLEGED
ONSET**

       DECISION DATE**
DENIAL   TERM   ALLOW

 
RESULTS***

             
             
             
             
             
             
  *

Response should be YES/NIF (Not In File or No Record)/NA (Not Applicable).

 **

Show UNK if date cannot be determined.

***

Y = Medical evidence in folder; N = No medical evidence in folder or no folder located; D = Folder destroyed.

 

REMARKS:

5. All item 3. sources have been checked -- see reverse for documentation -- search ended.

     
     
Signature Position/Location Date

6. FOLDER SEARCH DOCUMENTATION

 

  1. Alert CAN/HUN Folders

     

SOURCE/
QUERY
CONTACT DATECONTACT LOCATION*PHONE/FAX #
OR ADM
MSG RI
CONTACT PERSON**SEARCH RESULTS
      
      
      
      
      
      
      
      
      
      
      

 

  1. Cross Reference Folders

     

SSN:   (1)               (2)               (3)            

SOURCE/
QUERY
CONTACT DATECONTACT LOCATION*PHONE/FAX #
OR ADM
MSG RI
CONTACT PERSON**SEARCH RESULTS
      
      
      
      
      
      
      
      

 

*Show (T) beside phone #, if telephone; show (F), if FAX.

** Y = Medical evidence in folder; N = No medical evidence in folder or no folder located; D = Folder destroyed.

Instructions for Completing the Folder Retrieval Worksheet

  1. When to Use

This worksheet will be prepared by the folder retrieval component to document search efforts to locate Stieberger claims.

  1. Procedure - Completion of Form

    1. Item 1

      Enter the court case name and listing code. The Listing Code for Stieberger is 750.

    2. Item 2

      Enter the number holder's name and social security number (SSN).

    3. Item 3a.

      Obtain a query for each source listed and complete as follows:

      • Response

        Enter Yes or NIF (Not in File) or NA (Not applicable)

      • Date

        Enter the date each query was obtained.

      NOTE: SSR/STALE and AR-25 queries will be provided with the CATS alert. However, if the SSI case control system shows NIF, an AR-25 will not be generated. NIF will be shown in the Folder Location Information field on the CATS alert instead.

      Item 3b-c.

      Enter the results of the ODIO or PSC special search. Enter the date the folder search began.

      NOTE: This item will be completed when a folder reads into ODIO or a PSC but cannot be located.

    4. Item 4

      Complete as follows based on queries or information in the folder. Show UNK if the information is not known.

      1. CAN (BIC)/HUN(ID)

        Enter the CAN/HUN for each claim searched.

      2. Application Date

        Enter the application date of each denial/termination adjudicated on or after within the appropriate time period. The period covered by the Stieberger settlement is on or after July 27, 1990 and before July 2, 1993.

      3. Denial/Termination/Allowance Date

        • Enter “Y” if the claim was found.

        • Enter “N” if the claim is not found.

        • Enter “D” if the folder was destroyed.

    5. Item 5

      After all item 3 sources have been checked and documented on the reverse side of the worksheet per B.6 below, sign and date the worksheet.

    6. Item 6

      Complete the development documentation as follows:

      1. Source Query

        Enter name of source query.

      2. Date

        Enter the date the location shown on the source query was checked.

      3. Location Contacted

        Show the name of the location contacted.

      4. Phone/FAX/Administrative Message Routing Indicator

        Enter the phone number of the location contacted.

        NOTE: Wilkes-Barre cannot be contacted by phone. Folder retrieval requests can be made by Automated Recall (AR33) for folders currently reading in L00, L86, L88, L89, L94, L95, or L96 or by Administrative Message if a special search is requested.

        The PSC in Suitland, MD also cannot be contacted by phone. All folder requests must be made through ODIO.

      5. Person Contacted

        Enter the name of the person contacted.

      6. Results

        Enter the results of the contact, i.e., UTL found, etc.

  2. Procedure - Disposition of Material

    1. Sign and date the worksheet.

    2. Place all material, including the folder retrieval worksheet and queries, in the STIEBERGER responder jacket.

Exhibit 8 - Attachment 1 ( Stieberger Settlement Teletype Instructions)

TELEGRAPHIC MESSAGE

Agency: HHS, SSA

Author: Gaye WallaceDate: July 2, 1992

Phone: (410) 965-1770

From: ODCP, Litigation Staff, Baltimore, MD

To: SSARC in Region II

To: All SSAARCSFOS/SSAARCSPGS in New York State

To: New York State DDS

To: SSAODCPLS (SAWNY)

To: SSAODARCO (SAWDY)

To: All SSAPSCS/PSCDRS in New York State

To: ODIO

To: All SSADOS/SSABOS/SSATSCS in New York State

To: SSAOOMPI

To: All SSAADS in New York State

To: All SSAROPIR/SSADQBS

To: All SSADPEQS/SSADPEQSOS

To: All SSAOPIRS

To: SSAODARRO in Region II

To: All ODARHOS in New York State

To: SSAOD

To: SSADCO

To: COS

To: Chief Counsel, Region II (SSARO - Deliver)

 

IT-92-11

Emergency DI/SSI InstructionsOD-92-071 (2782)

 

Published Instructions Will Follow Shortly

 

SUBJECT: Stieberger v. Sullivan Class Action Lawsuit Settlement Agreement - Adjudication Instructions - ACTION

INTRODUCTION

On June 18, 1992, Judge Sand, of the Southern District of New York, signed the Stieberger v. Sullivan class action lawsuit settlement agreement. In accordance with the provisions of the settlement agreement, all state and federal adjudicators must comply with Second Circuit holding in adjudicating or reviewing claims of New York State residents for disability benefits, as set forth below. POMS and HALLEX instructions related to the 1985 Stieberger preliminary injunction (including POMS DI 12586.001 - DI 12586.095) (Transmittal No. 1, SSA Pub. No. 68-0432500, April 1986), DI 42586.001 - DI 42586.015 (Transmittal No. 1, SSA Pub. No. 68-0442500, April 1986, and HALLEX I-5-413, I-5-413A, I-5-413B) are hereby rescinded. Also rescinded are any instructions that could in any way be interpreted as calling for nonacquiescence in holdings of the Second Circuit in disability cases. (SSA does not believe such instructions exist; this direction is simply precautionary).

The following instruction is taken verbatim from Attachment 1 of the Stieberger settlement agreement, and will be published for placement in the “Manual of Second Circuit Disability Decisions”, which is discussed below, within the next 3 months. In the meantime, however, please use this teletyped instruction on how to apply Second Circuit holdings in adjudicating or reviewing claims of New York State residents. Please distribute a copy of this teletype to all decisionmakers and reviewers of decisions as soon as possible.

SSA realizes that adjudicators and reviewers will have questions about this. Please send them to the Office of General Counsel, Correspondence Control Staff, Altmeyer Room 617, 6401 Security Blvd., Baltimore, MD 21235, Attn: Class Action Coordinator via the New York Regional Office. ODAR personnel should route any questions through the usual channels.

 

APPLICATION OF SECOND CIRCUIT DECISIONS TO SOCIAL SECURITY ACT DISABILITY BENEFIT CLAIMS OF NEW YORK RESIDENTS

  1. General Rule

    Effective immediately, all persons who decide Social Security Act disability benefit claims of New York State residents or who review such decisions shall follow and apply the holdings of the United States Court of Appeals for the Second Circuit, except when written instructions to the contrary are issued pursuant to paragraphs D and E. This instruction applies to all Second Circuit disability decisions except those that are expressly designated not for publication.

  2. How to Apply Holdings

    Holdings of the Second Circuit Court of Appeals must be applied at all levels of administrative review to all claims for title II and title XVI disability benefits filed by New York State residents, unless written instructions to the contrary are issued pursuant to paragraphs D and E. You must apply those holdings in good faith and to the best of your ability and understanding whether or not you view them as correct or sound.

    In general, a holding in a decision is a legal principle that is the basis of the court's decision on any issue in the case. There may be more than one holding in a decision. A holding must be applied whenever the legal principle is relevant.

    Not all of the discussion in a decision is a holding. For example, the factual discussion in a decision is not a holding although it can help you understand the holding by placing it in context. Also, in their decisions courts may make observations or other remarks that are helpful in understanding the court's reasoning. You are required to apply the holdings, not those observations or other comments of the court.

    Of course, you should continue to make sure that the decision whether a claimant is disabled is an individualized decision based on the evidence regarding that claimant.

  3. Availability of Decisions and Instructions

    To help ensure that decisionmakers and reviewers of decisions apply Second Circuit holdings, SSA will do the following:

    1. SSA will provide each office of decisionmakers and reviewers of decisions with a copy of the settlement approved by the Court in Stieberger v. Sullivan.

    2. SSA will provide all decisionmakers and reviewers of decisions with a Manual of Second Circuit disability decisions (“Manual”) containing excerpts of the principal holdings of the Second Circuit issued before June 18, 1992, the date that the settlement in Stieberger was approved by the Court.

    3. SSA will provide each office of decisionmakers and reviewers of decisions with a copy of each Second Circuit disability decision issued after June 17, 1992 promptly after the decision is issued by the Court. Each such office shall maintain a volume containing copies of these decisions. This volume shall be readily accessible to decisionmakers and reviewers of decisions.

    4. SSA will issue instructions to ODD decisionmakers and reviewers of decisions about applying Second Circuit decisions rendered after June 17, 1992. These instructions must be added to the Manual as supplements. SSA may issue instructions to ODAR adjudicators.

      You should familiarize yourself with the Manual, with SSA's instructions on Second Circuit holdings, and with Second Circuit decisions as they are issued.

      While SSA will take the steps described above to help you apply Second Circuit holdings, you must apply the holdings even in the absence of an instruction, and even if they are not included in the Manual.

      EXAMPLE: You have become aware of a Second Circuit disability decision (for example, a claimant draws it to your attention or you receive notification of it from SSA), but you have not yet received the instruction from SSA on how to apply the decision and it is not in the Manual. You must apply the holding[s] of that decision to all claims where it is relevant.

  4. Instructions Regarding When Decisions Become Effective

    1. You must apply the holdings in a decision once the decision becomes effective. A decision of the Second Circuit generally becomes effective 201 days after the decision is issued by the Court, unless a specific written instruction is issued that requires the decision to be applied earlier or later. If you have not received instructions about a particular Second Circuit decision issued after the date of this instruction, consult with your supervisor for further guidance about whether the decision has become effective. (If you are an administrative law judge, you may inquire with the Regional Office concerning the status of the decision.)

      1After the Stieberger settlement was approved, court rules increased the time for issuing mandates to 52 days.

    2. As long as a Second Circuit decision is pending further court review, SSA may instruct decisionmakers and reviewers of decisions not to apply some or all holdings stated in that Second Circuit decision. In such instances SSA will issue specific instructions explaining which holdings are not to be applied and identifying the issues addressed by those holdings. When such instructions are issued, decisionmaking and reviewing offices will maintain a list of disability claims decisions that may be affected because the Second Circuit holding is not being applied. Any notice sent to claimants on the list, denying benefits in whole or in part, will include the following language:

      If you do not agree with this decision, you can appeal. You must ask for an appeal within 60 days.

      You should know that we decided your claim without applying all of what the court said about the law in       .        is a recent court ruling that we do not consider final because it may be reviewed further by the courts. If it becomes final, we may contact you again.

      If you disagree with our decision in your case, do not wait for us to contact you. You should appeal within 60 days of the date you receive this notice. If you do not appeal within 60 days, you may lose benefits.

    3. When no further judicial review of a Second Circuit decision will occur, SSA will promptly rescind any instructions issued under this paragraph D, and will advise decisionmakers and reviewers of decisions about the final decision in the case. SSA will also explain what action is to be taken, including any reopenings, with respect to claimants whose cases may have been affected by the instruction not to apply the Second Circuit decision pending further court review.

  5. Issuance and Rescission of Acquiescence Rulings

    This instruction on application of Second Circuit decisions to disability benefit claims does not prevent SSA from issuing or rescinding acquiescence rulings, or relitigating issues under 20 C.F.R. 404.985 and 416.1485.

  6. Questions Concerning this Instruction and Second Circuit Decisions

    This instruction is issued pursuant to the settlement agreement in Stieberger v. Sullivan, 84 Civ. 1302 (S.D.N.Y.). A copy of the complete agreement is available in your office. Any questions about applying Second Circuit decisions that you cannot resolve yourself may be directed to your supervisors and, if more guidance is needed, through supervisory channels to the Office of General Counsel, Correspondence Control Staff, Altmeyer Room 617, 6401 Security Blvd., Baltimore, MD 21235, Attn: Class Action Coordinator. In addition, a team of SSA personnel will visit the New York ODD one month after you receive this instruction and quarterly thereafter for 3 years to discuss any questions decisionmakers and reviewers of decisions have about applying Second Circuit disability decisions.

  7. Binding Effect of This Instruction

    This instruction is binding on all personnel, including state employees, ALJ's Appeals Council Administrative Appeals Judges, quality assurance staff, and all other personnel who process, render decisions on, or review claims of New York residents for disability benefits under the Social Security Act.

    Because this instruction arises out of a lawsuit, it does not apply to claims of any persons who do not reside in the State of New York. However, this limitation does not lessen the extent to which court decisions are to be applied to claims of persons who reside in any other state. This limitation also should not be deemed to suggest that such decisions are not given or should not be given proper consideration in any other state.

     

 

                        

 

Jean H. Hinckley,
Director,
ODCP Litigation Staff

 

File Code: HA-4-7

 

Published instructions are targeted to reach users by October 2, 1992.

Exhibit 9 - DEVELOPMENT/PAYMENT PERIOD Worksheet

 

STIEBERGER DEVELOPMENT/PAYMENT PERIOD WORKSHEET
SUMMARY SHEET --- KEEP ON TOP!

 

CLAIMANT'S SSN:            -         -               

PERSON WHO COMPLETED THIS WORKSHEET:

                             ,   ;                ;  (        )           -                 
Surname and initial        Office code          Telephone

============================================================== = =====

FIRST MONTH OF DEVELOPMENT PERIOD:        /       

============================================================== = =====

TITLE II PAYMENT: BIC:       

POTENTIAL ADMINISTRATIVE ONSET:           /01/        [  ] Cessation Case

                                                                  See DI 32586.020

POTENTIAL MOET:                           /        

[  ]

DDS could establish onset as early as        /        /         if 10(e)(5) exception is met.

[  ]

If disability is established, benefits terminate        /        ; if claimant is found currently disabled, re-entitle to benefits effective        / 0 1 /        .

[  ]

Prisoner suspension period (s):        /        -        /        

                                      /       -        /        

[  ]

Payment is intermittent - see worksheet.

[  ]

Consider TWP provisions if there was work after 11/91.

[  ]

DDS Established actual onset        /        /         -LATER than administrative onset.

[  ]

DDS Established actual onset        /        /         -EARLIER than administrative onset. Pay benefits only from the “Potential MOET”, and only if insured status is met at the established onset date.

TITLE XVI PAYMENT:

POTENTIAL ONSET AND ENTITLEMENT:        / 01 /        (“administrative

                                                           onset”)

DDS could establish onset as early as        /        /         if 10(e)(5) exception is met.

[  ]

Payment is intermittent - see worksheet.

[  ]

DDS Established actual onset        /        /         -LATER than administrative onset.

[  ]

DDS Established actual onset        /        /         -EARLIER than administrative onset. Pay benefits only from the “Potential MOET”.

STIEBERGER DEVELOPMENT/PAYMENT PERIOD WORKSHEET

PART I: GATHER INFORMATION - DEVELOPMENT PERIOD

A.

1. Month request for review rec'd (from alert):
2. Month of class member's death:
3. Enter the earlier of A.1 and A.2

      /        

      /        

      /        

B.

  1. Filing date of the earliest Title II denial covered by Stieberger:

      /        

 
  1. Alleged onset date in that denial:

      /         /        

 
  1. If a DWB or surviving child claim, NH's date of death:

      /        

 
  1. If a CDB claim, month CDB attains age 22:

      /        

 
  1. If a DWB claim, month DWB attains age 50:

      /        

 
  1. If a DWB claim, last month of prescribed period; if a CDB reentitlement claim, last month of the reentitlement period:

      /        

C.

Filing date of the earliest Title XVI denial covered by Stieberger:

      /        

D.

If Stieberger determination was a cessation, month of Title II or XVI termination:

      /        

E.

Periods of entitlement to unreduced “A” , “HA”, DWB or CDB benefits before the month shown in A.3

 

began:       /        

ended:       /        

 

began:       /        

ended:       /        

F.

Periods of entitlement to Title XVI benefits before the month shown in A.3

 

began:       /       

ended:       /        

 

began:       /        

ended:       /        

G.

Is there a current claim pending which, if approved, would be retroactive to a month before the month shown in A.1?

Y / N

 

If so, period of potential entitlement based on the current claim:

begins:       /        

ends:       /        

H.

Was there ever a final medical denial issued when (s)he did not reside in NY State?

Y / N

 

Period covered by denial:

AOD:       /        

Date of decision:        /       

J.

Using SEQY postings show:
Yrs pre-1990 with earnings over $3600/stat. blind (do not use year of onset - B2)

1 9          1 9       
1 9          1 9       

 

Yrs after 1989 with earnings over $6000/stat blind (do not use year of onset - B2)

1 9          1 9       
1 9          1 9       

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

PART II: DETERMINE THE DEVELOPMENT PERIOD

 

USE THE CHART ON THE NEXT PAGE TO COMPUTE THE DEVELOPMENT PERIOD

For the following calculations, use the results of Part I.

1.

“X” out any month later than the month shown in A.3.

 

2.

Find the earlier of the months shown in B.2., C OR D. “X” out any months before this month.

3.

“X” out any months in the periods shown in E, F, G, or H

4.

“X” out ALL months in any year shown in J.

 

5.

Find the most recent 48 months that were not been “X'ed” out. If there are fewer than 48 such months, use all the boxes that were not “X'ed”. Counting back with the month shown in A.3, place a “D” in the 48th month not “X'ed” out. Enter that month here:

   

     /     

6.

If the month in 5. above is later than the month shown in B.4 or B.6, enter the month shown in B.4 or B.6.

   

      /        

7.

The first month of the DEVELOPMENT PERIOD is the earlier of the month in 5. or 6. above. Show that month at the top of the Summary Sheet.

   

      /        

 

Stieberger DEVELOPMENT PERIOD Chart:

 

 J
a
n
F
e
b
M
a
r
A
p
r
M
a
y
J
u
n
J
u
l
A
u
g
S
e
p
O
c
t
N
o
v
D
e
c
1996            
1995            
1994            
1993            
1992            
1991            
1990            
1989            
1988            
1987            
1986            
1985            
1984            
1983            
1982            
1981            
1980            
1979            

PART III: GATHER INFORMATION - PAYMENT PERIOD(S)

Before you compute PAYMENT PERIODS, you will have to show additional information (from your interview with the class member, if necessary):

  1. Periods of entitlement to “A” (reduced or unreduced), “HA” , DWB or CDB benefits:

    • began:       /           ended:        /        

      began:       /           ended:        /        

  2. Periods the class member was confined due to felony-related conviction:

    • began:       /           ended:        /        

      began:       /           ended:        /        

  3. Periods the class member absent from the U.S., or institutionalized (N02) (SI 00501.400; 00520.001):

    • began:       /           ended:        /        

      began:       /           ended:        /        

PART IV: COMPUTE THE TITLE II PAYMENT PERIOD

 

USE THE CHART ON THE NEXT PAGE TO COMPUTE THE TITLE II PAYMENT PERIOD

 

1.

Determine the MOET based on the earliest Stieberger claim. If the claimant had no previous Title II entitlement, you can use the following procedure; otherwise, use regular Title II rules for the result of this step.

 

If the Stieberger determination is a cessation, show the month of termination, as shown in D above:

   

      /         

 

If it was an initial claim for HA, HC, or DWB benefits, subtract 12 months from the month shown in B.1. If it was a claim for C benefits (RSI), subtract 6 months from the month shown in B.1:

   

      /         

 

If it was a claim for HA or DWB benefits, add 5 full calendar months to the date shown in B.2. If it was a claim for C or HC benefits, show the month shown in B.2 (or the following month, if the AOD in B.2 is not the first day of the month):

   

      /         

 

If it was a claim for DWB or surviving child benefits, show the date of death of the number holder as shown in B.3:

   

      /         

 

If it was a claim for DWB benefits, show the date the DWB attained age 50 as shown in B.3:

   

      /         

Circle the latest date.

2.

Using the chart on THIS page, “X” out any month before the month you circled in step 1 above.

3.

Put a “T” in the box for any month in the period shown in H.

4.

“X” out any months in periods shown in G, K or L.

5.

Count the LATEST 48 months that have not been marked. Mark these boxes with an “E”.

 

The FIRST “E” month is the potential month of entitlement (MOET):

   

      /         

6.

The Potential MOET is also the potential administrative onset for cessations, all SSI claims , and CDB claims. For initial claims for HA or DWB benefits subtract 5 months from the MOET. This will be the potential estabiished onset date:

   

      /0 1/         .

 

(note: The DDS may make the onset as early as the AOD [or termination date in cessations], if the 10(e)(5) conditions are met).

7.

If any “T” months are shown, benefits AND THE PERIOD OF DISABILITY will TERMINATE with the first “T” month. Benefits and the period of disability will resume with the first non-“T” month if the claimant is found to be currently disabled.

 

Potential benefits would terminate:

   

      /         

 

Potential resumption of benefits:

   

      /         

 

Stieberger PAYMENT PERIOD CHART Title II

 

 J
a
n
F
e
b
M
a
r
A
p
r
M
a
y
J
u
n
J
u
l
A
u
g
S
e
p
O
c
t
N
o
v
D
e
c
1991           ///
1990            
1989            
1988            
1987            
1986            
1985            
1984            
1983            
1982            
1981            
1980            
1979            

PART V: COMPUTE THE TITLE XVI PAYMENT PERIOD

 

USE THE CHART ON THIS PAGE TO COMPUTE THE TITLE XVI PAYMENT PERIOD

 

Stieberger PAYMENT PERIOD CHART Title XVI

 

 J
a
n
F
e
b
M
a
r
A
p
r
M
a
y
J
u
n
J
u
l
A
u
g
S
e
p
O
c
t
N
o
v
D
e
c
1991           ///
1990            
1989            
1988            
1987            
1986            
1985            
1984            
1983            
1982            
1981            
1980            
1979            
  1. “X” out any month before the month shown in C.

  2. “X” out any month in the periods shown in F, G, H, K, or M.

  3. Count the LATEST 48 months that have not been marked. Mark these boxes with an “E”.

    The FIRST “E” month is the potential established onset date:

 

      /0 1/        

(NOTE: The DDS may make the onset as early as the AOD, if the 10(e)(5) conditions are met).

  1. Payment may be made for all “E” months, subject to the regular rules of eligibility and applying the Stieberger tolerances in DI 12586.080. As of Jan. 1st of the year prior to the year in which the favorable SSA-831 was signed, regular development rules apply.

Exhibit 10 - 48-Month Chart

48 MONTH TABLE
  
12/93 - 01/9012/91 - 01/88
11/93 - 12/8911/91 - 12/87
10/93 - 11/8910/91 - 11/87
09/93 - 10/8909/91 - 10/87
08/93 - 09/898/91 - 09/87
07/93 - 08/8907/91 - 08/87
06/93 - 07/8906/91 - 07/87
05/93 - 06/8905/91 - 06/87
04/93 - 05/8904/91 - 05/87
03/93 - 04/8903/91 - 04/87
02/93 - 03/8902/91 - 03/87
01/93 - 02/8901/91 - 02/87
12/92 - 01/8912/90 - 01/87
11/92 - 12/8811/90 - 12/86
10/92 - 11/8810/90 - 11/86
09/92 - 10/8809/90 - 10/86
08/92 - 09/8808/90 - 09/86
07/92 - 08/8807/90 - 08/86
06/92 - 07/8806/90 - 07/86
05/92 - 06/8805/90 - 06/86
04/92 - 05/8804/90 - 05/86
03/92 - 04/8803/90 - 04/86
02/92 - 03/8802/90 - 03/86
01/92 - 02/8801/90 - 02/86
12/89 - 01/8612/87 - 01/84
11/89 - 12/8511/87 - 12/83
10/89 - 11/8510/87 - 11/83
09/89 - 10/8509/87 - 10/83
08/89 - 09/8508/87 - 09/83
07/89 - 08/8507/87 - 08/83
06/89 - 07/8506/87 - 07/83
05/89 - 06/8505/87 - 06/83
04/89 - 05/8504/87 - 05/83
03/89 - 04/8503/87 - 04/83
02/89 - 03/8502/87 - 03/83
01/89 - 02/8501/87 - 02/83
12/88 - 01/8512/86 - 01/82
11/88 - 12/8411/86 - 12/82
10/88 - 11/8410/86 - 11/82
09/88 - 10/8409/86 - 10/82
08/88 - 09/8408/86 - 09/82
07/88 - 08/8407/86 - 08/82
06/88 - 07/8406/86 - 07/82
  
05/88 - 06/8405/86 - 06/82
04/88 - 05/8404/86 - 05/82
03/88 - 04/8403/86 - 04/82
02/88 - 03/8402/86 - 03/82
01/88 - 02/8401/86 - 02/82
12/89 - 01/8612/87 - 01/84
11/89 - 12/8511/87 - 12/83
10/89 - 11/8510/87 - 11/83
09/89 - 10/8509/87 - 10/83
08/89 - 09/8508/87 - 09/83
07/89 - 08/8507/87 - 08/83
06/89 - 07/8506/87 - 07/83
05/89 - 06/8505/87 - 06/83
04/89 - 05/8504/87 - 05/83
03/89 - 04/8503/87 - 04/83
02/89 - 03/8502/87 - 03/83
01/89 - 02/8501/87 - 02/83
12/88 - 01/8512/86 - 01/83
11/88 - 12/8411/86 - 12/82
10/88 - 11/8410/86 - 11/82
09/88 - 10/8409/86 - 10/82
08/88 - 09/8408/86 - 09/82
07/88 - 08/8407/86 - 08/82
06/88 - 07/8406/86 - 07/82
05/88 - 06/8405/86 - 06/82
04/88 - 05/8404/86 - 05/82
03/88 - 04/8403/86 - 04/82
02/88 - 03/8402/86 - 03/82
01/88 - 02/8401/86 - 02/82
12/85 - 01/8212/83 - 01/80
11/85 - 12/8111/83 - 12/79
10/85 - 11/8110/83 - 11/79
09/85 - 10/8108/83 - 09/79
08/85 - 09/8108/83 - 09/79
07/85 - 08/8107/83 - 08/79
06/85 - 07/8106/83 - 07/79
05/85 - 06/8105/83 - 06/79
04/85 - 05/8104/83 - 05/79
03/85 - 04/8103/83 - 04/79
02/85 - 03/8102/83 - 03/79
01/85 - 02/8101/83 - 02/79
12/84 - 01/8112/82 - 01/79
11/84 - 12/8011/82 - 12/78
10/84 - 11/8010/82 - 11/78
09/84 - 10/8009/82 - 10/78
08/84 - 09/8008/82 - 09/78
07/84 - 08/8007/82 - 08/78
06/84 - 07/8006/82 - 07/78
05/84 - 06/8005/82 - 06/78
04/84 - 05/8004/82 - 05/78
03/84 - 04/8003/82 - 04/78
02/84 - 03/8002/82 - 03/78
01/84 - 02/8001/82 - 02/78
12/81 - 01/7812/79 - 01/77
11/81 - 12/7811/79 - 12/76
10/81 - 11/7810/79 - 11/76
09/81 - 10/7809/79 - 08/76
08/81 - 09/7808/79 - 09/76
07/81 - 08/7808/79 - 09/76
06/81 - 07/7806/79 - 07/76
05/81 - 06/7805/79 - 06/76
04/81 - 05/7804/79 - 05/76
03/81 - 04/7803/79 - 04/76
02/81 - 03/7802/79 - 03/76
01/81 - 02/7801/79 - 02/76
12/80 - 01/7812/78 - 01/76
11/80 - 12/7711/78 - 12/75
10/80 - 11/7710/78 - 11/75
09/80 - 10/7709/78 - 10/75
08/80 - 09/7708/78 - 09/75
07/80 - 08/7707/78 - 08/75
06/80 - 07/7706/78 - 07/75
05/80 - 06/7705/78 - 06/75
04/80 - 05/7704/78 - 05/75
03/80 - 04/7703/78 - 04/75
02/80 - 03/7702/78 - 03/75
01/80 - 02/7701/78 - 02/75

Exhibit 11 - Stieberger Supplement

 

STIEBERGER SUPPLEMENT
To be completed in all Stieberger Case Reviews

 

Name                         

Social Security Number            /         /                 

PART I: (For Social Security Administration Completion)

  1. Earliest Date Covered by a Stieberger Denial/Termination (AOD for Title II, Date of Filing for Title XVI:        /        /       

  2. Earliest Date Covered by the SSA-3368:        /        /        

PART II: Information about your disability.

  1. 1. Have any conditions you mentioned on the Disability Report (SSA-3368) changed since the date in A. above?

                   Y    N

    2. If there was any change in your condition, did it get

                    Worse    Better

    3. Describe when and how your condition was worse or better

                                                 

                                                 

                                                 

                                                 

  2. 1. Have you had any conditions, during the period between the dates in Part I A. & B above, that you did not describe on the Disability Report (SSA-3368)?

               Y    N

  • 2. If yes, describe the other conditions and when they bothered you

  • 3. If the other condition(s) that you described in D.2 made you feel worse during the period between the dates in Part I A & B above, describe how and when.

  1. 1. Did you receive treatment for any condition, from a medical source (doctor, hospital, clinic, etc.) that is not already listed on the Disability Report (SSA-3368)?

               Y    N

  • If yes, show the names and addresses of the source, the dates of treatment and the condition you were treated for.

PART III: PAYMENT PERIOD Questions

  1. 1. Since the date in A. above, have you been incarcerated due to conviction on a felony or felony-level offense?

               Y    N

  • 2. If yes, show the dates and place(s) of confinement below.

  1. 1. Were there any months since the date in A. above that you resided in a public institution?

               Y    N

  • 2. If yes, show the name of the institution and the dates of residence

  1. 1. Were there any times since the date in A. above that you were outside the United States throughout a calendar month or for 30 days or more? (Outside the United States means outside the 50 states, American Samoa and/or the Northern Mariana Islands)?

               Y    N

  • 2. If yes, for each period of absence, show the date you left and the date on which you returned.

PART IV: Protective Filing

  1. If you wish to protect the rights of your spouse and/or children to any benefits to which they may be entitled on your record as a result of the Stieberger review, show their name(s) and date(s) of birth below.

Signature                            Date                      

Exhibit 12 - Request For Court Case Review/Change of Address Worksheet

 

REQUEST FOR COURT CASE REVIEW/CHANGE OF ADDRESS WORKSHEET
 1.COURT CASE NAME:                         
 2.COURT CASE IDENTIFIER:     
   

  3.  CHECK ONE:  [ ]  REQUEST FOR REVIEW    [ ]  CHANGE OF ADDRESS

 4.DATE OF CONTACT:       -       -              
 5.CLAIMANT'S OWN SSN          -       -              
   
 6.CLAIMANT'S DATE OF BIRTH:       -       -              
 7.CLAIMANT'S FIRST NAME:                                      
 CLAIMANT'S MIDDLE
INITIAL
:  
 CLAIMANT'S LAST NAME:                                          
  8.STREET ADDRESS:
   
   
 CITY:                                             
 STATE:       
 ZIP:                         
 9.PHONE #:(                   -             
10.NAME OF PAYEE:                                             
11.NAME OF ATTY/REP:                                          
   
  1. CLAIM/SSN NUMBERS (LIST ALL KNOWN CLAIM/SSN NUMBERS)

TII (CLAIM NO. & BIC)VERIFYTXVI (SSN. & ID)VERIFY
    

     -   -    -  

     -   -    -  

     -   -    -  

       

       

       

   -    -     -   

    -    -     -   

    -    -     -   

    

    

    

13.                                       
SIGNATURE (If claimant/payee appears in person, please obtain signature).

  1. For SSA Use Only

PREPARED BY:              OFFICE CODE             

 

PREPARERS TELEPHONE NO:              (INCLUDE AREA CODE)

Instructions For Completion of the Request For Court Case Review/Change of Address Worksheet

Item 1.

Print the name of the court case claimant/payee/representative is inquiring about (i.e., “Stieberger”).

Item 2.

This worksheet can be used to implement all class action court cases. The court case identifier for “Stieberger” is ST.

Item 3.

If a claimant/payee/representative is requesting review (e.g., walk-in) under the “Stieberger” Court Order, check the first block. If the claimant/payee/representative has previously requested review under “Stieberger” and is informing SSA of a new address, check the second block. If the claimant/payee/representative is requesting review and notifying SSA of a new address simultaneously, check both blocks.

Item 4.

Provide date of contact (mm/dd/yyyy).

Item 5.

Provide claimant's own social security number.

Item 6.

Provide claimant's date of birth (mm/dd/yyyy).

Item 7.

Print claimant's complete first name, middle initial, if appropriate, and complete last name, allowing one letter for each underscore provided on the worksheet.

Item 8.

Print the street address, city, state abbreviation, and zip code of the claimant or claimant's payee/representative, as appropriate, allowing one letter for each underscore provided on the worksheet.

Item 9.

Provide the telephone number, including area code, of the claimant/payee/representative, as appropriate.

Item 10.

Print the complete first name, middle initial, and last name of the payee, not to exceed 19 characters, if appropriate. If the complete name exceeds 19 characters, shorten the first name to ensure that the complete last name is provided. Leave a space after the first name and after the middle initial.

Item 11.

Print the complete first name, middle initial, if appropriate, and complete last name of the attorney/representative, if claimant has representation.

Items 12.

Complete only if claimant/payee/representative is requesting court case review. It is not necessary to complete the claims information when only reporting a change of address. This information is required to establish a “walk-in” record on the Civil Action Tracking System (CATS). If not complete, the form will be returned for completion.

Provide all claim numbers, including BIC and/or ID, under which the claimant filed for benefits. Use the back of the sheet, if necessary. This is needed to ensure that all appropriate claims are reviewed under the class action. Attempt to verify the claim numbers via MBR and/or SSR. If there is no record on the MBR/SSR, verify the SSN on the Numident. Be sure to write “YES” in the space provided in the “VERIFY” column on the worksheet indicating that the account numbers were verified.

Item 13.

Obtain the signature of the claimant/payee/representative only if he/she appears in person.

Item 14.

Print the name, office code, and telephone number, including area code, of the SSA employee completing this form.

MAIL THE COMPLETED WORKSHEET TO THE FOLLOWING ADDRESS:

  • SSA, Office of Disability and International Operations
    Class Action Section
    Attn: STIEBERGER Coordinator
    P. O. Box 17369
    Baltimore, MD 21298-0050

Exhibit 13 - Corroboration Checklist

 

CORROBORATION OF STIEBERGER 10(e)(5)(i)-(ii) CONDITIONS WORKSHEET

This 3-page worksheet must be completed, signed and placed in the Stieberger green jacket file, if the DDS determines that the claimant was not disabled for all or part of the basic Stieberger “DEVELOPMENT PERIOD,” which ordinarily begins 48 months prior to SSA's receipt of claimant's request for readjudication.

*************************************************************** *****************

DECISION

If readjudicating a:

  • DENIAL -- Consider factors under CORROBORATION PROCESS below and check 1. or 2, as appropriate.

1.

   

EARLIER DEVELOPMENT/ADJUDICATION REQUIRED.

2.

   

EARLIER DEVELOPMENT/ADJUDICATION NOT REQUIRED.

  • CESSATION--Claimant deemed to qualify, so check 3.

3.

   

EARLIER DEVELOPMENT/ADJUDICATION REQUIRED.

 

                    ,

               ,

   /   /   

SIGNATURE

TITLE

DATE

*************************************************************** *****************

CORROBORATION PROCESS

Below is an overview of the factors to consider in deciding whether one of the following conditions requires DDS to develop/adjudicate an earlier period when readjudicating a denial:

  • Claimant had a chronic impairment that s/he alleged was more severe in the past (e.g., rheumatoid arthritis in major joints that is not currently active), and more information is needed about any earlier acute phase; OR

  • claimant had a new or no treating source during the DEVELOPMENT PERIOD and it is learned that other evidence may be available (e.g., from a former treating source) that may attest to more serious impairment in the past.

============================================================== =

IN APPLYING THE FACTORS BELOW, ALWAYS GIVE THE BENEFIT OF ANY UNCERTAINTY TO THE CLAIMANT.

============================================================== =

  1. COMPARISON DATE:

Enter here the earliest date covered by the DEVELOPMENT PERIOD:

 

    /    /     .

 

  1. 10(e)(5)(i) CHRONIC IMPAIRMENT:

    1. Did claimant allege that a condition(s) present during the DEVELOPMENT PERIOD was a chronic impairment that was more severe before the above date? If yes, or there is reason to disregard a negative response, e.g., claimant confused, disoriented, poor historian, or, if the file shows a mental condition that would make the negative response questionable: Continue. If no: Go to

    2. Does the green jacket file refer to a chronic impairment that started, or could have, before the above date and that could have been worse in the past? If yes: Continue. If no: Go to C.

      CONSIDER FACTORS SUCH AS: Is the CI (physical or mental) one that is subject to exacerbations and remissions and might have been more severe in the past? Did the claimant allege, or does the green jacket file show, a past acute phase before the above date that made him/her more severely impaired in the past, e.g., period preceding and/or following open heart surgery, or following some kind of trauma?

    3. Did claimant submit corroboration form a medical source, e.g., a letter from a doctor, that his/her condition(s) was worse in the past and might possibly have been disabling? If yes: EARLIER DEVELOPMENT AND ADJUDICATION REQUIRED. If No: Continue.

      NOTE: Assume that a corroborated past condition might possibly have been disabling unless the corroborating evidence clearly indicates that it could not have been disabling, e.g., it clearly establishes that the condition lasted for too short a period to meet the duration requirement, e.g., severe only a few days or weeks. Resolve uncertainty in the claimant's favor.

    4. If the claimant did not submit corroboration, does the green jacket file show that the condition was worse prior to the above date and might possibly have been disabling? (See NOTE in B.3 above.) If yes: Continue. If no: Go to C.

    5. Is more information needed about any earlier acute phase (e.g., rheumatoid arthritis in major joint that became inactive, or previously uncontrolled epilepsy or diabetes that later was under control)? If yes: Continue. If no: If there is enough information for a favorable decision, prepare one; if not, go to C.

    6. Did claimant, or does the green jacket file, identify a medical source(s) that could substantiate that a chronic impairment was more severe in the past? If yes: EARLIER DEVELOPMENT AND ADJUDICATION REQUIRED. If no: Go to C.

  1. 10(e)(5)(ii) NEW OR NO TREATING SOURCE:

The following questions apply whether or not the impairment(s) is chronic.

  1. Did the claimant's treating source(s) (TS) during the DEVELOPMENT PERIOD differ from his/her prior TS(s), or did s/he have no TS(s) during the DEVELOPMENT PERIOD? If yes (new or no TS): Continue. If no: EARLIER DEVELOPMENT AND ADJUDICATION NOT REQUIRED.

  2. Did claimant allege a more severe past condition that might possibly have been disabling? (See NOTE in B.3.) If yes: Go to C.5. If no: Continue.

  3. Did claimant submit corroboration from a medical source, such as a letter from a doctor, that s/he had a past condition that might possibly have been disabling? (See NOTE B.3. above.) If yes: go to C.5. If no: Continue.

  4. Does the green jacket file show a condition prior to the above date that might possibly have been disabling? (See NOTE in B.3 above.) If yes: continue. If no: EARLIER DEVELOPMENT AND ADJUDICATION NOT REQUIRED.

  5. Did claimant identify, or does the green jacket file reference, other medical evidence that may be available, and that may attest to the past condition referred to in C.2., 3 or 4? If yes: EARLIER DEVELOPMENT AND ADJUDICATION REQUIRED. If not: EARLIER DEVELOPMENT AND ADJUDICATION NOT REQUIRED.


NOTE: Please do not forward completed folders to The Class Action Section (CAS) located in Baltimore, Maryland. Upon completion of a case, the folder should be forwarded to the appropriate storage facility (PSC, WBDOC, ODO). CAS does not house completed folders.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0442586095
DI 42586.095 - Exhibits -- Stieberger - 04/09/2013
Batch run: 04/09/2013
Rev:04/09/2013